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1. Shard Calculation

Query:

Response:

Calculated Shard: 47 (from laksa127)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa047.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://childmind.org/article/medication-for-kids-with-depression/\')), getAhrefsUnparsedNoserviceFromURL(\'https://childmind.org/article/medication-for-kids-with-depression/\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/","crawl_time":1775933059,"first_indexed_time":1658856928,"http_code":200,"src_unparsed":"org,childmind!\/article\/medication-for-kids-with-depression\/ s443","src_root_hash":"2813447190280129447","history_drop_reason":null,"meta_title":"Antidepressants for Children and Teenagers","meta_descriptions":["How do antidepressants work? Why might it take several tries to find one that's effective for your child? How long should kids keep taking them, and what should happen when it’s time to stop?"],"attrs_boilerpipe_text":"For kids with depression, experts agree that the\nfirst choice in medication treatment\nis the group of anti-depressant medications called SSRIs — selective serotonin reuptake inhibitors. And if the first SSRI a child is prescribed is not successful in combatting depression, they recommend trying another one, since individual kids respond differently to different SSRIs.\nBut before we say more about antidepressants, it’s important to keep in mind that not all kids who are depressed need to be treated with medication. For children and teenagers whose depression symptoms are mild, therapy is the recommended first choice. There are\nseveral kinds of therapy,\nincluding cognitive behavior therapy (CBT) and interpersonal therapy (IPT), that have been shown to be effective for kids with depression. If there’s no response with the therapy over a period of 12 weeks — or these therapies are not available — then SSRI medications should be considered.\nFor kids with moderate to severe depression, an SSRI is usually recommended, either alone or in combination with therapy. For kids with severe symptoms,\nstarting with combined therapy and medication is recommended\n. “Depression is serious and it can take one’s life,” notes Sarper Taskiran, MD, a child and adolescent psychiatrist at the Child Mind Institute. “It needs to be treated effectively and robustly.”\nPlanning depression treatment\nThe approach to medication treatment for each child varies, says Dr. Taskiran, because many children develop depression as a result of other challenges they are facing, including anxiety and ADHD. If they are treated only for depression, without recognizing the underlying problems, the treatment may not be effective.\nSo the first task for a clinician prescribing medication is to decide whether any other conditions need to be treated at the same time. In the period since the pandemic lockdown, Dr. Taskiran says, he’s seeing many young patients who had been dealing with anxiety or ADHD before who developed depression as their struggles compounded.\n“I think, as clinicians, we need to be very careful not to just jump into treating depression as if it is something that happened just now,” he adds, “but examine the child’s history, the unfolding of the symptoms, so that we can address their needs.\nHow do antidepressants work?\nAntidepressants usually work by balancing the levels of neurotransmitters — chemicals that send signals between neurons — in the brain. These chemicals include serotonin, dopamine, and norepinephrine. Higher levels of these chemicals usually correspond with lower levels of depression.\nSSRIs work by increasing the availability of serotonin in the brain. They are the first choice of medication for children and adolescents with depression because they have been shown to be effective in reducing symptoms and they have fewer problematic side effects than other kinds of antidepressants.\nAnother closely related category of antidepressant is SNRIs, or serotonin and norepinephrine reuptake inhibitors. Since SNRIs affect two kinds of neurotransmitters, they tend to produce more side effects, and are usually considered after SSRIs have been tried.\nStarting an anti-depressant medication\nSSRIs and SNRIs usually take four to six weeks to have an effect on depression symptoms, and their effectiveness continues to grow for several more weeks after that. The best dose — the most reduction of symptoms without problematic side effects — varies from child to child. So the doctor should start with a low dose and work up gradually.\nThere are several different SSRI medications a doctor might recommend as their first choice for a depressed child. Only two, fluoxetine (Prozac) and escitalopram (Lexapro), have FDA approval for treatment of depression in children or teens. Fluoxetine is approved for kids 8 and up, and escitalopram for those 12 and up.\nFluoxetine is the most studied of the SSRIs — its effectiveness in kids has been confirmed by\nmajor studies\n— and it is the SSRI most often prescribed for teenagers and children with depression.\nOther antidepressants have been approved for use in children but not specifically for depression. Sertraline (Zoloft) and Fluvoxamine (Luvox) are FDA approved for children with OCD (sertraline 6 and older, and fluvoxamine 8 and older). Duloxetine (Cymbalta), which is an SNRI, has FDA approval for anxiety in children and adolescents. All of these are also used for depression.\nDoctors usually start by prescribing an SSRI that has been FDA approved for some use (if not depression) in children and teenagers. But if that isn’t successful, they may try other SSRIs that have FDA approval in adults, though not children. This is called “off-label” use of the medication.\nLack of FDA approval for use in kids doesn’t mean that a medication hasn’t been thoroughly tested in clinical trials with kids. It reflects the fact that once a drug is approved for use in adults, the company that makes it often chooses not to go through the expensive FDA approval process again for use in kids.\nIn the case of anti-depressants, including those that don’t have FDA approval, other researchers have amassed a large body of evidence, including double-blind studies, for their safety and effectiveness for children and teens.\nThe SSRIs most commonly prescribed in children and teenagers are:\nFluoxetine (Prozac)\nEscitalopram (Lexapro)\nSertraline (Zoloft)\nCitalopram (Celexa)\nFluvoxamine (Luvox)\nParoxetine (Paxil)\nSNRIs:\nDuloxetine (Cymbalta)\nVenlafaxine (Effexor)\nSide effects of SSRIs and SNRIs\nSide effects of SSRIs and SNRIs are usually relatively mild, compared to other medications. They are usually experienced during the first few weeks, and they decline over time. Clinicians should be in close touch with families during these first several weeks, monitoring how children are feeling and any changes in their behavior.\nIf side effects don’t decline and they’re making a child uncomfortable, it’s appropriate for the doctor to prescribe a different SSRI. Children who experience unpleasant side effects on one SSRI often respond differently to another.\nSide effects can include:\nNausea, vomiting or diarrhea\nStomachaches\nHeadache\nDrowsiness\nDry mouth\nInsomnia\nNervousness, agitation, or restlessness\nActivation — increasing irritability and impulsiveness\nDizziness\nReduced sexual desire\nImpact on appetite, leading to weight loss or weight gain\nBlack box warning\nSSRIs and SNRIs come with what’s called a “Black Box” warning from the FDA that children and adolescents taking them may experience an increased risk of suicidal thoughts. These medications have not been linked to attempted or completed suicides, but it’s recommended that clinicians and parents monitor kids taking them for any worsening in depression or emergence of suicidal thinking as they are adjusting to a new medication.\nMore recent research has not supported the increased risk of suicidal thoughts, Dr. Taskiran notes, and\nmost experts conclude\nthat the benefits of SSRIs outweigh the risks. Some research has found that suicide rates in children decrease when they take antidepressants.\nOther antidepressants\nSome other antidepressants are used to treat children when SSRIs aren’t effective for them, or when they have problems with side effects.\nBupropion (Wellbutrin) is an antidepressant that is called an NDRI (norepinephrine\/dopamine-reuptake inhibitor). It works by increasing the availability in the brain of neurotransmitters norepinephrine and dopamine. Bupropion is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms. Adding buproprion can help ease sexual side effects of the SSRI if that is a concern for the adolescent.\nThere are several newer antidepressants that are FDA-approved for treatment of depression in adults, but they have not been studied extensively in children and adolescents. They are sometimes prescribed off-label, Dr. Taskiran explains, when kids have problems with side effects on SSRIs, particularly weight gain and sexual side effects.\nOne of them,\nmirtazapine\n(Remeron), is in a group of medications called tetracyclic antidepressants (TeCAs). By inhibiting a particular set of receptors in the brain, Mirtazapine causes an increased release of serotonin and norepinephrine.\nAnother,\nVilazodone\n(Viibryd), increases the effect of serotonin in the brain in two ways — by slowing its removal and by stimulating serotonin receptors. Because of this dual activity, it is called a serotonin partial agonist–reuptake inhibitor (SPARI) and is expected to have more robust anti-anxiety action.\nWhen the first medication doesn’t work\nBecause more than\na third of kids\n— between\n55 and 65 percent\n— don’t respond  to the initial antidepressant they take, it’s not unusual to try a second medication. Kids who don’t respond to the first often\ndo find success with a different antidepressant\n. Therapy may also be added if it hasn’t been tried.\nIf a child does not have a clear response to the medication — about a 40 percent reduction in symptoms — after six weeks, a switch should be made, Dr. Taskiran says. “If we’re not seeing that, it’s not worthwhile to keep the patient on the same medication.”\nBut he emphasizes that a medication should not be rejected until it’s been tried for the full six weeks.\nIn a rush for improvement, he notes, a medication will sometimes be judged ineffective after just two weeks, and kids will be switched to a second choice. But two weeks isn’t enough time for an SSRI to become fully effective, so medications that are potentially useful can be discarded too quickly. “It’s really important that we give these medications enough of a chance, from a time perspective and a dose perspective, to be effective.”\nOf the kids who are switched to a second medication, he says, 60 percent of them respond to the second medication. “For those who are still non-responders,” Dr. Taskiron says, “we need to add either mood stabilizers or atypical antipsychotics to increase the remission rate.”\nOf the mood stabilizers, lithium has been approved by the FDA for use in teenagers and children. Among atypical antipsychotics, aripiprazole (Abilify) and risperidone (Risperdal) are the ones that are most studied and most often used in kids, and they are FDA approved for some uses in kids. Aripiprazole is often the first choice because it has fewer problematic side effects than lithium or risperidone.\nIf a second medication isn’t successful, Dr. Taskiran notes that it’s also important to look at the diagnosis again, to consider whether there might be other factors going on that are affecting the outcome. “We know that family conflict, drug and alcohol use, and comorbid disorders are sometimes the culprit, and when we address those, we can get a better remission.”\nHow long should kids keep taking antidepressants?\nWhen teenagers or children are treated successfully with an antidepressant, experts advise that they stay on the medication for nine months to a year after their symptoms are gone to prevent a relapse. “This is usually the time that is needed for the brain to correct the chemical imbalances that result in depression,” Dr. Taskiran explains.\nIf there’s a relapse after the child has tapered down and gone off the medication, longer treatment may be needed to help prevent recurrence.\nAbout one in three kids treated for depression, he adds, will need more time on the medication. “After two years, we can stop the medication again, cautiously and carefully. But if we see another relapse, a second relapse, continuing on SSRIs indefinitely may be the best course.” \nHow do kids tend to feel about taking antidepressants?\nFor children and teenagers, getting a diagnosis of depression can be a relief, because they understand that the way they are feeling is not a permanent condition. “Depressed kids are often thinking that there is something inherently wrong with them,” Dr. Taskiran explains, “that they are built this way, and that’s the core belief that leads to suicidal ideation. They think they are flawed and that’s why they give up on themselves so easily.”\nWhen they understand that this is a disorder that can be treated, they usually welcome it. In his experience, he says, most are comfortable with the idea of medication.  \nHaving said that, he adds, teenagers need parental support to make sure they are compliant with treatment. “They’re kids. No 14-year-old should be responsible to remember to take their medication every day.”\nDr. Taskiran notes that success in treatment depends on the patient, the parents, and the provider all being on the same page. “I usually tell parents, ‘Look, we need to have a trusting relationship and you need to be on board with the process that is your child’s treatment in order for this to work.’ “\nFrequently Asked Questions\nWhat is the safest antidepressant for teens and young adults?\nFor teens and young adults with depression, experts agree that the first choice in medication treatment is a group of antidepressant medications called SSRIs — selective serotonin reuptake inhibitors. If the first SSRI medication a child tries does not work, experts recommend trying a different one because individual children respond differently to different SSRIs.\nWhen is Wellbutrin prescribed for teens?\nWellbutrin (Bupropion) is a medication that is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms.