🕷️ Crawler Inspector

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Direct Parameter Lookup

Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 99 (from laksa194)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa099.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://www.aap.org/en/patient-care/mental-health-minute/antidepressants/\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.aap.org/en/patient-care/mental-health-minute/antidepressants/\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.aap.org\/en\/patient-care\/mental-health-minute\/antidepressants\/","crawl_time":1776614456,"first_indexed_time":1649712166,"http_code":200,"src_unparsed":"org,aap!www,\/en\/patient-care\/mental-health-minute\/antidepressants\/ s443","src_root_hash":"6712292359742421299","history_drop_reason":null,"meta_title":"Antidepressants: Pediatric Mental Health Minute Series","meta_descriptions":["Antidepressants are medications commonly used to treat depressive and anxiety disorders in children and adolescents. These medications are generally divided into selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)."],"attrs_boilerpipe_text":"Antidepressants are medications commonly used to treat depressive and anxiety disorders in children and adolescents. These medications are generally divided into selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).\nScope in Pediatrics\nSSRIs are the first line of psychopharmacologic treatment for anxiety and depressive disorders.\nAntidepressant selection should be evidence-based and currently the strongest evidence exists for SSRIs including escitalopram, fluoxetine, and sertraline. SNRIs may be less effective in children and adolescents.\nDosing and titration should be guided by data from clinical trials which suggests starting low, but actively titrating medication to ensure the highest likelihood of success.\nSide effects of SSRIs may occur in 1 of 10 children or adolescents. Some side effects relate to blood levels (eg, exposure) while others are related to pharmacodynamic factors. Frequently, the management strategy is to reduce the dose or discontinue the medication.\nSSRIs include a black-box warning with regard to the risk of suicidal ideation in children and adolescents. Although the risk is low, it is very important to monitor for any clue that the patient may be experiencing this side effect. \nOne challenge in treating anxiety disorders is managing the dose to minimize the side effects without reducing the dose to a point where the benefit of the SSRI is lost. At times, side effects outweigh the medication’s benefit and a change in medication is needed.\nAlthough FDA approved for depression, once a drug is licensed, it can be used “off-label” based on available evidence for safety and efficacy at the discretion of the prescribing clinician. \nTeaching Points\nSSRIs block serotonin reuptake at the \npre-synaptic neuron, although they vary in the degree to which they block other receptors. Blocking the serotonin transporter, increases the concentrations of serotonin at the synapse. Blocking the norepinephrine transporter—as is the case with SNRIs—increases the concentrations of norepinephrine (as well as causing a slight increase in dopamine).\n \nSide effects are generally mild and dissipate relatively quickly, although some may require dose adjustment or—in some cases—a change in medication.\n \nThe \nmost common and most problematic side effects are abdominal symptoms, activation, and tiredness\/insomnia. \n \nClinicians \nselecting antidepressant medications to treat pediatric patients need to understand the cause of side effects as well as management strategies, particularly as antidepressant side effects increase the likelihood of discontinuation, slow the trajectory of improvement and potentially limit titration to effective doses.\n \nContacts\nFor COVID related questions, please email \ncovid-19@aap.org.\nFor Mental Health related questions, please email \nmentalhealth@aap.org.\nBrought to you by AAP Education. For more educational content visit \nwww.pedialink.org.\nSpecial Acknowledgment\nThe AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI.","attrs_markdown":"Internet Explorer Alert\n\nIt appears you are using Internet Explorer as your web browser. 