Antidepressants in Adolescents
Antidepressants are sometimes indicated in adolescents, i.e. teenagers younger than 18 years old. The most frequently prescribed type of medication in this age group are SSRIs, which is short for Selective Serotonin Reuptake Inhibitor. SSRIs have been shown to decrease symptoms of depression and anxiety disorders. They are are overall safer and more tolerable than previous medicines used for the same psychiatric disorders, as well as being the most studied group of medications in the younger population.
Modern antidepressants, such as SSRIs, are increasingly used in the clinical setting - both in adult patients and in adolescents and children. Prescribing an SSRI for teenagers is commonplace in moderate-to-severe depression, while mild depression might be primarily treated with other means, such as psychotherapy.
How SSRIs Work
Selective serotonin reuptake inhibitors work the same in teenagers as it does in adults. As the name suggests , it decreases the amount of serotonin being reabsorbed in the synaptic cleft of the brain's nerve cells. Serotonin is an important neurotransmitter, and it staying longer in the synaptic cleft leads to an increased effect of serotonin on the brain.
Note that it usually takes 2-6 weeks to achieve full effect from the treatment after beginning a new antidepressant, or even after increasing the dosage. There are research suggesting that Escitalopram, in particular, may have slightly faster onset of action.
When Are Antidepressants Used?
There are different psychiatric conditions that may lead medical providers (such as primary care physicians or psychiatrists) to prescribe SSRI to adolescents. The most common indications are depression, anxiety disorders, and obsessive and compulsive disorders.
Depression
Depression is characterized by long-lasting sadness and lack of interest in previously enjoyable activities. In adolescents, it can especially affect sleep and appetite, as well as causing poor concentration or social isolation. Moderate to severe depression is the most common reasons for prescribing SSRIs to an adolescent.
While not a replacement for medication, there are
other ways to combat depression, especially if it is a milder type. It can also be useful for complementing medical treatment in moderate-to-severe depression.
Anxiety Disorders
Anxiety disorders are a group of mental health conditions characterized by nervousness, fear and panic. Often the affected individual might experience bodily symptoms, such as sweating or rapid heartbeat. The anxiety can be triggered by specific fears (phobias, social interaction, separation) or it can be
generalized and continuous.
While cognitive-behavioral therapy (CBT) is the first choice of treatment, both
CBT and pharmacological care are effective
at treating anxiety in children and teenagers. For panic disorders, treatment with SSRIs are as effective as therapy.
Obsessive and Compulsive Disorders
Obsessive-Compulsive Disorder (OCD) is a common behavioral disorder among children and adolescents. CBT is the first treatment choice in teenagers with OCD, but SSRIs such as Fluoxetine and Sertraline are proven to be effective in those who only benefitted partially, or not at all, from therapy.
Recommended Medications in Adolescents
For depression, treatment with
Fluoxetine is nearly always the first choice of SSRI for teenagers. Fluoxetine is the most well-studied SSRI in adolescent and children, and it's FDA-approved for depression from the age of 8 and up.
Escitalopram is another FDA-approved medication used in adolescent depression for those over 12 years of age. Other SSRIs are usually reserved for situations where Fluoxetine or Escitalopram has not had the desired effect or when it can't be used due to tolerance or for other reasons.
For other conditions other than depression, there is a wider choice of SSRIs. Commonly used are
Sertraline, as it is usually well-tolerated. Hence, it's quite frequently used off-label in the treatment of children and adolescent depression.
However, the choice of SSRI is always individual and several factors must be considered, including potential interactions with other medications, presence of other diseases or disorders, as well as drug availability at your location. The treatment choice should always be discussed with a medical doctor.
Non-SSRI Antidepressants For Teenagers
There are other types of antidepressant medicines used in treatment of adolescent depression and anxiety disorders, such as Selective Noradrenaline Reuptake Inhibitors (SNRIs) and
atypical antidepressants.
One of the more favorable atypical antidepressants for teenagers is
Mirtazapine, which also has been found to have a beneficial effect on sleep. However, Mirtazapine commonly causes weight-gain, and might be a poor choice for adolescents struggling with their weight.
Potential Side Effects of SSRIs
Taking any medicine can have lead to potential side effects, nevertheless SSRIs are known for being well tolerated and with mostly mild side effects. Hence, prescribing SSRIs for teenagers is not uncommon practice if there is a medical indication.
Knowing what to expect from a new medication is difficult. There are
charts that compare the different side effects of antidepressants, but ultimately it comes down to the individual response that can only be known once treatment has started.
Common Side Effects
Common potential side effects include
weight gain and metabolic effects, but those are the least prominent with Fluoxetine and Sertraline. Escitalopram and Citalopram appear particularly likely to cause decreased libido, which is something an adolescent will not willingly discuss with their parent or healthcare workers. There are, however, antidepressants
without sexual side effects.
Insomnia, referring to difficulties related to sleep, is another common side effect of antidepressants.
Trazodone, another atypical antidepressant, is not approved for adolescents for depression, but is frequently used off-label in lower dosages to treat sleeping difficulties.
Black Box Warning
Increased occurrence of
self-destructive behavior has been documented in adolescents and children when first starting treatment with antidepressants. Because of this, the FDA has mandated a black box warning on all antidepressants, warning for the increase in suicidal ideations when starting the medicine in children, adolescents and young adults. However, after the initial couple of weeks of treatment, SSRIs have been found to
decrease suicidal thinking.
It's important to discuss with your mental health provider if a intolerable side effect arises. SSRIs should not be halted immediately and has to be slowly tapered off and the treatment can be adjusted. Side effects are highly individual. One particular SSRI causing certain side effects does not necessarily mean that all the other antidepressants will have the same effect on the body.