\nIs Lexapro a common antidepressant for kids?\nLexapro is among the most commonly prescribed antidepressants for kids. Other common SSRIs a child or teen might be prescribed include Prozac, Zoloft, Celexa, Paxil, and Luvox.\nLast reviewed or updated on November 18, 2024.","attrs_markdown":"We Value Your Privacy\n\nWe use functional cookies on this website, which are essential to the operation of this website and are always on. With your consent, we’ll also use non-essential cookies to improve your experience and analyze traffic. By clicking “Accept,” you agree to our use of non-essential cookies. 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Puede intentar su búsqueda de nuevo o visitar la lista de [temas populares.](https:\/\/childmind.org\/es\/topics-a-z\/)\n\nMedication for Kids With Depression\n\nby [Caroline Miller](https:\/\/childmind.org\/bio\/caroline-miller\/)\n\n[Download](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/ \"Printer Friendly, PDF & Email\")\n\n[Share](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/)\n\n[Download]()\n\n### Get this as a PDF\nEnter email to download and get news and resources in your inbox.\n\n### Share this on social\n[Copy Link Link Copied](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/)\n\n[Email](https:\/\/childmind.org\/cdn-cgi\/l\/email-protection#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)\n\n[Facebook](https:\/\/www.facebook.com\/sharer.php?u=https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/)\n\n[Twitter](https:\/\/twitter.com\/intent\/tweet?url=https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/&text=Medication%20for%20Kids%20With%20Depression)\n\n[LinkedIn](https:\/\/www.linkedin.com\/sharing\/share-offsite\/?url=https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/)\n\n[Download](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/)\n\n[Family Resource Center](https:\/\/childmind.org\/resources\/)\n\n[Depression & Mood Disorders](https:\/\/childmind.org\/topics\/depression-mood-disorders\/) \/ [Treatment](https:\/\/childmind.org\/topics\/treatment\/)\n\n# Medication for Kids With Depression\nWhat parents should know about children and teenagers taking antidepressants\n\nWriter: [Caroline Miller](https:\/\/childmind.org\/bio\/caroline-miller\/)\n\nClinical Expert: [Sarper Taskiran, MD](https:\/\/childmind.org\/bio\/sarper-taskiran-md\/)\n\n[en Español](https:\/\/childmind.org\/es\/articulo\/medicamentos-para-ninos-con-depresion\/)\n\n## What You'll Learn\n- What antidepressants are FDA approved for children and teenagers?\n- What is the best treatment recommended for kids with severe depression symptoms?\n- Why do many kids have to try more than one antidepressant before treatment is successful?\n\n- [Quick Read](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#quickread)\n- [Full Article](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#full_article)\n- [Planning depression treatment](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#planning-depression-treatment)\n- [How do antidepressants work?](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#how-do-antidepressants-work)\n- [Starting an anti-depressant medication](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#starting-an-anti-depressant-medication)\n- [Side effects of SSRIs and SNRIs](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#side-effects-of-ssris-and-snris)\n- [Black box warning](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#black-box-warning)\n- [Other antidepressants](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#other-antidepressants)\n- [When the first medication doesn’t work](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#when-the-first-medication-doesn%E2%80%99t-work)\n- [How long should kids keep taking antidepressants?](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#how-long-should-kids-keep-taking-antidepressants)\n- [How do kids tend to feel about taking antidepressants?](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#how-do-kids-tend-to-feel-about-taking-antidepressants)\n\n[Back to Top](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#top_of_page)\n\n## Quick Read\nFor children and teenagers with depression, the first choice in medication treatment is a group of antidepressants called SSRIs (selective serotonin reuptake inhibitors). But it’s important to know that if the first SSRI your child tries is not successful in treating their depression, a different SSRI or another antidepressant medication may be successful. Individual kids respond differently to different medications. And the most effective treatment for depression is medication combined with cognitive behavior therapy.\n\nAnother thing it’s useful to keep in mind is that many kids who develop depression have been struggling with an earlier challenge, like anxiety or ADHD. They may develop depression because the anxiety or ADHD has had a negative impact on their lives or their self-esteem. So a doctor treating the depression should consider whether there are other challenges that need attention too, to make sure the treatment is successful.\n\nThere are a number of SSRIs your doctor may prescribe (see the [full story below](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#starting-an-anti-depressant-medication)), though only fluoxetine (Prozac) has been approved by the FDA for use in children and teenagers. But the others have been thoroughly researched and found to be safe and effective.\n\nSide effects of SSRIs (see the [full story below](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/#side-effects-of-ssris-and-snris)) tend to get better after the first few weeks, but if a child has problematic side effects that don’t fade, another SSRI should be considered.\n\nIf an SSRI has not substantially reduced depression symptoms by six weeks, your doctor should try switching to a different SSRI or another antidepressant called an SNRI (serotonin and norepinephrine reuptake inhibitor).\n\nOnce a child’s depression is in remission, they should continue to take the medication for nine months to a year, to make sure they are stabilized. If they stop the medication and the depression symptoms recur, a longer course of treatment is advised.\n\n[More](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/)\n\nFull Article\n\n14 min read\n\nFor kids with depression, experts agree that the [first choice in medication treatment](https:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/resource_centers\/resources\/med_guides\/DepressionGuide-web.pdf) is the group of anti-depressant medications called SSRIs — selective serotonin reuptake inhibitors. And if the first SSRI a child is prescribed is not successful in combatting depression, they recommend trying another one, since individual kids respond differently to different SSRIs.\n\nBut before we say more about antidepressants, it’s important to keep in mind that not all kids who are depressed need to be treated with medication. For children and teenagers whose depression symptoms are mild, therapy is the recommended first choice. There are [several kinds of therapy,](https:\/\/childmind.org\/article\/treatment-for-depression\/) including cognitive behavior therapy (CBT) and interpersonal therapy (IPT), that have been shown to be effective for kids with depression. If there’s no response with the therapy over a period of 12 weeks — or these therapies are not available — then SSRI medications should be considered.\n\nFor kids with moderate to severe depression, an SSRI is usually recommended, either alone or in combination with therapy. For kids with severe symptoms, [starting with combined therapy and medication is recommended](https:\/\/www.jaacap.org\/article\/S0890-8567\$09\$62053-0\/fulltext). “Depression is serious and it can take one’s life,” notes Sarper Taskiran, MD, a child and adolescent psychiatrist at the Child Mind Institute. “It needs to be treated effectively and robustly.”\n\n## Planning depression treatment\nThe approach to medication treatment for each child varies, says Dr. Taskiran, because many children develop depression as a result of other challenges they are facing, including anxiety and ADHD. If they are treated only for depression, without recognizing the underlying problems, the treatment may not be effective.\n\nSo the first task for a clinician prescribing medication is to decide whether any other conditions need to be treated at the same time. In the period since the pandemic lockdown, Dr. Taskiran says, he’s seeing many young patients who had been dealing with anxiety or ADHD before who developed depression as their struggles compounded.\n\n“I think, as clinicians, we need to be very careful not to just jump into treating depression as if it is something that happened just now,” he adds, “but examine the child’s history, the unfolding of the symptoms, so that we can address their needs.\n\n## How do antidepressants work?\nAntidepressants usually work by balancing the levels of neurotransmitters — chemicals that send signals between neurons — in the brain. These chemicals include serotonin, dopamine, and norepinephrine. Higher levels of these chemicals usually correspond with lower levels of depression.\n\nSSRIs work by increasing the availability of serotonin in the brain. They are the first choice of medication for children and adolescents with depression because they have been shown to be effective in reducing symptoms and they have fewer problematic side effects than other kinds of antidepressants.\n\nAnother closely related category of antidepressant is SNRIs, or serotonin and norepinephrine reuptake inhibitors. Since SNRIs affect two kinds of neurotransmitters, they tend to produce more side effects, and are usually considered after SSRIs have been tried.\n\n## Starting an anti-depressant medication\nSSRIs and SNRIs usually take four to six weeks to have an effect on depression symptoms, and their effectiveness continues to grow for several more weeks after that. The best dose — the most reduction of symptoms without problematic side effects — varies from child to child. So the doctor should start with a low dose and work up gradually.\n\nThere are several different SSRI medications a doctor might recommend as their first choice for a depressed child. Only two, fluoxetine (Prozac) and escitalopram (Lexapro), have FDA approval for treatment of depression in children or teens. Fluoxetine is approved for kids 8 and up, and escitalopram for those 12 and up.\n\nFluoxetine is the most studied of the SSRIs — its effectiveness in kids has been confirmed by [major studies](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3285253\/) — and it is the SSRI most often prescribed for teenagers and children with depression.\n\nOther antidepressants have been approved for use in children but not specifically for depression. Sertraline (Zoloft) and Fluvoxamine (Luvox) are FDA approved for children with OCD (sertraline 6 and older, and fluvoxamine 8 and older). Duloxetine (Cymbalta), which is an SNRI, has FDA approval for anxiety in children and adolescents. All of these are also used for depression.\n\nDoctors usually start by prescribing an SSRI that has been FDA approved for some use (if not depression) in children and teenagers. But if that isn’t successful, they may try other SSRIs that have FDA approval in adults, though not children. This is called “off-label” use of the medication.\n\nLack of FDA approval for use in kids doesn’t mean that a medication hasn’t been thoroughly tested in clinical trials with kids. It reflects the fact that once a drug is approved for use in adults, the company that makes it often chooses not to go through the expensive FDA approval process again for use in kids.\n\nIn the case of anti-depressants, including those that don’t have FDA approval, other researchers have amassed a large body of evidence, including double-blind studies, for their safety and effectiveness for children and teens.\n\nThe SSRIs most commonly prescribed in children and teenagers are:\n\n- Fluoxetine (Prozac)\n- Escitalopram (Lexapro)\n- Sertraline (Zoloft)\n- Citalopram (Celexa)\n- Fluvoxamine (Luvox)\n- Paroxetine (Paxil)\n\nSNRIs:\n\n- Duloxetine (Cymbalta)\n- Venlafaxine (Effexor)\n## **Side effects of SSRIs and SNRIs**\nSide effects of SSRIs and SNRIs are usually relatively mild, compared to other medications. They are usually experienced during the first few weeks, and they decline over time. Clinicians should be in close touch with families during these first several weeks, monitoring how children are feeling and any changes in their behavior.\n\nIf side effects don’t decline and they’re making a child uncomfortable, it’s appropriate for the doctor to prescribe a different SSRI. Children who experience unpleasant side effects on one SSRI often respond differently to another.\n\nSide effects can include:\n\n- Nausea, vomiting or diarrhea\n- Stomachaches\n- Headache\n- Drowsiness\n- Dry mouth\n- Insomnia\n- Nervousness, agitation, or restlessness\n- Activation — increasing irritability and impulsiveness\n- Dizziness\n- Reduced sexual desire\n- Impact on appetite, leading to weight loss or weight gain\n## **Black box warning**\nSSRIs and SNRIs come with what’s called a “Black Box” warning from the FDA that children and adolescents taking them may experience an increased risk of suicidal thoughts. These medications have not been linked to attempted or completed suicides, but it’s recommended that clinicians and parents monitor kids taking them for any worsening in depression or emergence of suicidal thinking as they are adjusting to a new medication.\n\nMore recent research has not supported the increased risk of suicidal thoughts, Dr. Taskiran notes, and [most experts conclude](https:\/\/caringforkids.cps.ca\/handouts\/mentalhealth\/using_ssris_to_treat_depression_and_anxiety_in_children_and_youth) that the benefits of SSRIs outweigh the risks. Some research has found that suicide rates in children decrease when they take antidepressants.\n\n## Other antidepressants\nSome other antidepressants are used to treat children when SSRIs aren’t effective for them, or when they have problems with side effects.