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The experiences and opportunities offered in early childhood lay the foundation for how children grow, learn, build relationships, and prepare for school.\n  \n  [Early Childhood](https:\/\/www.aap.org\/en\/patient-care\/early-childhood\/)\n  \n  - [Early Relational Health](https:\/\/www.aap.org\/en\/patient-care\/early-childhood\/early-relational-health\/ \"Early Relational Health\")\n  - [Early Childhood Health & Development](https:\/\/www.aap.org\/en\/patient-care\/early-childhood\/ \"Early Childhood Health & Development\")\n- [Gun Safety & Injury Prevention](https:\/\/www.aap.org\/en\/patient-care\/mental-health-minute\/antidepressants\/)\n  Gun Safety & Injury Prevention\n  \n  The AAP has developed and published position statements with recommended public policy and clinical approaches to reduce the incidence of firearm injuries in children and adolescents and to reduce the effects of gun violence.\n  \n  [Gun Safety](https:\/\/www.aap.org\/en\/patient-care\/gun-safety-and-injury-prevention\/)\n  \n  - [Safe Storage of Firearms](https:\/\/www.aap.org\/en\/patient-care\/gun-safety-and-injury-prevention\/safe-storage-of-firearms\/ \"Safe Storage of Firearms\")\n  - [Promoting Firearm Injury Prevention](https:\/\/www.aap.org\/en\/patient-care\/gun-safety-and-injury-prevention\/promoting-firearm-injury-prevention--patient-safety-in-the-emergency-department\/ \"Promoting Firearm Injury Prevention\")\n- [Mental Health Initiatives](https:\/\/www.aap.org\/en\/patient-care\/mental-health-minute\/antidepressants\/)\n  Mental Health Initiatives\n  \n  Mental health is an essential component of overall health. Pediatricians are an important first resource for parents and caregivers who are worried about their child's emotional and behavioral health or who want to promote healthy mental development.\n  \n  [Mental Health](https:\/\/www.aap.org\/en\/patient-care\/mental-health-initiatives\/)\n  \n  - [Mental Health Education & Training](https:\/\/www.aap.org\/en\/patient-care\/mental-health-initiatives\/mental-health-resources-for-families\/)\n  - [Practice Tools & Resources](https:\/\/www.aap.org\/en\/patient-care\/mental-health-initiatives\/mental-health-practice-tools-and-resources\/ \"Practice Tools & Resources\")\n  \n  - [Policies on Mental Health](https:\/\/www.aap.org\/en\/patient-care\/mental-health-initiatives\/mental-health-policies\/ \"Policies on Mental Health\")\n  - [Mental Health Resources for Families](https:\/\/www.aap.org\/en\/patient-care\/mental-health-initiatives\/mental-health-resources-for-families\/ \"Mental Health Resources for Families\")\n- [Quality Improvement](https:\/\/www.aap.org\/en\/quality-improvement\/)\n\n- [Early Childhood](https:\/\/www.aap.org\/en\/patient-care\/early-childhood\/)\n- [Gun Safety & Injury Prevention](https:\/\/www.aap.org\/en\/patient-care\/gun-safety-and-injury-prevention\/)\n- [Mental Health Initiatives](https:\/\/www.aap.org\/en\/patient-care\/mental-health-initiatives\/)\n- [Quality Improvement](https:\/\/www.aap.org\/en\/quality-improvement\/)\n\n# Antidepressants: Pediatric Mental Health Minute Series\n[Home](https:\/\/www.aap.org\/en\/)  \/  [Patient Care](https:\/\/www.aap.org\/en\/patient-care\/)  \/  [Pediatric Mental Health Minute Series](https:\/\/www.aap.org\/en\/patient-care\/mental-health-minute\/)  \/  Antidepressants: Pediatric Mental Health Minute Series\n\n![](https:\/\/cf-images.us-east-1.prod.boltdns.net\/v1\/static\/6056665225001\/ddfa155d-a37b-4a0c-92c0-42213c834660\/40a9373e-d2bb-4f5e-bf69-54b0f0a04a69\/1280x720\/match\/image.jpg)\n\n![](https:\/\/cf-images.us-east-1.prod.boltdns.net\/v1\/static\/6056665225001\/ddfa155d-a37b-4a0c-92c0-42213c834660\/40a9373e-d2bb-4f5e-bf69-54b0f0a04a69\/1280x720\/match\/image.jpg)\n\nAntidepressant: Pediatric Mental Health Minute\n\nVideo Player is loading.\n\nPlay Video\n\nPlay\n\nSkip Backward\n\nSkip Forward\n\nMute\n\nCurrent Time 0:00\n\n\/\n\nDuration 10:44\n\nLoaded: 1\\.54%\n\n00:00\n\nStream Type LIVE\n\nSeek to live, currently behind liveLIVE\n\nRemaining Time \\-10:44\n\n1x\n\nPlayback Rate\n\nChapters\n\n- Chapters\n\nDescriptions\n\n- descriptions off, selected\n\nCaptions\n\n- captions settings, opens captions settings dialog\n- captions off, selected\n\nAudio Track\n\n- en (Main), selected\n\nPicture-in-Picture\n\nFullscreen\n\nThis is a modal window.