Anxiety and depression is a common condition in childhood that often goes undiagnosed. It goes way more than just temporary feeling of “blahs” or the more common developmental fears of childhood. When children have these symptoms that interfere with their day to day activities and relationships or their sleep–it can be a signal for something more. However, as with any of these behavioral disorders, medication may be considered as part of the overall treatment. When medication is to be considered, families must know the facts so they can feel comfortable with the decision to proceed with medication.
As you know I have a series of medication fact sheets for ADHD (methylphenidate, amphetamine-mixed salts,atomoxetine, guanfacine, and clonidine) that were designed to help families understand what the medicine is used for, how it works, what to expect & what to watch out for.
SSRIs for the treatment of anxiety & depression
Fluoxetine is a type of medication used in the treatment of depression and anxiety. It is a selective serotonin reuptake inhibitor (SSRI), a class of drugs commonly used to also treat depression. Serotonin is a neurotransmitter found in the brain, blood platelets and gut. It is also known as the “happy” chemical and is responsible for overall sense of wellbeing. When levels of serotonin are low, depression can ensue. SSRIs are believed to work by increasing the level of serotonin available to brain cells by “blocking the exit doors” before they are transported deeper into the brain cells. Check out this video:
SSRIs and children and teens
Of all antidepressant classes available to treat depression and anxiety, SSRIs are definitely the safer of the options with fewer side effects. They also have been shown to be much more effective for moderate to severe cases than mild depression. Just four of the SSRIs have FDA approval for use in children. Fluoxetine, sertraline, fluvoxamine and escitalopram and only for certain types of mood disorders. However, there is off-label use of these medications in children and teenagers.
But what about the black box warning?
The black box warning was issued in 2004 for all antidepressant use among children and teenagers (under 18 years of age) because of concern the use of SSRIs increased the risk of suicide. In 2006, the black box warning was extended for patients up to 24 years of age. The concern that use of SSRIs and increased suicidality was NOT found for patients 24 years of age and older and it has otherwise been shown to be protective. Doctors must weigh the pros and cons of not using medication and leave depressive symptoms untreated, which could lead to suicidal thoughts.
One study showed that family medicine and pediatric doctors may have slowed down the use of SSRIs for mood disorders in children and teens after the black box warning. However, suicide rates increased by 22% in the same time frame.
In the end, the FDA has urged doctors to consider and weigh the pros and cons of prescribing versus not prescribing SSRIs when a patient with moderate to severe depression or anxiety is identified.
Doctors have clinical care guidelines to guide their decision making process
Along with talking with the family and understanding patient and family preference for treatment, doctors have clinical care guidelines based on research that can provide additional support for choosing certain types of treatment of behavior and mental health issues. The Guidelines for Adolescent Depression in Primary Care (GLAD-PC) toolkit was first issued in 2008 and then revised in 2018.
The important piece is that doctors should be screening all adolescents routinely starting at age 12 during well child visits and doing a mental health check up. The guidelines help doctors choose what type of questionnaire to use and then what steps to consider should depression be identified.
There is not a similar guideline for pediatric anxiety (yet) but likely coming.
Want a handout for SSRIs? Here is the first of a new series.
Sometimes medication is needed to help children and teens with their overall mood. Here is the first of my new handouts for SSRIs. The first is Fluoxetine. Remember, information contained in the handout does NOT constitute medical advice. Always consult your child’s doctor about information you read here and elsewhere.
Just click below to get your copy of the handout!
Of course, medication is just one piece of the puzzle. Check out my previous post: Anxiety and Kids: How to Become your Child’s Emotion Coach