\n\nBupropion (Wellbutrin) is an antidepressant that is called an NDRI (norepinephrine\/dopamine-reuptake inhibitor). It works by increasing the availability in the brain of neurotransmitters norepinephrine and dopamine. Bupropion is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms. Adding buproprion can help ease sexual side effects of the SSRI if that is a concern for the adolescent.\n\nThere are several newer antidepressants that are FDA-approved for treatment of depression in adults, but they have not been studied extensively in children and adolescents. They are sometimes prescribed off-label, Dr. Taskiran explains, when kids have problems with side effects on SSRIs, particularly weight gain and sexual side effects.\n\nOne of them, [mirtazapine](https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519059\/) (Remeron), is in a group of medications called tetracyclic antidepressants (TeCAs). By inhibiting a particular set of receptors in the brain, Mirtazapine causes an increased release of serotonin and norepinephrine.\n\nAnother, [Vilazodone](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3278186\/) (Viibryd), increases the effect of serotonin in the brain in two ways — by slowing its removal and by stimulating serotonin receptors. Because of this dual activity, it is called a serotonin partial agonist–reuptake inhibitor (SPARI) and is expected to have more robust anti-anxiety action.\n\n## When the first medication doesn’t work\nBecause more than [a third of kids](https:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/resource_centers\/resources\/med_guides\/DepressionGuide-web.pdf) — between [55 and 65 percent](https:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/resource_centers\/resources\/med_guides\/DepressionGuide-web.pdf) — don’t respond to the initial antidepressant they take, it’s not unusual to try a second medication. Kids who don’t respond to the first often [do find success with a different antidepressant](https:\/\/ajp.psychiatryonline.org\/doi\/10.1176\/appi.ajp.2010.09040552?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3Dpubmed). Therapy may also be added if it hasn’t been tried.\n\nIf a child does not have a clear response to the medication — about a 40 percent reduction in symptoms — after six weeks, a switch should be made, Dr. Taskiran says. “If we’re not seeing that, it’s not worthwhile to keep the patient on the same medication.”\n\nBut he emphasizes that a medication should not be rejected until it’s been tried for the full six weeks.\n\nIn a rush for improvement, he notes, a medication will sometimes be judged ineffective after just two weeks, and kids will be switched to a second choice. But two weeks isn’t enough time for an SSRI to become fully effective, so medications that are potentially useful can be discarded too quickly. “It’s really important that we give these medications enough of a chance, from a time perspective and a dose perspective, to be effective.”\n\nOf the kids who are switched to a second medication, he says, 60 percent of them respond to the second medication. “For those who are still non-responders,” Dr. Taskiron says, “we need to add either mood stabilizers or atypical antipsychotics to increase the remission rate.”\n\nOf the mood stabilizers, lithium has been approved by the FDA for use in teenagers and children. Among atypical antipsychotics, aripiprazole (Abilify) and risperidone (Risperdal) are the ones that are most studied and most often used in kids, and they are FDA approved for some uses in kids. Aripiprazole is often the first choice because it has fewer problematic side effects than lithium or risperidone.\n\nIf a second medication isn’t successful, Dr. Taskiran notes that it’s also important to look at the diagnosis again, to consider whether there might be other factors going on that are affecting the outcome. “We know that family conflict, drug and alcohol use, and comorbid disorders are sometimes the culprit, and when we address those, we can get a better remission.”\n\n## How long should kids keep taking antidepressants?\nWhen teenagers or children are treated successfully with an antidepressant, experts advise that they stay on the medication for nine months to a year after their symptoms are gone to prevent a relapse. “This is usually the time that is needed for the brain to correct the chemical imbalances that result in depression,” Dr. Taskiran explains.\n\nIf there’s a relapse after the child has tapered down and gone off the medication, longer treatment may be needed to help prevent recurrence.\n\nAbout one in three kids treated for depression, he adds, will need more time on the medication. “After two years, we can stop the medication again, cautiously and carefully. But if we see another relapse, a second relapse, continuing on SSRIs indefinitely may be the best course.”\n\n## How do kids tend to feel about taking antidepressants?\nFor children and teenagers, getting a diagnosis of depression can be a relief, because they understand that the way they are feeling is not a permanent condition. “Depressed kids are often thinking that there is something inherently wrong with them,” Dr. Taskiran explains, “that they are built this way, and that’s the core belief that leads to suicidal ideation. They think they are flawed and that’s why they give up on themselves so easily.”\n\nWhen they understand that this is a disorder that can be treated, they usually welcome it. In his experience, he says, most are comfortable with the idea of medication.\n\nHaving said that, he adds, teenagers need parental support to make sure they are compliant with treatment. “They’re kids. No 14-year-old should be responsible to remember to take their medication every day.”\n\nDr. Taskiran notes that success in treatment depends on the patient, the parents, and the provider all being on the same page. “I usually tell parents, ‘Look, we need to have a trusting relationship and you need to be on board with the process that is your child’s treatment in order for this to work.’ “\n\n## Frequently Asked Questions\nWhat is the safest antidepressant for teens and young adults?\n\nFor teens and young adults with depression, experts agree that the first choice in medication treatment is a group of antidepressant medications called SSRIs — selective serotonin reuptake inhibitors. If the first SSRI medication a child tries does not work, experts recommend trying a different one because individual children respond differently to different SSRIs.\n\nWhen is Wellbutrin prescribed for teens?\n\nWellbutrin (Bupropion) is a medication that is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms.\n\nIs Lexapro a common antidepressant for kids?\n\nLexapro is among the most commonly prescribed antidepressants for kids. Other common SSRIs a child or teen might be prescribed include Prozac, Zoloft, Celexa, Paxil, and Luvox.\n\n[![](https:\/\/childmind.org\/wp-content\/uploads\/2023\/06\/Write-a-Review-400x400.png) Sign Up for Newsletters Get articles, expert advice, and clinical updates direct to your inbox. Sign Up](https:\/\/childmind.org\/stay-in-touch-with-the-child-mind-institute\/)\n\nLast reviewed or updated on November 18, 2024.\n\nLearn more about our [Family Resource Center](https:\/\/childmind.org\/resources\/) and our [editorial mission](https:\/\/childmind.org\/about-us\/editorial-mission\/).\n\n### References\nThe Child Mind Institute publishes articles based on extensive research and interviews with experts, including child and adolescent psychiatrists, clinical psychologists, clinical neuropsychologists, pediatricians, and learning specialists. Other sources include peer-reviewed studies, government agencies, medical associations, and the latest Diagnostic and Statistical Manual (DSM-5). Articles are reviewed for accuracy, and we link to sources and list references where applicable. You can learn more by reading our [editorial mission](https:\/\/childmind.org\/about-us\/editorial-mission\/).\n\n- American Academy of Child and Adolescent Psychiatry. *Depression: A Guide for Parents.* American Academy of Child and Adolescent Psychiatry. Accessed November 18, 2024.\n  <https:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/resource_centers\/resources\/med_guides\/DepressionGuide-web.pdf>\n- Birmaher, Boris, M.D., David Brent, M.D., and The AACAP Work Group on Quality Issues. \"Practice Parameter for the Assessment and Treatment of Children and Adolescents with Depressive Disorders.\" *Journal of the American Academy of Child & Adolescent Psychiatry* 47, no. 11 (November 2008): 1413–1436.\n  <https:\/\/www.jaacap.org\/article\/S0890-8567(09)62053-0\/fulltext>\n- Canadian Paediatric Society. \"Using SSRIs to Treat Depression and Anxiety in Children and Youth.\" *Caring for Kids,* accessed November 18, 2024.\n  <https:\/\/caringforkids.cps.ca\/handouts\/mentalhealth\/using_ssris_to_treat_depression_and_anxiety_in_children_and_youth>\n- Emslie, Graham, Christopher Kratochvil, Benedetto Vitiello, Susan Silva, Taryn Mayes, Steven McNulty, Elizabeth Weller, Bruce Waslick, Charles Casat, John Walkup, Sanjeev Pathak, Paul Rohde, Kelly Posner, John March, The Columbia Suicidality Classification Group, and the TADS Team. \"Treatment for Adolescents with Depression Study (TADS): Safety Results.\" *The American Journal of Psychiatry* 163, no. 6 (June 2006): 1041–1047.\n  <https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC3285253\/>\n- Emslie, Graham J., Taryn Mayes, Giovanna Porta, Benedetto Vitiello, Greg Clarke, Karen Dineen Wagner, Joan Rosenbaum Asarnow, Anthony Spirito, Boris Birmaher, Neal Ryan, Betsy Kennard, Lynn DeBar, James McCracken, Michael Strober, Matthew Onorato, Jamie Zelazny, Marty Keller, Satish Iyengar, and David Brent. \"Treatment of Resistant Depression in Adolescents (TORDIA): Week 24 Outcomes.\" *The American Journal of Psychiatry* 167, no. 7 (July 2010): 782–791.\n  [https:\/\/psychiatryonline.org\/doi\/10.1176\/appi.ajp.2010.09040552?url\\_ver=Z39.88-2003\\&rfr\\_id=ori%3Arid%3Acrossref.org\\&rfr\\_dat=cr\\_pub%3Dpubmed](https:\/\/psychiatryonline.org\/doi\/10.1176\/appi.ajp.2010.09040552?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed)\n\nTopics\n\n[Depression & Mood Disorders](https:\/\/childmind.org\/topics\/depression-mood-disorders\/)[Treatment](https:\/\/childmind.org\/topics\/treatment\/)\n\n![Caroline Miller](https:\/\/childmind.org\/wp-content\/uploads\/Miller_Caroline_424x424.jpg.jpeg)\n\nCaroline Miller\n\nCaroline Miller\n\nCaroline Miller is Editor-at-Large at the Child Mind Institute. She was the editorial director of the organization for more than … [Read Bio](https:\/\/childmind.org\/bio\/caroline-miller\/)\n\n### Was this article helpful?\nYes\n\nNo\n\n[Copy link Link copied](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/)   [Share](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/)   [Download](https:\/\/childmind.org\/article\/medication-for-kids-with-depression\/)\n\n### More Like This\n- [What Are the Kinds of Depression?](https:\/\/childmind.org\/article\/what-are-the-kinds-of-depression\/)\n- [What Are the Symptoms of Depression in Teenagers?](https:\/\/childmind.org\/article\/what-are-the-symptoms-of-depression-in-teenagers\/)\n- [How to Work Well With Your Child’s Therapist](https:\/\/childmind.org\/article\/how-to-work-well-with-your-childs-therapist\/)\n\n### Topics\n[Depression & Mood Disorders](https:\/\/childmind.org\/topics\/depression-mood-disorders\/)[Treatment](https:\/\/childmind.org\/topics\/treatment\/)\n\n### Related Reading\n- [![What Are the Symptoms of Depression in Teenagers?](https:\/\/childmind.org\/wp-content\/uploads\/Spannish-What-Are-the-Symptoms-of-Depression-in-Teenagers-e1697463119376-640x293.png) What Are the Symptoms of Depression in Teenagers? 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transition](https:\/\/childmind.org\/article\/how-to-take-kids-off-medication\/)\n- [![Side Effects of ADHD Medication](https:\/\/childmind.org\/wp-content\/uploads\/27-late-e1697208291260-640x295.png) Side Effects of ADHD Medication What to look for, and how to handle them](https:\/\/childmind.org\/article\/side-effects-of-adhd-medication\/)\n- [![Complete Guide to Getting Good Care](https:\/\/childmind.org\/wp-content\/uploads\/2016\/01\/Complete-Guide-to-Getting-Good-Care-640x427.jpg) Complete Guide to Getting Good Care When a child is struggling, or their behavior worries you, it can be hard to…](https:\/\/childmind.org\/guide\/parents-guide-to-getting-good-care\/)\n\nMore Related\n\n## Explore Popular Topics\n[![Tweens, Teens, & Young Adults](https:\/\/childmind.org\/wp-content\/uploads\/2021\/07\/topic-teens-young-adults-hero-400x400.jpg) Tweens, Teens, & Young Adults](https:\/\/childmind.org\/topics\/teens-young-adults\/)\n\n[![ADHD & 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All rights reserved.   \n  \n The Child Mind Institute Family Resource Center was made possible by a generous grant from the Morgan Stanley Foundation.   \n Created by [Constructive](https:\/\/constructive.co\/).\n\n- [Terms of Use](https:\/\/childmind.org\/terms\/)\n- [Online Privacy Statement](https:\/\/childmind.org\/privacy\/)\n- [Donor Privacy Policy](https:\/\/childmind.org\/donor-privacy-policy\/)\n- [Disclaimer](https:\/\/childmind.org\/disclaimer\/)\n- [Manage Cookies](https:\/\/childmind.org\/cookie-policy\/?cmplz_region_redirect=true)\n\nManage consent\n\nManage consent\n\nDonate\n\nHas the Child Mind Institute given your family \\$25 of practical resources and advice this year?\n\nYes\n\nNo\n\nYour \\$25 donation supports our free resources and life-changing information for families.\n\nx\n\nDonate\n\nHas the Child Mind Institute given your family \\$25 of practical resources and advice this year?\n\nYes\n\nNo\n\nYour \\$25 donation supports our free resources and life-changing information for families.\n\nx\n\n## Donate\nHas the Child Mind Institute given your family \\$25 of practical resources and advice this year?\n\nYes\n\nNo\n\nYour \\$25 donation supports our free resources and life-changing information for families.\n\nx\n\n## Join Our Care Community\nGet exclusive updates on our care services and resources to support children’s mental health.\n\n\"\\*\" indicates required fields\n\nx\n\n## Join Our Care Community\nGet updates on our care services in California and resources to support children’s mental health.\n\n\"\\*\" indicates required fields\n\nx\n\n## Stay Informed & Supported\nJoin our weekly newsletter for expert tips, parenting guides, and more.