\n\nBeginning of dialog window. Escape will cancel and close the window.\n\nText\n\nColor\n\nOpacity\n\nText Background\n\nColor\n\nOpacity\n\nCaption Area Background\n\nColor\n\nOpacity\n\nFont Size\n\nText Edge Style\n\nFont Family\n\nReset\n\nDone\n\nClose Modal Dialog\n\nEnd of dialog window.\n\nClose Modal Dialog\n\nThis is a modal window. This modal can be closed by pressing the Escape key or activating the close button.\n\nAntidepressants are medications commonly used to treat depressive and anxiety disorders in children and adolescents. These medications are generally divided into selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).\n\n### Scope in Pediatrics\n- SSRIs are the first line of psychopharmacologic treatment for anxiety and depressive disorders.\n- Antidepressant selection should be evidence-based and currently the strongest evidence exists for SSRIs including escitalopram, fluoxetine, and sertraline. SNRIs may be less effective in children and adolescents.\n- Dosing and titration should be guided by data from clinical trials which suggests starting low, but actively titrating medication to ensure the highest likelihood of success.\n- Side effects of SSRIs may occur in 1 of 10 children or adolescents. Some side effects relate to blood levels (eg, exposure) while others are related to pharmacodynamic factors. Frequently, the management strategy is to reduce the dose or discontinue the medication.\n- SSRIs include a black-box warning with regard to the risk of suicidal ideation in children and adolescents. Although the risk is low, it is very important to monitor for any clue that the patient may be experiencing this side effect.\n- One challenge in treating anxiety disorders is managing the dose to minimize the side effects without reducing the dose to a point where the benefit of the SSRI is lost. At times, side effects outweigh the medication’s benefit and a change in medication is needed.\n- Although FDA approved for depression, once a drug is licensed, it can be used “off-label” based on available evidence for safety and efficacy at the discretion of the prescribing clinician.\n### Teaching Points\n- SSRIs block serotonin reuptake at the pre-synaptic neuron, although they vary in the degree to which they block other receptors. Blocking the serotonin transporter, increases the concentrations of serotonin at the synapse. Blocking the norepinephrine transporter—as is the case with SNRIs—increases the concentrations of norepinephrine (as well as causing a slight increase in dopamine).\n- Side effects are generally mild and dissipate relatively quickly, although some may require dose adjustment or—in some cases—a change in medication.\n- The most common and most problematic side effects are abdominal symptoms, activation, and tiredness\/insomnia.\n- Clinicians selecting antidepressant medications to treat pediatric patients need to understand the cause of side effects as well as management strategies, particularly as antidepressant side effects increase the likelihood of discontinuation, slow the trajectory of improvement and potentially limit titration to effective doses.\n\n## Resources\n## For Physicians\n[Anxiety. Pediatric Mental Health Minute Series. American Academy of Pediatrics.](https:\/\/www.aap.org\/en\/patient-care\/mental-health-minute\/anxiety\/)  \n[Adolescent Depression. Pediatric Mental Health Minute Series. American Academy of Pediatrics.](https:\/\/www.aap.org\/en\/patient-care\/mental-health-minute\/adolescent-depression\/)  \n[Reid *et al.* Side-effects of SSRIs disrupt multimodal treatment for pediatric OCD in a randomized-controlled trial. *J. Psychiatr. Res.*](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0022395615002952?via%3Dihub) [71, 140–147 (2015)](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0022395615002952?via%3Dihub).   \n[Hathaway *et al***.** Antidepressant treatment duration in pediatric depressive and anxiety disorders: how long is long enough? *Current Problems in Pediatrics and Adolescent Health Care.