Doctors may sometimes prescribe fluoxetine for children or teens after a diagnosis of anxiety or depression. Families often have lingering questions about treatment after the visit. Having a handout or reference sheet to refer to and share with other family members can help ease stress.
Anxiety and depression is a common in childhood and can go undiagnosed. It’s more than just a temporary feeling of “blahs” or a developmental stage. If children have symptoms that interfere with their daily activities and relationships or sleep, it can be a signal for something more.
Fluoxetine (Prozac) for the treatment of anxiety & depression in kids & teens
If your child or teen has eepression or anxiety, the doctor may prescribe fluoxetine (also known as Prozac). It is a selective serotonin reuptake inhibitor (SSRI) and affects the level of serotonin in the brain. It is responsible for overall sense of wellbeing. If levels of serotonin are low, depression can ensue. These drugs “block the exit doors” and allow levels to increase, before being transported deeper into the brain cells. Check out this video:
Of all antidepressant classes available to treat depression and anxiety, SSRIs are definitely the safer of the options with fewer side effects. These drugs are much more effective for moderate to severe cases than mild depression. Just four of the SSRIs (fluoxetine, sertraline, fluvoxamine and escitalopram) have FDA approval for use in children. However, there is off-label use of these medications in children and teenagers.
What should I Know as a Parent
- Medicine is usually taken ONCE a day
- Takes 3-4 weeks at the RIGHT dose before expected benefits
- Medicines may be adjusted every 1-2 weeks until the “right” dose is reached
- Medicine adjustments may be slower if your child has an upset stomach or any changes in behavior
- Make sure you have a clear plan for checking back with your child’s doctor each week for the first month and then every two weeks the second month
Things to Look Out for
- Nausea or belly pain
- Agitation or a change in behavior
- Daytime sleepiness
- Dry mouth, constipation or diarrhea
- Increase in sweating
- Change in appetite or weight
- Suicidal thoughts
But what about the black box warning?
The FDA issued a black box warning in 2004 for all antidepressant use in children and teenagers (under 18 years of age) because of concern of an increased risk of suicideThe warning was extended for patients up to 24 years of age in 2006. Doctors must weigh the pros and cons of not using medication and leave depressive symptoms untreated, which could lead to suicidal thoughts.
Even though prescribing of SSRIs have slowed down after the black box warning, suicide rates increased by 22% in the same time frame.
Doctors should screen all teens once a year for depression.
The Guidelines for Adolescent Depression in Primary Care (GLAD-PC) toolkit was first issued in 2008 and then revised in 2018. Doctors should be screening all adolescents routinely starting at age 12 during well child visits. The guidelines help doctors choose what type of questionnaire to use and what steps to take when depression is a concern.
There is not a similar guideline for pediatric anxiety (yet) but likely coming.
My medicine fact sheet for Fluoxetine is a one pager to remind families what they need to know when starting medicine for mood
Sometimes children and teens need medicine to help with their overall mood. Remember, information contained in the handout does NOT constitute medical advice. Always consult your child’s doctor about information you read here and elsewhere. I’ve got a separate 2 page conversation starter handout available with tips on how to start the discussion with their child when you leave the doctor’s office. Grab it by subscribing to my email list from this post page!
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
This handout can be used to understand why this medicine may be used, how it works and what to expect. Families can share this handout with other family members, including your child/teen. Remember you can learn together as you go along. Keep lines of communication open between you and your child and check in with them daily.