\n\n\"\\*\" indicates required fields\n\nx\n\nNotifications\n\n![](https:\/\/www.facebook.com\/tr?id=434567883606725&ev=PageView&noscript=1)","attrs_readable_markdown":"For kids with depression, experts agree that the [first choice in medication treatment](https:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/resource_centers\/resources\/med_guides\/DepressionGuide-web.pdf) is the group of anti-depressant medications called SSRIs — selective serotonin reuptake inhibitors. And if the first SSRI a child is prescribed is not successful in combatting depression, they recommend trying another one, since individual kids respond differently to different SSRIs.\n\nBut before we say more about antidepressants, it’s important to keep in mind that not all kids who are depressed need to be treated with medication. For children and teenagers whose depression symptoms are mild, therapy is the recommended first choice. There are [several kinds of therapy,](https:\/\/childmind.org\/article\/treatment-for-depression\/) including cognitive behavior therapy (CBT) and interpersonal therapy (IPT), that have been shown to be effective for kids with depression. If there’s no response with the therapy over a period of 12 weeks — or these therapies are not available — then SSRI medications should be considered.\n\nFor kids with moderate to severe depression, an SSRI is usually recommended, either alone or in combination with therapy. For kids with severe symptoms, [starting with combined therapy and medication is recommended](https:\/\/www.jaacap.org\/article\/S0890-8567\$09\$62053-0\/fulltext). “Depression is serious and it can take one’s life,” notes Sarper Taskiran, MD, a child and adolescent psychiatrist at the Child Mind Institute. “It needs to be treated effectively and robustly.”\n\nPlanning depression treatment\n\nThe approach to medication treatment for each child varies, says Dr. Taskiran, because many children develop depression as a result of other challenges they are facing, including anxiety and ADHD. If they are treated only for depression, without recognizing the underlying problems, the treatment may not be effective.\n\nSo the first task for a clinician prescribing medication is to decide whether any other conditions need to be treated at the same time. In the period since the pandemic lockdown, Dr. Taskiran says, he’s seeing many young patients who had been dealing with anxiety or ADHD before who developed depression as their struggles compounded.\n\n“I think, as clinicians, we need to be very careful not to just jump into treating depression as if it is something that happened just now,” he adds, “but examine the child’s history, the unfolding of the symptoms, so that we can address their needs.\n\nHow do antidepressants work?\n\nAntidepressants usually work by balancing the levels of neurotransmitters — chemicals that send signals between neurons — in the brain. These chemicals include serotonin, dopamine, and norepinephrine. Higher levels of these chemicals usually correspond with lower levels of depression.\n\nSSRIs work by increasing the availability of serotonin in the brain. They are the first choice of medication for children and adolescents with depression because they have been shown to be effective in reducing symptoms and they have fewer problematic side effects than other kinds of antidepressants.\n\nAnother closely related category of antidepressant is SNRIs, or serotonin and norepinephrine reuptake inhibitors. Since SNRIs affect two kinds of neurotransmitters, they tend to produce more side effects, and are usually considered after SSRIs have been tried.\n\nStarting an anti-depressant medication\n\nSSRIs and SNRIs usually take four to six weeks to have an effect on depression symptoms, and their effectiveness continues to grow for several more weeks after that. The best dose — the most reduction of symptoms without problematic side effects — varies from child to child. So the doctor should start with a low dose and work up gradually.\n\nThere are several different SSRI medications a doctor might recommend as their first choice for a depressed child. Only two, fluoxetine (Prozac) and escitalopram (Lexapro), have FDA approval for treatment of depression in children or teens. Fluoxetine is approved for kids 8 and up, and escitalopram for those 12 and up.\n\nFluoxetine is the most studied of the SSRIs — its effectiveness in kids has been confirmed by [major studies](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3285253\/) — and it is the SSRI most often prescribed for teenagers and children with depression.\n\nOther antidepressants have been approved for use in children but not specifically for depression. Sertraline (Zoloft) and Fluvoxamine (Luvox) are FDA approved for children with OCD (sertraline 6 and older, and fluvoxamine 8 and older). Duloxetine (Cymbalta), which is an SNRI, has FDA approval for anxiety in children and adolescents. All of these are also used for depression.\n\nDoctors usually start by prescribing an SSRI that has been FDA approved for some use (if not depression) in children and teenagers. But if that isn’t successful, they may try other SSRIs that have FDA approval in adults, though not children. This is called “off-label” use of the medication.\n\nLack of FDA approval for use in kids doesn’t mean that a medication hasn’t been thoroughly tested in clinical trials with kids. It reflects the fact that once a drug is approved for use in adults, the company that makes it often chooses not to go through the expensive FDA approval process again for use in kids.\n\nIn the case of anti-depressants, including those that don’t have FDA approval, other researchers have amassed a large body of evidence, including double-blind studies, for their safety and effectiveness for children and teens.\n\nThe SSRIs most commonly prescribed in children and teenagers are:\n\n- Fluoxetine (Prozac)\n- Escitalopram (Lexapro)\n- Sertraline (Zoloft)\n- Citalopram (Celexa)\n- Fluvoxamine (Luvox)\n- Paroxetine (Paxil)\n\nSNRIs:\n\n- Duloxetine (Cymbalta)\n- Venlafaxine (Effexor)\n\n**Side effects of SSRIs and SNRIs**\n\nSide effects of SSRIs and SNRIs are usually relatively mild, compared to other medications. They are usually experienced during the first few weeks, and they decline over time. Clinicians should be in close touch with families during these first several weeks, monitoring how children are feeling and any changes in their behavior.\n\nIf side effects don’t decline and they’re making a child uncomfortable, it’s appropriate for the doctor to prescribe a different SSRI. Children who experience unpleasant side effects on one SSRI often respond differently to another.\n\nSide effects can include:\n\n- Nausea, vomiting or diarrhea\n- Stomachaches\n- Headache\n- Drowsiness\n- Dry mouth\n- Insomnia\n- Nervousness, agitation, or restlessness\n- Activation — increasing irritability and impulsiveness\n- Dizziness\n- Reduced sexual desire\n- Impact on appetite, leading to weight loss or weight gain\n\n**Black box warning**\n\nSSRIs and SNRIs come with what’s called a “Black Box” warning from the FDA that children and adolescents taking them may experience an increased risk of suicidal thoughts. These medications have not been linked to attempted or completed suicides, but it’s recommended that clinicians and parents monitor kids taking them for any worsening in depression or emergence of suicidal thinking as they are adjusting to a new medication.\n\nMore recent research has not supported the increased risk of suicidal thoughts, Dr. Taskiran notes, and [most experts conclude](https:\/\/caringforkids.cps.ca\/handouts\/mentalhealth\/using_ssris_to_treat_depression_and_anxiety_in_children_and_youth) that the benefits of SSRIs outweigh the risks. Some research has found that suicide rates in children decrease when they take antidepressants.\n\nOther antidepressants\n\nSome other antidepressants are used to treat children when SSRIs aren’t effective for them, or when they have problems with side effects.\n\nBupropion (Wellbutrin) is an antidepressant that is called an NDRI (norepinephrine\/dopamine-reuptake inhibitor). It works by increasing the availability in the brain of neurotransmitters norepinephrine and dopamine. Bupropion is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms. Adding buproprion can help ease sexual side effects of the SSRI if that is a concern for the adolescent.\n\nThere are several newer antidepressants that are FDA-approved for treatment of depression in adults, but they have not been studied extensively in children and adolescents. They are sometimes prescribed off-label, Dr. Taskiran explains, when kids have problems with side effects on SSRIs, particularly weight gain and sexual side effects.\n\nOne of them, [mirtazapine](https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519059\/) (Remeron), is in a group of medications called tetracyclic antidepressants (TeCAs). By inhibiting a particular set of receptors in the brain, Mirtazapine causes an increased release of serotonin and norepinephrine.\n\nAnother, [Vilazodone](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3278186\/) (Viibryd), increases the effect of serotonin in the brain in two ways — by slowing its removal and by stimulating serotonin receptors. Because of this dual activity, it is called a serotonin partial agonist–reuptake inhibitor (SPARI) and is expected to have more robust anti-anxiety action.\n\nWhen the first medication doesn’t work\n\nBecause more than [a third of kids](https:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/resource_centers\/resources\/med_guides\/DepressionGuide-web.pdf) — between [55 and 65 percent](https:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/resource_centers\/resources\/med_guides\/DepressionGuide-web.pdf) — don’t respond to the initial antidepressant they take, it’s not unusual to try a second medication. Kids who don’t respond to the first often [do find success with a different antidepressant](https:\/\/ajp.psychiatryonline.org\/doi\/10.1176\/appi.ajp.2010.09040552?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3Dpubmed). Therapy may also be added if it hasn’t been tried.\n\nIf a child does not have a clear response to the medication — about a 40 percent reduction in symptoms — after six weeks, a switch should be made, Dr. Taskiran says. “If we’re not seeing that, it’s not worthwhile to keep the patient on the same medication.”\n\nBut he emphasizes that a medication should not be rejected until it’s been tried for the full six weeks.\n\nIn a rush for improvement, he notes, a medication will sometimes be judged ineffective after just two weeks, and kids will be switched to a second choice. But two weeks isn’t enough time for an SSRI to become fully effective, so medications that are potentially useful can be discarded too quickly. “It’s really important that we give these medications enough of a chance, from a time perspective and a dose perspective, to be effective.”\n\nOf the kids who are switched to a second medication, he says, 60 percent of them respond to the second medication. “For those who are still non-responders,” Dr. Taskiron says, “we need to add either mood stabilizers or atypical antipsychotics to increase the remission rate.”\n\nOf the mood stabilizers, lithium has been approved by the FDA for use in teenagers and children. Among atypical antipsychotics, aripiprazole (Abilify) and risperidone (Risperdal) are the ones that are most studied and most often used in kids, and they are FDA approved for some uses in kids. Aripiprazole is often the first choice because it has fewer problematic side effects than lithium or risperidone.\n\nIf a second medication isn’t successful, Dr. Taskiran notes that it’s also important to look at the diagnosis again, to consider whether there might be other factors going on that are affecting the outcome. “We know that family conflict, drug and alcohol use, and comorbid disorders are sometimes the culprit, and when we address those, we can get a better remission.”\n\nHow long should kids keep taking antidepressants?\n\nWhen teenagers or children are treated successfully with an antidepressant, experts advise that they stay on the medication for nine months to a year after their symptoms are gone to prevent a relapse. “This is usually the time that is needed for the brain to correct the chemical imbalances that result in depression,” Dr. Taskiran explains.\n\nIf there’s a relapse after the child has tapered down and gone off the medication, longer treatment may be needed to help prevent recurrence.\n\nAbout one in three kids treated for depression, he adds, will need more time on the medication. “After two years, we can stop the medication again, cautiously and carefully. But if we see another relapse, a second relapse, continuing on SSRIs indefinitely may be the best course.”\n\nHow do kids tend to feel about taking antidepressants?\n\nFor children and teenagers, getting a diagnosis of depression can be a relief, because they understand that the way they are feeling is not a permanent condition. “Depressed kids are often thinking that there is something inherently wrong with them,” Dr. Taskiran explains, “that they are built this way, and that’s the core belief that leads to suicidal ideation. They think they are flawed and that’s why they give up on themselves so easily.”\n\nWhen they understand that this is a disorder that can be treated, they usually welcome it. In his experience, he says, most are comfortable with the idea of medication.\n\nHaving said that, he adds, teenagers need parental support to make sure they are compliant with treatment. “They’re kids. No 14-year-old should be responsible to remember to take their medication every day.”\n\nDr. Taskiran notes that success in treatment depends on the patient, the parents, and the provider all being on the same page. “I usually tell parents, ‘Look, we need to have a trusting relationship and you need to be on board with the process that is your child’s treatment in order for this to work.’ “\n\n## Frequently Asked Questions\nWhat is the safest antidepressant for teens and young adults?\n\nFor teens and young adults with depression, experts agree that the first choice in medication treatment is a group of antidepressant medications called SSRIs — selective serotonin reuptake inhibitors. If the first SSRI medication a child tries does not work, experts recommend trying a different one because individual children respond differently to different SSRIs.\n\nWhen is Wellbutrin prescribed for teens?\n\nWellbutrin (Bupropion) is a medication that is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms.\n\nIs Lexapro a common antidepressant for kids?\n\nLexapro is among the most commonly prescribed antidepressants for kids. Other common SSRIs a child or teen might be prescribed include Prozac, Zoloft, Celexa, Paxil, and Luvox.\n\nLast reviewed or updated on November 18, 2024.","meta_canonical":null}