* 2018;48(2):31-39. PMID: 29337001](https:\/\/doi.org\/10.1016\/j.cppeds.2017.12.002)   \n[Mills and Strawn. Antidepressant tolerability in pediatric anxiety and obsessive compulsive disorders: a Bayesian hierarchical modeling meta-analysis. *Journal of the American Academy of Child & Adolescent Psychiatry.* 2020 (in press).](https:\/\/jaacap.org\/article\/S0890-8567\\(19\\)32113-6\/fulltext)\n\n### Related AAP Policy\n[Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management](https:\/\/pediatrics.aappublications.org\/content\/141\/3\/e20174081)  \n[Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management](https:\/\/pediatrics.aappublications.org\/content\/141\/3\/e20174082)\n\n### Related AAP Resources\n[AAP Developmental and Behavioral Pediatrics, 2nd Edition](https:\/\/shop.aap.org\/aap-developmental-and-behavioral-pediatrics-2nd-edition-paperback\/)  \n[Mental Health Care of Children and Adolescents: A Guide for Primary Care Clinicians \\[Paperback\\]](https:\/\/shop.aap.org\/mental-health-care-of-children-and-adolescents-a-guide-for-primary-care-clinicians-paperback\/)  \n[Pediatric Psychopharmacology for Primary Care, 2nd Edition](https:\/\/shop.aap.org\/pediatric-psychopharmacology-for-primary-care-2nd-edition-paperback\/)\n\n## For Families\n[Anxiety Disorders: Parents’ Medication Guide](https:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/resource_centers\/resources\/med_guides\/anxiety-parents-medication-guide.pdf)\n\n### Additional Information\n- [Luft et al. Antidepressant-Induced Activation in Children and Adolescents: Risk, Recognition and Management. *Curr. Probl. Pediatr. Adolesc. Health Care* 48, 50–62 (2018).](https:\/\/doi.org\/10.1016\/j.cppeds.2017.12.001)\n- [American Academy of Child & Adolescent Psychiatry Resources for Primary Care](https:\/\/www.aacap.org\/)\n- [Depression Medicines. FDA Website.](https:\/\/www.fda.gov\/consumers\/free-publications-women\/depression-medicines)\n\n#### **Contacts**\nFor COVID related questions, please email [covid-19@aap.org.](https:\/\/form.jotform.com\/Subspecialty\/COVID19InquiryForm)  \nFor Mental Health related questions, please email [mentalhealth@aap.org.](mailto:mentalhealth@aap.org)  \nBrought to you by AAP Education. For more educational content visit [www.pedialink.org.](http:\/\/www.pedialink.org\/)\n\n#### **Special Acknowledgment**\nThe AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI.\n\nWe're 67,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults.\n\n- [AAP Home](https:\/\/www.aap.org\/en\/)\n- [Policy](https:\/\/www.aap.org\/en\/policy\/)\n- [Advocacy](https:\/\/www.aap.org\/en\/advocacy\/)\n\n- [PediaLink](https:\/\/www.aap.org\/en\/pedialink\/)\n- [Practice Management](https:\/\/www.aap.org\/en\/practice-management\/)\n- [Patient Care](https:\/\/www.aap.org\/en\/patient-care\/)\n\n- [Get Involved](https:\/\/www.aap.org\/en\/get-involved\/)\n- [Healthy Children](http:\/\/healthychildren.org\/English\/Pages\/default.aspx)\n- [shopAAP](https:\/\/www.aap.org\/en\/shopaap\/)\n\n- [Privacy Statement](https:\/\/www.aap.org\/en\/pages\/privacy-statement\/)\n- [Terms of Use](https:\/\/www.aap.org\/en\/pages\/terms-of-use\/)\n- [Auto-Renew Terms](https:\/\/www.aap.org\/en\/my-account\/settings-preferences\/auto-renew\/aap-subscription-auto-renewal-terms-and-conditions\/)\n- [Support Center](https:\/\/www.aap.org\/en\/support-center\/)\n- [Contact Us](https:\/\/www.aap.org\/en\/pages\/contact-us\/)\n- [Code of Conduct](https:\/\/www.aap.org\/en\/about-the-aap\/american-academy-of-pediatrics-equity-and-inclusion-efforts\/code-of-conduct\/)\n\n© Copyright 2026 American Academy of Pediatrics. All rights reserved.\n\n[Feedback Form](https:\/\/www.aap.org\/en\/forms\/feedback-form\/)\n\nPlease ensure Javascript is enabled for purposes of [website accessibility](https:\/\/userway.org\/)\n\n[Provide feedback](https:\/\/www.aap.org\/en\/patient-care\/mental-health-minute\/antidepressants\/)","attrs_readable_markdown":"Antidepressants are medications commonly used to treat depressive and anxiety disorders in children and adolescents. These medications are generally divided into selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).\n\n### Scope in Pediatrics\n- SSRIs are the first line of psychopharmacologic treatment for anxiety and depressive disorders.