HEALTHY FAMILY
What Parents Need
to Know About
Antidepressants for
Children and Teens
ates of anxiety and depression
among youth have soared over the
course of the COVID-19 pandemic.

Last fall, a coalition of the nation’s leading
experts in pediatric health declared a national
emergency in child and adolescent mental
health. Due to structural inequities, this
mental health crisis is worst among already
vulnerable groups, such as low-income
youth, LGBTQ youth, youth with disabilities
and youth from communities of color.

However, even before the pandemic’s
disruptions and fallouts, youth anxiety and
depression were rising. Social media has
played a role by disrupting sleep and exposing
youth to cyberbullying and unrealistic views
of other people’s lives and bodies.

For many children and teens antidepressants
are an effective way to treat anxiety, depression
and other mental health conditions, but under
what circumstances should they be prescribed?
What should parents know before considering
antidepressants? Prescription conundrums
self-injury, addiction and suicide attempts.

“Treating with therapy and medication works
the fastest to help children with depression,”
says Dr. Elana Neshkes, a pediatrician and child
psychiatrist at Children’s National Hospital.

However, selective serotonin reuptake
inhibitors (SSRIs), which are considered the
first-line option for youth with depression,
may cause or worsen suicidal thinking or
behavior in a small number of children and
teens. In 2004, the FDA issued a black-box
warning on SSRIs based on an extensive
analysis of clinical trials.

The meta-analysis showed youth who took
antidepressants had a 4% rate of suicidal
thinking or behavior, as compared with 2%
among those taking a sugar pill (placebo).

“There’s a lot of misinformation in the
news and the internet about the black-
box warning that scares parents,” says Dr.

Josephine Elia, division chief of psychiatry
at Nemours Children’s Hospital in Delaware.

None of the children in any of the studies
committed suicide, she says. Additionally, an
expanded black-box warning in 2007 stated
that depression itself was associated with an
increased risk of suicide. Some experts have
questioned the validity of the initial black-box
warning. Newer research suggests that the
pros of antidepressants outweigh the cons.

“We often think that the benefit is worth
that risk as long as there’s close monitoring
and everyone knows what to expect,” says
Dr. Hal Benjamin Kronsberg, a psychiatrist
for Johns Hopkins Bayview Medical Center’s
School-based Mental Health Program and
the Child Mobile Treatment team.

If a child has mild depression, psychotherapy
may be enough to help with the symptoms. If
the depression is moderate or severe, “that’s
when we consider medications,” says
psychiatrist Dr. Sarah M. Edwards, medical
director of the children and adolescent
psychiatric unit at the University of Maryland
Children’s Hospital.

Some signs that can signal a youth is
severely depressed include having thoughts
of suicide or changing eating, showering and
basic grooming habits. Other signs are
impaired academic performance and a
pronounced loss of interest in activities the Risk and signs of suicidality
child previously enjoyed.

Children should have a thorough
If left untreated, depression can lead to psychiatric evaluation before starting an
34 Washington FAMILY APRIL 2022
SOLOVYOVA/ISTOCK/GETTY IMAGES PLUS
R BY RUDY MALCOM