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Meta Title	Antidepressants for Children and Teenagers
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Boilerpipe Text	For kids with depression, experts agree that the first choice in medication treatment is the group of anti-depressant medications called SSRIs — selective serotonin reuptake inhibitors. And if the first SSRI a child is prescribed is not successful in combatting depression, they recommend trying another one, since individual kids respond differently to different SSRIs. But before we say more about antidepressants, it’s important to keep in mind that not all kids who are depressed need to be treated with medication. For children and teenagers whose depression symptoms are mild, therapy is the recommended first choice. There are several kinds of therapy, including cognitive behavior therapy (CBT) and interpersonal therapy (IPT), that have been shown to be effective for kids with depression. If there’s no response with the therapy over a period of 12 weeks — or these therapies are not available — then SSRI medications should be considered. For kids with moderate to severe depression, an SSRI is usually recommended, either alone or in combination with therapy. For kids with severe symptoms, starting with combined therapy and medication is recommended . “Depression is serious and it can take one’s life,” notes Sarper Taskiran, MD, a child and adolescent psychiatrist at the Child Mind Institute. “It needs to be treated effectively and robustly.” Planning depression treatment The approach to medication treatment for each child varies, says Dr. Taskiran, because many children develop depression as a result of other challenges they are facing, including anxiety and ADHD. If they are treated only for depression, without recognizing the underlying problems, the treatment may not be effective. So the first task for a clinician prescribing medication is to decide whether any other conditions need to be treated at the same time. In the period since the pandemic lockdown, Dr. Taskiran says, he’s seeing many young patients who had been dealing with anxiety or ADHD before who developed depression as their struggles compounded. “I think, as clinicians, we need to be very careful not to just jump into treating depression as if it is something that happened just now,” he adds, “but examine the child’s history, the unfolding of the symptoms, so that we can address their needs. How do antidepressants work? Antidepressants usually work by balancing the levels of neurotransmitters — chemicals that send signals between neurons — in the brain. These chemicals include serotonin, dopamine, and norepinephrine. Higher levels of these chemicals usually correspond with lower levels of depression. SSRIs work by increasing the availability of serotonin in the brain. They are the first choice of medication for children and adolescents with depression because they have been shown to be effective in reducing symptoms and they have fewer problematic side effects than other kinds of antidepressants. Another closely related category of antidepressant is SNRIs, or serotonin and norepinephrine reuptake inhibitors. Since SNRIs affect two kinds of neurotransmitters, they tend to produce more side effects, and are usually considered after SSRIs have been tried. Starting an anti-depressant medication SSRIs and SNRIs usually take four to six weeks to have an effect on depression symptoms, and their effectiveness continues to grow for several more weeks after that. The best dose — the most reduction of symptoms without problematic side effects — varies from child to child. So the doctor should start with a low dose and work up gradually. There are several different SSRI medications a doctor might recommend as their first choice for a depressed child. Only two, fluoxetine (Prozac) and escitalopram (Lexapro), have FDA approval for treatment of depression in children or teens. Fluoxetine is approved for kids 8 and up, and escitalopram for those 12 and up. Fluoxetine is the most studied of the SSRIs — its effectiveness in kids has been confirmed by major studies — and it is the SSRI most often prescribed for teenagers and children with depression. Other antidepressants have been approved for use in children but not specifically for depression. Sertraline (Zoloft) and Fluvoxamine (Luvox) are FDA approved for children with OCD (sertraline 6 and older, and fluvoxamine 8 and older). Duloxetine (Cymbalta), which is an SNRI, has FDA approval for anxiety in children and adolescents. All of these are also used for depression. Doctors usually start by prescribing an SSRI that has been FDA approved for some use (if not depression) in children and teenagers. But if that isn’t successful, they may try other SSRIs that have FDA approval in adults, though not children. This is called “off-label” use of the medication. Lack of FDA approval for use in kids doesn’t mean that a medication hasn’t been thoroughly tested in clinical trials with kids. It reflects the fact that once a drug is approved for use in adults, the company that makes it often chooses not to go through the expensive FDA approval process again for use in kids. In the case of anti-depressants, including those that don’t have FDA approval, other researchers have amassed a large body of evidence, including double-blind studies, for their safety and effectiveness for children and teens. The SSRIs most commonly prescribed in children and teenagers are: Fluoxetine (Prozac) Escitalopram (Lexapro) Sertraline (Zoloft) Citalopram (Celexa) Fluvoxamine (Luvox) Paroxetine (Paxil) SNRIs: Duloxetine (Cymbalta) Venlafaxine (Effexor) Side effects of SSRIs and SNRIs Side effects of SSRIs and SNRIs are usually relatively mild, compared to other medications. They are usually experienced during the first few weeks, and they decline over time. Clinicians should be in close touch with families during these first several weeks, monitoring how children are feeling and any changes in their behavior. If side effects don’t decline and they’re making a child uncomfortable, it’s appropriate for the doctor to prescribe a different SSRI. Children who experience unpleasant side effects on one SSRI often respond differently to another. Side effects can include: Nausea, vomiting or diarrhea Stomachaches Headache Drowsiness Dry mouth Insomnia Nervousness, agitation, or restlessness Activation — increasing irritability and impulsiveness Dizziness Reduced sexual desire Impact on appetite, leading to weight loss or weight gain Black box warning SSRIs and SNRIs come with what’s called a “Black Box” warning from the FDA that children and adolescents taking them may experience an increased risk of suicidal thoughts. These medications have not been linked to attempted or completed suicides, but it’s recommended that clinicians and parents monitor kids taking them for any worsening in depression or emergence of suicidal thinking as they are adjusting to a new medication. More recent research has not supported the increased risk of suicidal thoughts, Dr. Taskiran notes, and most experts conclude that the benefits of SSRIs outweigh the risks. Some research has found that suicide rates in children decrease when they take antidepressants. Other antidepressants Some other antidepressants are used to treat children when SSRIs aren’t effective for them, or when they have problems with side effects. Bupropion (Wellbutrin) is an antidepressant that is called an NDRI (norepinephrine/dopamine-reuptake inhibitor). It works by increasing the availability in the brain of neurotransmitters norepinephrine and dopamine. Bupropion is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms. Adding buproprion can help ease sexual side effects of the SSRI if that is a concern for the adolescent. There are several newer antidepressants that are FDA-approved for treatment of depression in adults, but they have not been studied extensively in children and adolescents. They are sometimes prescribed off-label, Dr. Taskiran explains, when kids have problems with side effects on SSRIs, particularly weight gain and sexual side effects. One of them, mirtazapine (Remeron), is in a group of medications called tetracyclic antidepressants (TeCAs). By inhibiting a particular set of receptors in the brain, Mirtazapine causes an increased release of serotonin and norepinephrine. Another, Vilazodone (Viibryd), increases the effect of serotonin in the brain in two ways — by slowing its removal and by stimulating serotonin receptors. Because of this dual activity, it is called a serotonin partial agonist–reuptake inhibitor (SPARI) and is expected to have more robust anti-anxiety action. When the first medication doesn’t work Because more than a third of kids — between 55 and 65 percent — don’t respond to the initial antidepressant they take, it’s not unusual to try a second medication. Kids who don’t respond to the first often do find success with a different antidepressant . Therapy may also be added if it hasn’t been tried. If a child does not have a clear response to the medication — about a 40 percent reduction in symptoms — after six weeks, a switch should be made, Dr. Taskiran says. “If we’re not seeing that, it’s not worthwhile to keep the patient on the same medication.” But he emphasizes that a medication should not be rejected until it’s been tried for the full six weeks. In a rush for improvement, he notes, a medication will sometimes be judged ineffective after just two weeks, and kids will be switched to a second choice. But two weeks isn’t enough time for an SSRI to become fully effective, so medications that are potentially useful can be discarded too quickly. “It’s really important that we give these medications enough of a chance, from a time perspective and a dose perspective, to be effective.” Of the kids who are switched to a second medication, he says, 60 percent of them respond to the second medication. “For those who are still non-responders,” Dr. Taskiron says, “we need to add either mood stabilizers or atypical antipsychotics to increase the remission rate.” Of the mood stabilizers, lithium has been approved by the FDA for use in teenagers and children. Among atypical antipsychotics, aripiprazole (Abilify) and risperidone (Risperdal) are the ones that are most studied and most often used in kids, and they are FDA approved for some uses in kids. Aripiprazole is often the first choice because it has fewer problematic side effects than lithium or risperidone. If a second medication isn’t successful, Dr. Taskiran notes that it’s also important to look at the diagnosis again, to consider whether there might be other factors going on that are affecting the outcome. “We know that family conflict, drug and alcohol use, and comorbid disorders are sometimes the culprit, and when we address those, we can get a better remission.” How long should kids keep taking antidepressants? When teenagers or children are treated successfully with an antidepressant, experts advise that they stay on the medication for nine months to a year after their symptoms are gone to prevent a relapse. “This is usually the time that is needed for the brain to correct the chemical imbalances that result in depression,” Dr. Taskiran explains. If there’s a relapse after the child has tapered down and gone off the medication, longer treatment may be needed to help prevent recurrence. About one in three kids treated for depression, he adds, will need more time on the medication. “After two years, we can stop the medication again, cautiously and carefully. But if we see another relapse, a second relapse, continuing on SSRIs indefinitely may be the best course.” How do kids tend to feel about taking antidepressants? For children and teenagers, getting a diagnosis of depression can be a relief, because they understand that the way they are feeling is not a permanent condition. “Depressed kids are often thinking that there is something inherently wrong with them,” Dr. Taskiran explains, “that they are built this way, and that’s the core belief that leads to suicidal ideation. They think they are flawed and that’s why they give up on themselves so easily.” When they understand that this is a disorder that can be treated, they usually welcome it. In his experience, he says, most are comfortable with the idea of medication. Having said that, he adds, teenagers need parental support to make sure they are compliant with treatment. “They’re kids. No 14-year-old should be responsible to remember to take their medication every day.” Dr. Taskiran notes that success in treatment depends on the patient, the parents, and the provider all being on the same page. “I usually tell parents, ‘Look, we need to have a trusting relationship and you need to be on board with the process that is your child’s treatment in order for this to work.’ “ Frequently Asked Questions What is the safest antidepressant for teens and young adults? For teens and young adults with depression, experts agree that the first choice in medication treatment is a group of antidepressant medications called SSRIs — selective serotonin reuptake inhibitors. If the first SSRI medication a child tries does not work, experts recommend trying a different one because individual children respond differently to different SSRIs. When is Wellbutrin prescribed for teens? Wellbutrin (Bupropion) is a medication that is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms. Is Lexapro a common antidepressant for kids? Lexapro is among the most commonly prescribed antidepressants for kids. Other common SSRIs a child or teen might be prescribed include Prozac, Zoloft, Celexa, Paxil, and Luvox. Last reviewed or updated on November 18, 2024.
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Puede intentar su búsqueda de nuevo o visitar la lista de [temas populares.](https://childmind.org/es/topics-a-z/) Medication for Kids With Depression by [Caroline Miller](https://childmind.org/bio/caroline-miller/) [Download](https://childmind.org/article/medication-for-kids-with-depression/ "Printer Friendly, PDF & Email") [Share](https://childmind.org/article/medication-for-kids-with-depression/) [Download]() ### Get this as a PDF Enter email to download and get news and resources in your inbox. ### Share this on social [Copy Link Link Copied](https://childmind.org/article/medication-for-kids-with-depression/) [Email](https://childmind.org/cdn-cgi/l/email-protection#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) [Facebook](https://www.facebook.com/sharer.php?u=https://childmind.org/article/medication-for-kids-with-depression/) [Twitter](https://twitter.com/intent/tweet?url=https://childmind.org/article/medication-for-kids-with-depression/&text=Medication%20for%20Kids%20With%20Depression) [LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https://childmind.org/article/medication-for-kids-with-depression/) [Download](https://childmind.org/article/medication-for-kids-with-depression/) [Family Resource Center](https://childmind.org/resources/) [Depression & Mood Disorders](https://childmind.org/topics/depression-mood-disorders/) / [Treatment](https://childmind.org/topics/treatment/) # Medication for Kids With Depression What parents should know about children and teenagers taking antidepressants Writer: [Caroline Miller](https://childmind.org/bio/caroline-miller/) Clinical Expert: [Sarper Taskiran, MD](https://childmind.org/bio/sarper-taskiran-md/) [en Español](https://childmind.org/es/articulo/medicamentos-para-ninos-con-depresion/) ## What You'll Learn - What antidepressants are FDA approved for children and teenagers? - What is the best treatment recommended for kids with severe depression symptoms? - Why do many kids have to try more than one antidepressant before treatment is successful? - [Quick Read](https://childmind.org/article/medication-for-kids-with-depression/#quickread) - [Full Article](https://childmind.org/article/medication-for-kids-with-depression/#full_article) - [Planning depression treatment](https://childmind.org/article/medication-for-kids-with-depression/#planning-depression-treatment) - [How do antidepressants work?](https://childmind.org/article/medication-for-kids-with-depression/#how-do-antidepressants-work) - [Starting an anti-depressant medication](https://childmind.org/article/medication-for-kids-with-depression/#starting-an-anti-depressant-medication) - [Side effects of SSRIs and SNRIs](https://childmind.org/article/medication-for-kids-with-depression/#side-effects-of-ssris-and-snris) - [Black box warning](https://childmind.org/article/medication-for-kids-with-depression/#black-box-warning) - [Other antidepressants](https://childmind.org/article/medication-for-kids-with-depression/#other-antidepressants) - [When the first medication doesn’t work](https://childmind.org/article/medication-for-kids-with-depression/#when-the-first-medication-doesn%E2%80%99t-work) - [How long should kids keep taking antidepressants?](https://childmind.org/article/medication-for-kids-with-depression/#how-long-should-kids-keep-taking-antidepressants) - [How do kids tend to feel about taking antidepressants?](https://childmind.org/article/medication-for-kids-with-depression/#how-do-kids-tend-to-feel-about-taking-antidepressants) [Back to Top](https://childmind.org/article/medication-for-kids-with-depression/#top_of_page) ## Quick Read For children and teenagers with depression, the first choice in medication treatment is a group of antidepressants called SSRIs (selective serotonin reuptake inhibitors). But it’s important to know that if the first SSRI your child tries is not successful in treating their depression, a different SSRI or another antidepressant medication may be successful. Individual kids respond differently to different medications. And the most effective treatment for depression is medication combined with cognitive behavior therapy. Another thing it’s useful to keep in mind is that many kids who develop depression have been struggling with an earlier challenge, like anxiety or ADHD. They may develop depression because the anxiety or ADHD has had a negative impact on their lives or their self-esteem. So a doctor treating the depression should consider whether there are other challenges that need attention too, to make sure the treatment is successful. There are a number of SSRIs your doctor may prescribe (see the [full story below](https://childmind.org/article/medication-for-kids-with-depression/#starting-an-anti-depressant-medication)), though only fluoxetine (Prozac) has been approved by the FDA for use in children and teenagers. But the others have been thoroughly researched and found to be safe and effective. Side effects of SSRIs (see the [full story below](https://childmind.org/article/medication-for-kids-with-depression/#side-effects-of-ssris-and-snris)) tend to get better after the first few weeks, but if a child has problematic side effects that don’t fade, another SSRI should be considered. If an SSRI has not substantially reduced depression symptoms by six weeks, your doctor should try switching to a different SSRI or another antidepressant called an SNRI (serotonin and norepinephrine reuptake inhibitor). Once a child’s depression is in remission, they should continue to take the medication for nine months to a year, to make sure they are stabilized. If they stop the medication and the depression symptoms recur, a longer course of treatment is advised. [More](https://childmind.org/article/medication-for-kids-with-depression/) Full Article 14 min read For kids with depression, experts agree that the [first choice in medication treatment](https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/DepressionGuide-web.pdf) is the group of anti-depressant medications called SSRIs — selective serotonin reuptake inhibitors. And if the first SSRI a child is prescribed is not successful in combatting depression, they recommend trying another one, since individual kids respond differently to different SSRIs. But before we say more about antidepressants, it’s important to keep in mind that not all kids who are depressed need to be treated with medication. For children and teenagers whose depression symptoms are mild, therapy is the recommended first choice. There are [several kinds of therapy,](https://childmind.org/article/treatment-for-depression/) including cognitive behavior therapy (CBT) and interpersonal therapy (IPT), that have been shown to be effective for kids with depression. If there’s no response with the therapy over a period of 12 weeks — or these therapies are not available — then SSRI medications should be considered. For kids with moderate to severe depression, an SSRI is usually recommended, either alone or in combination with therapy. For kids with severe symptoms, [starting with combined therapy and medication is recommended](https://www.jaacap.org/article/S0890-8567$09$62053-0/fulltext). “Depression is serious and it can take one’s life,” notes Sarper Taskiran, MD, a child and adolescent psychiatrist at the Child Mind Institute. “It needs to be treated effectively and robustly.” ## Planning depression treatment The approach to medication treatment for each child varies, says Dr. Taskiran, because many children develop depression as a result of other challenges they are facing, including anxiety and ADHD. If they are treated only for depression, without recognizing the underlying problems, the treatment may not be effective. So the first task for a clinician prescribing medication is to decide whether any other conditions need to be treated at the same time. In the period since the pandemic lockdown, Dr. Taskiran says, he’s seeing many young patients who had been dealing with anxiety or ADHD before who developed depression as their struggles compounded. “I think, as clinicians, we need to be very careful not to just jump into treating depression as if it is something that happened just now,” he adds, “but examine the child’s history, the unfolding of the symptoms, so that we can address their needs. ## How do antidepressants work? Antidepressants usually work by balancing the levels of neurotransmitters — chemicals that send signals between neurons — in the brain. These chemicals include serotonin, dopamine, and norepinephrine. Higher levels of these chemicals usually correspond with lower levels of depression. SSRIs work by increasing the availability of serotonin in the brain. They are the first choice of medication for children and adolescents with depression because they have been shown to be effective in reducing symptoms and they have fewer problematic side effects than other kinds of antidepressants. Another closely related category of antidepressant is SNRIs, or serotonin and norepinephrine reuptake inhibitors. Since SNRIs affect two kinds of neurotransmitters, they tend to produce more side effects, and are usually considered after SSRIs have been tried. ## Starting an anti-depressant medication SSRIs and SNRIs usually take four to six weeks to have an effect on depression symptoms, and their effectiveness continues to grow for several more weeks after that. The best dose — the most reduction of symptoms without problematic side effects — varies from child to child. So the doctor should start with a low dose and work up gradually. There are several different SSRI medications a doctor might recommend as their first choice for a depressed child. Only two, fluoxetine (Prozac) and escitalopram (Lexapro), have FDA approval for treatment of depression in children or teens. Fluoxetine is approved for kids 8 and up, and escitalopram for those 12 and up. Fluoxetine is the most studied of the SSRIs — its effectiveness in kids has been confirmed by [major studies](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3285253/) — and it is the SSRI most often prescribed for teenagers and children with depression. Other antidepressants have been approved for use in children but not specifically for depression. Sertraline (Zoloft) and Fluvoxamine (Luvox) are FDA approved for children with OCD (sertraline 6 and older, and fluvoxamine 8 and older). Duloxetine (Cymbalta), which is an SNRI, has FDA approval for anxiety in children and adolescents. All of these are also used for depression. Doctors usually start by prescribing an SSRI that has been FDA approved for some use (if not depression) in children and teenagers. But if that isn’t successful, they may try other SSRIs that have FDA approval in adults, though not children. This is called “off-label” use of the medication. Lack of FDA approval for use in kids doesn’t mean that a medication hasn’t been thoroughly tested in clinical trials with kids. It reflects the fact that once a drug is approved for use in adults, the company that makes it often chooses not to go through the expensive FDA approval process again for use in kids. In the case of anti-depressants, including those that don’t have FDA approval, other researchers have amassed a large body of evidence, including double-blind studies, for their safety and effectiveness for children and teens. The SSRIs most commonly prescribed in children and teenagers are: - Fluoxetine (Prozac) - Escitalopram (Lexapro) - Sertraline (Zoloft) - Citalopram (Celexa) - Fluvoxamine (Luvox) - Paroxetine (Paxil) SNRIs: - Duloxetine (Cymbalta) - Venlafaxine (Effexor) ## Side effects of SSRIs and SNRIs Side effects of SSRIs and SNRIs are usually relatively mild, compared to other medications. They are usually experienced during the first few weeks, and they decline over time. Clinicians should be in close touch with families during these first several weeks, monitoring how children are feeling and any changes in their behavior. If side effects don’t decline and they’re making a child uncomfortable, it’s appropriate for the doctor to prescribe a different SSRI. Children who experience unpleasant side effects on one SSRI often respond differently to another. Side effects can include: - Nausea, vomiting or diarrhea - Stomachaches - Headache - Drowsiness - Dry mouth - Insomnia - Nervousness, agitation, or restlessness - Activation — increasing irritability and impulsiveness - Dizziness - Reduced sexual desire - Impact on appetite, leading to weight loss or weight gain ## Black box warning SSRIs and SNRIs come with what’s called a “Black Box” warning from the FDA that children and adolescents taking them may experience an increased risk of suicidal thoughts. These medications have not been linked to attempted or completed suicides, but it’s recommended that clinicians and parents monitor kids taking them for any worsening in depression or emergence of suicidal thinking as they are adjusting to a new medication. More recent research has not supported the increased risk of suicidal thoughts, Dr. Taskiran notes, and [most experts conclude](https://caringforkids.cps.ca/handouts/mentalhealth/using_ssris_to_treat_depression_and_anxiety_in_children_and_youth) that the benefits of SSRIs outweigh the risks. Some research has found that suicide rates in children decrease when they take antidepressants. ## Other antidepressants Some other antidepressants are used to treat children when SSRIs aren’t effective for them, or when they have problems with side effects. Bupropion (Wellbutrin) is an antidepressant that is called an NDRI (norepinephrine/dopamine-reuptake inhibitor). It works by increasing the availability in the brain of neurotransmitters norepinephrine and dopamine. Bupropion is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms. Adding buproprion can help ease sexual side effects of the SSRI if that is a concern for the adolescent. There are several newer antidepressants that are FDA-approved for treatment of depression in adults, but they have not been studied extensively in children and adolescents. They are sometimes prescribed off-label, Dr. Taskiran explains, when kids have problems with side effects on SSRIs, particularly weight gain and sexual side effects. One of them, [mirtazapine](https://www.ncbi.nlm.nih.gov/books/NBK519059/) (Remeron), is in a group of medications called tetracyclic antidepressants (TeCAs). By inhibiting a particular set of receptors in the brain, Mirtazapine causes an increased release of serotonin and norepinephrine. Another, [Vilazodone](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278186/) (Viibryd), increases the effect of serotonin in the brain in two ways — by slowing its removal and by stimulating serotonin receptors. Because of this dual activity, it is called a serotonin partial agonist–reuptake inhibitor (SPARI) and is expected to have more robust anti-anxiety action. ## When the first medication doesn’t work Because more than [a third of kids](https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/DepressionGuide-web.pdf) — between [55 and 65 percent](https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/DepressionGuide-web.pdf) — don’t respond to the initial antidepressant they take, it’s not unusual to try a second medication. Kids who don’t respond to the first often [do find success with a different antidepressant](https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2010.09040552?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3Dpubmed). Therapy may also be added if it hasn’t been tried. If a child does not have a clear response to the medication — about a 40 percent reduction in symptoms — after six weeks, a switch should be made, Dr. Taskiran says. “If we’re not seeing that, it’s not worthwhile to keep the patient on the same medication.” But he emphasizes that a medication should not be rejected until it’s been tried for the full six weeks. In a rush for improvement, he notes, a medication will sometimes be judged ineffective after just two weeks, and kids will be switched to a second choice. But two weeks isn’t enough time for an SSRI to become fully effective, so medications that are potentially useful can be discarded too quickly. “It’s really important that we give these medications enough of a chance, from a time perspective and a dose perspective, to be effective.” Of the kids who are switched to a second medication, he says, 60 percent of them respond to the second medication. “For those who are still non-responders,” Dr. Taskiron says, “we need to add either mood stabilizers or atypical antipsychotics to increase the remission rate.” Of the mood stabilizers, lithium has been approved by the FDA for use in teenagers and children. Among atypical antipsychotics, aripiprazole (Abilify) and risperidone (Risperdal) are the ones that are most studied and most often used in kids, and they are FDA approved for some uses in kids. Aripiprazole is often the first choice because it has fewer problematic side effects than lithium or risperidone. If a second medication isn’t successful, Dr. Taskiran notes that it’s also important to look at the diagnosis again, to consider whether there might be other factors going on that are affecting the outcome. “We know that family conflict, drug and alcohol use, and comorbid disorders are sometimes the culprit, and when we address those, we can get a better remission.” ## How long should kids keep taking antidepressants? When teenagers or children are treated successfully with an antidepressant, experts advise that they stay on the medication for nine months to a year after their symptoms are gone to prevent a relapse. “This is usually the time that is needed for the brain to correct the chemical imbalances that result in depression,” Dr. Taskiran explains. If there’s a relapse after the child has tapered down and gone off the medication, longer treatment may be needed to help prevent recurrence. About one in three kids treated for depression, he adds, will need more time on the medication. “After two years, we can stop the medication again, cautiously and carefully. But if we see another relapse, a second relapse, continuing on SSRIs indefinitely may be the best course.” ## How do kids tend to feel about taking antidepressants? For children and teenagers, getting a diagnosis of depression can be a relief, because they understand that the way they are feeling is not a permanent condition. “Depressed kids are often thinking that there is something inherently wrong with them,” Dr. Taskiran explains, “that they are built this way, and that’s the core belief that leads to suicidal ideation. They think they are flawed and that’s why they give up on themselves so easily.” When they understand that this is a disorder that can be treated, they usually welcome it. In his experience, he says, most are comfortable with the idea of medication. Having said that, he adds, teenagers need parental support to make sure they are compliant with treatment. “They’re kids. No 14-year-old should be responsible to remember to take their medication every day.” Dr. Taskiran notes that success in treatment depends on the patient, the parents, and the provider all being on the same page. “I usually tell parents, ‘Look, we need to have a trusting relationship and you need to be on board with the process that is your child’s treatment in order for this to work.’ “ ## Frequently Asked Questions What is the safest antidepressant for teens and young adults? For teens and young adults with depression, experts agree that the first choice in medication treatment is a group of antidepressant medications called SSRIs — selective serotonin reuptake inhibitors. If the first SSRI medication a child tries does not work, experts recommend trying a different one because individual children respond differently to different SSRIs. When is Wellbutrin prescribed for teens? Wellbutrin (Bupropion) is a medication that is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms. Is Lexapro a common antidepressant for kids? Lexapro is among the most commonly prescribed antidepressants for kids. Other common SSRIs a child or teen might be prescribed include Prozac, Zoloft, Celexa, Paxil, and Luvox. [![](https://childmind.org/wp-content/uploads/2023/06/Write-a-Review-400x400.png) Sign Up for Newsletters Get articles, expert advice, and clinical updates direct to your inbox. Sign Up](https://childmind.org/stay-in-touch-with-the-child-mind-institute/) Last reviewed or updated on November 18, 2024. Learn more about our [Family Resource Center](https://childmind.org/resources/) and our [editorial mission](https://childmind.org/about-us/editorial-mission/). ### References The Child Mind Institute publishes articles based on extensive research and interviews with experts, including child and adolescent psychiatrists, clinical psychologists, clinical neuropsychologists, pediatricians, and learning specialists. Other sources include peer-reviewed studies, government agencies, medical associations, and the latest Diagnostic and Statistical Manual (DSM-5). Articles are reviewed for accuracy, and we link to sources and list references where applicable. You can learn more by reading our [editorial mission](https://childmind.org/about-us/editorial-mission/). - American Academy of Child and Adolescent Psychiatry. Depression: A Guide for Parents. American Academy of Child and Adolescent Psychiatry. Accessed November 18, 2024. <https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/DepressionGuide-web.pdf> - Birmaher, Boris, M.D., David Brent, M.D., and The AACAP Work Group on Quality Issues. "Practice Parameter for the Assessment and Treatment of Children and Adolescents with Depressive Disorders." Journal of the American Academy of Child & Adolescent Psychiatry 47, no. 11 (November 2008): 1413–1436. <https://www.jaacap.org/article/S0890-8567(09)62053-0/fulltext> - Canadian Paediatric Society. "Using SSRIs to Treat Depression and Anxiety in Children and Youth." Caring for Kids, accessed November 18, 2024. <https://caringforkids.cps.ca/handouts/mentalhealth/using_ssris_to_treat_depression_and_anxiety_in_children_and_youth> - Emslie, Graham, Christopher Kratochvil, Benedetto Vitiello, Susan Silva, Taryn Mayes, Steven McNulty, Elizabeth Weller, Bruce Waslick, Charles Casat, John Walkup, Sanjeev Pathak, Paul Rohde, Kelly Posner, John March, The Columbia Suicidality Classification Group, and the TADS Team. "Treatment for Adolescents with Depression Study (TADS): Safety Results." The American Journal of Psychiatry 163, no. 6 (June 2006): 1041–1047. <https://pmc.ncbi.nlm.nih.gov/articles/PMC3285253/> - Emslie, Graham J., Taryn Mayes, Giovanna Porta, Benedetto Vitiello, Greg Clarke, Karen Dineen Wagner, Joan Rosenbaum Asarnow, Anthony Spirito, Boris Birmaher, Neal Ryan, Betsy Kennard, Lynn DeBar, James McCracken, Michael Strober, Matthew Onorato, Jamie Zelazny, Marty Keller, Satish Iyengar, and David Brent. "Treatment of Resistant Depression in Adolescents (TORDIA): Week 24 Outcomes." The American Journal of Psychiatry 167, no. 7 (July 2010): 782–791. [https://psychiatryonline.org/doi/10.1176/appi.ajp.2010.09040552?url\_ver=Z39.88-2003\&rfr\_id=ori%3Arid%3Acrossref.org\&rfr\_dat=cr\_pub%3Dpubmed](https://psychiatryonline.org/doi/10.1176/appi.ajp.2010.09040552?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed) Topics [Depression & Mood Disorders](https://childmind.org/topics/depression-mood-disorders/)[Treatment](https://childmind.org/topics/treatment/) ![Caroline Miller](https://childmind.org/wp-content/uploads/Miller_Caroline_424x424.jpg.jpeg) Caroline Miller Caroline Miller Caroline Miller is Editor-at-Large at the Child Mind Institute. She was the editorial director of the organization for more than … [Read Bio](https://childmind.org/bio/caroline-miller/) ### Was this article helpful? 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Readable Markdown	For kids with depression, experts agree that the [first choice in medication treatment](https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/DepressionGuide-web.pdf) is the group of anti-depressant medications called SSRIs — selective serotonin reuptake inhibitors. And if the first SSRI a child is prescribed is not successful in combatting depression, they recommend trying another one, since individual kids respond differently to different SSRIs. But before we say more about antidepressants, it’s important to keep in mind that not all kids who are depressed need to be treated with medication. For children and teenagers whose depression symptoms are mild, therapy is the recommended first choice. There are [several kinds of therapy,](https://childmind.org/article/treatment-for-depression/) including cognitive behavior therapy (CBT) and interpersonal therapy (IPT), that have been shown to be effective for kids with depression. If there’s no response with the therapy over a period of 12 weeks — or these therapies are not available — then SSRI medications should be considered. For kids with moderate to severe depression, an SSRI is usually recommended, either alone or in combination with therapy. For kids with severe symptoms, [starting with combined therapy and medication is recommended](https://www.jaacap.org/article/S0890-8567$09$62053-0/fulltext). “Depression is serious and it can take one’s life,” notes Sarper Taskiran, MD, a child and adolescent psychiatrist at the Child Mind Institute. “It needs to be treated effectively and robustly.” Planning depression treatment The approach to medication treatment for each child varies, says Dr. Taskiran, because many children develop depression as a result of other challenges they are facing, including anxiety and ADHD. If they are treated only for depression, without recognizing the underlying problems, the treatment may not be effective. So the first task for a clinician prescribing medication is to decide whether any other conditions need to be treated at the same time. In the period since the pandemic lockdown, Dr. Taskiran says, he’s seeing many young patients who had been dealing with anxiety or ADHD before who developed depression as their struggles compounded. “I think, as clinicians, we need to be very careful not to just jump into treating depression as if it is something that happened just now,” he adds, “but examine the child’s history, the unfolding of the symptoms, so that we can address their needs. How do antidepressants work? Antidepressants usually work by balancing the levels of neurotransmitters — chemicals that send signals between neurons — in the brain. These chemicals include serotonin, dopamine, and norepinephrine. Higher levels of these chemicals usually correspond with lower levels of depression. SSRIs work by increasing the availability of serotonin in the brain. They are the first choice of medication for children and adolescents with depression because they have been shown to be effective in reducing symptoms and they have fewer problematic side effects than other kinds of antidepressants. Another closely related category of antidepressant is SNRIs, or serotonin and norepinephrine reuptake inhibitors. Since SNRIs affect two kinds of neurotransmitters, they tend to produce more side effects, and are usually considered after SSRIs have been tried. Starting an anti-depressant medication SSRIs and SNRIs usually take four to six weeks to have an effect on depression symptoms, and their effectiveness continues to grow for several more weeks after that. The best dose — the most reduction of symptoms without problematic side effects — varies from child to child. So the doctor should start with a low dose and work up gradually. There are several different SSRI medications a doctor might recommend as their first choice for a depressed child. Only two, fluoxetine (Prozac) and escitalopram (Lexapro), have FDA approval for treatment of depression in children or teens. Fluoxetine is approved for kids 8 and up, and escitalopram for those 12 and up. Fluoxetine is the most studied of the SSRIs — its effectiveness in kids has been confirmed by [major studies](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3285253/) — and it is the SSRI most often prescribed for teenagers and children with depression. Other antidepressants have been approved for use in children but not specifically for depression. Sertraline (Zoloft) and Fluvoxamine (Luvox) are FDA approved for children with OCD (sertraline 6 and older, and fluvoxamine 8 and older). Duloxetine (Cymbalta), which is an SNRI, has FDA approval for anxiety in children and adolescents. All of these are also used for depression. Doctors usually start by prescribing an SSRI that has been FDA approved for some use (if not depression) in children and teenagers. But if that isn’t successful, they may try other SSRIs that have FDA approval in adults, though not children. This is called “off-label” use of the medication. Lack of FDA approval for use in kids doesn’t mean that a medication hasn’t been thoroughly tested in clinical trials with kids. It reflects the fact that once a drug is approved for use in adults, the company that makes it often chooses not to go through the expensive FDA approval process again for use in kids. In the case of anti-depressants, including those that don’t have FDA approval, other researchers have amassed a large body of evidence, including double-blind studies, for their safety and effectiveness for children and teens. The SSRIs most commonly prescribed in children and teenagers are: - Fluoxetine (Prozac) - Escitalopram (Lexapro) - Sertraline (Zoloft) - Citalopram (Celexa) - Fluvoxamine (Luvox) - Paroxetine (Paxil) SNRIs: - Duloxetine (Cymbalta) - Venlafaxine (Effexor) Side effects of SSRIs and SNRIs Side effects of SSRIs and SNRIs are usually relatively mild, compared to other medications. They are usually experienced during the first few weeks, and they decline over time. Clinicians should be in close touch with families during these first several weeks, monitoring how children are feeling and any changes in their behavior. If side effects don’t decline and they’re making a child uncomfortable, it’s appropriate for the doctor to prescribe a different SSRI. Children who experience unpleasant side effects on one SSRI often respond differently to another. Side effects can include: - Nausea, vomiting or diarrhea - Stomachaches - Headache - Drowsiness - Dry mouth - Insomnia - Nervousness, agitation, or restlessness - Activation — increasing irritability and impulsiveness - Dizziness - Reduced sexual desire - Impact on appetite, leading to weight loss or weight gain Black box warning SSRIs and SNRIs come with what’s called a “Black Box” warning from the FDA that children and adolescents taking them may experience an increased risk of suicidal thoughts. These medications have not been linked to attempted or completed suicides, but it’s recommended that clinicians and parents monitor kids taking them for any worsening in depression or emergence of suicidal thinking as they are adjusting to a new medication. More recent research has not supported the increased risk of suicidal thoughts, Dr. Taskiran notes, and [most experts conclude](https://caringforkids.cps.ca/handouts/mentalhealth/using_ssris_to_treat_depression_and_anxiety_in_children_and_youth) that the benefits of SSRIs outweigh the risks. Some research has found that suicide rates in children decrease when they take antidepressants. Other antidepressants Some other antidepressants are used to treat children when SSRIs aren’t effective for them, or when they have problems with side effects. Bupropion (Wellbutrin) is an antidepressant that is called an NDRI (norepinephrine/dopamine-reuptake inhibitor). It works by increasing the availability in the brain of neurotransmitters norepinephrine and dopamine. Bupropion is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms. Adding buproprion can help ease sexual side effects of the SSRI if that is a concern for the adolescent. There are several newer antidepressants that are FDA-approved for treatment of depression in adults, but they have not been studied extensively in children and adolescents. They are sometimes prescribed off-label, Dr. Taskiran explains, when kids have problems with side effects on SSRIs, particularly weight gain and sexual side effects. One of them, [mirtazapine](https://www.ncbi.nlm.nih.gov/books/NBK519059/) (Remeron), is in a group of medications called tetracyclic antidepressants (TeCAs). By inhibiting a particular set of receptors in the brain, Mirtazapine causes an increased release of serotonin and norepinephrine. Another, [Vilazodone](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278186/) (Viibryd), increases the effect of serotonin in the brain in two ways — by slowing its removal and by stimulating serotonin receptors. Because of this dual activity, it is called a serotonin partial agonist–reuptake inhibitor (SPARI) and is expected to have more robust anti-anxiety action. When the first medication doesn’t work Because more than [a third of kids](https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/DepressionGuide-web.pdf) — between [55 and 65 percent](https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/DepressionGuide-web.pdf) — don’t respond to the initial antidepressant they take, it’s not unusual to try a second medication. Kids who don’t respond to the first often [do find success with a different antidepressant](https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2010.09040552?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3Dpubmed). Therapy may also be added if it hasn’t been tried. If a child does not have a clear response to the medication — about a 40 percent reduction in symptoms — after six weeks, a switch should be made, Dr. Taskiran says. “If we’re not seeing that, it’s not worthwhile to keep the patient on the same medication.” But he emphasizes that a medication should not be rejected until it’s been tried for the full six weeks. In a rush for improvement, he notes, a medication will sometimes be judged ineffective after just two weeks, and kids will be switched to a second choice. But two weeks isn’t enough time for an SSRI to become fully effective, so medications that are potentially useful can be discarded too quickly. “It’s really important that we give these medications enough of a chance, from a time perspective and a dose perspective, to be effective.” Of the kids who are switched to a second medication, he says, 60 percent of them respond to the second medication. “For those who are still non-responders,” Dr. Taskiron says, “we need to add either mood stabilizers or atypical antipsychotics to increase the remission rate.” Of the mood stabilizers, lithium has been approved by the FDA for use in teenagers and children. Among atypical antipsychotics, aripiprazole (Abilify) and risperidone (Risperdal) are the ones that are most studied and most often used in kids, and they are FDA approved for some uses in kids. Aripiprazole is often the first choice because it has fewer problematic side effects than lithium or risperidone. If a second medication isn’t successful, Dr. Taskiran notes that it’s also important to look at the diagnosis again, to consider whether there might be other factors going on that are affecting the outcome. “We know that family conflict, drug and alcohol use, and comorbid disorders are sometimes the culprit, and when we address those, we can get a better remission.” How long should kids keep taking antidepressants? When teenagers or children are treated successfully with an antidepressant, experts advise that they stay on the medication for nine months to a year after their symptoms are gone to prevent a relapse. “This is usually the time that is needed for the brain to correct the chemical imbalances that result in depression,” Dr. Taskiran explains. If there’s a relapse after the child has tapered down and gone off the medication, longer treatment may be needed to help prevent recurrence. About one in three kids treated for depression, he adds, will need more time on the medication. “After two years, we can stop the medication again, cautiously and carefully. But if we see another relapse, a second relapse, continuing on SSRIs indefinitely may be the best course.” How do kids tend to feel about taking antidepressants? For children and teenagers, getting a diagnosis of depression can be a relief, because they understand that the way they are feeling is not a permanent condition. “Depressed kids are often thinking that there is something inherently wrong with them,” Dr. Taskiran explains, “that they are built this way, and that’s the core belief that leads to suicidal ideation. They think they are flawed and that’s why they give up on themselves so easily.” When they understand that this is a disorder that can be treated, they usually welcome it. In his experience, he says, most are comfortable with the idea of medication. Having said that, he adds, teenagers need parental support to make sure they are compliant with treatment. “They’re kids. No 14-year-old should be responsible to remember to take their medication every day.” Dr. Taskiran notes that success in treatment depends on the patient, the parents, and the provider all being on the same page. “I usually tell parents, ‘Look, we need to have a trusting relationship and you need to be on board with the process that is your child’s treatment in order for this to work.’ “ ## Frequently Asked Questions What is the safest antidepressant for teens and young adults? For teens and young adults with depression, experts agree that the first choice in medication treatment is a group of antidepressant medications called SSRIs — selective serotonin reuptake inhibitors. If the first SSRI medication a child tries does not work, experts recommend trying a different one because individual children respond differently to different SSRIs. When is Wellbutrin prescribed for teens? Wellbutrin (Bupropion) is a medication that is FDA approved for depression in adults, but not in kids. Bupropion is prescribed off-label for kids with ADHD, and it can also be used for depression. It is sometimes added to an SSRI when the SSRI alone isn’t providing enough relief from symptoms. Is Lexapro a common antidepressant for kids? Lexapro is among the most commonly prescribed antidepressants for kids. Other common SSRIs a child or teen might be prescribed include Prozac, Zoloft, Celexa, Paxil, and Luvox. Last reviewed or updated on November 18, 2024.
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