\n- Antidepressant selection should be evidence-based and currently the strongest evidence exists for SSRIs including escitalopram, fluoxetine, and sertraline. SNRIs may be less effective in children and adolescents.\n- Dosing and titration should be guided by data from clinical trials which suggests starting low, but actively titrating medication to ensure the highest likelihood of success.\n- Side effects of SSRIs may occur in 1 of 10 children or adolescents. Some side effects relate to blood levels (eg, exposure) while others are related to pharmacodynamic factors. Frequently, the management strategy is to reduce the dose or discontinue the medication.\n- SSRIs include a black-box warning with regard to the risk of suicidal ideation in children and adolescents. Although the risk is low, it is very important to monitor for any clue that the patient may be experiencing this side effect.\n- One challenge in treating anxiety disorders is managing the dose to minimize the side effects without reducing the dose to a point where the benefit of the SSRI is lost. At times, side effects outweigh the medication’s benefit and a change in medication is needed.\n- Although FDA approved for depression, once a drug is licensed, it can be used “off-label” based on available evidence for safety and efficacy at the discretion of the prescribing clinician.\n### Teaching Points\n- SSRIs block serotonin reuptake at the pre-synaptic neuron, although they vary in the degree to which they block other receptors. Blocking the serotonin transporter, increases the concentrations of serotonin at the synapse. Blocking the norepinephrine transporter—as is the case with SNRIs—increases the concentrations of norepinephrine (as well as causing a slight increase in dopamine).\n- Side effects are generally mild and dissipate relatively quickly, although some may require dose adjustment or—in some cases—a change in medication.\n- The most common and most problematic side effects are abdominal symptoms, activation, and tiredness\/insomnia.\n- Clinicians selecting antidepressant medications to treat pediatric patients need to understand the cause of side effects as well as management strategies, particularly as antidepressant side effects increase the likelihood of discontinuation, slow the trajectory of improvement and potentially limit titration to effective doses.\n\n#### **Contacts**\nFor COVID related questions, please email [covid-19@aap.org.](https:\/\/form.jotform.com\/Subspecialty\/COVID19InquiryForm)  \nFor Mental Health related questions, please email [mentalhealth@aap.org.](mailto:mentalhealth@aap.org)  \nBrought to you by AAP Education. For more educational content visit [www.pedialink.org.](http:\/\/www.pedialink.org\/)\n\n#### **Special Acknowledgment**\nThe AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI.","meta_canonical":null}

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URL	https://www.aap.org/en/patient-care/mental-health-minute/antidepressants/
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Meta Title	Antidepressants: Pediatric Mental Health Minute Series
Meta Description	Antidepressants are medications commonly used to treat depressive and anxiety disorders in children and adolescents. These medications are generally divided into selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
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Boilerpipe Text	Antidepressants are medications commonly used to treat depressive and anxiety disorders in children and adolescents. These medications are generally divided into selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Scope in Pediatrics SSRIs are the first line of psychopharmacologic treatment for anxiety and depressive disorders. Antidepressant selection should be evidence-based and currently the strongest evidence exists for SSRIs including escitalopram, fluoxetine, and sertraline. SNRIs may be less effective in children and adolescents. Dosing and titration should be guided by data from clinical trials which suggests starting low, but actively titrating medication to ensure the highest likelihood of success. Side effects of SSRIs may occur in 1 of 10 children or adolescents. Some side effects relate to blood levels (eg, exposure) while others are related to pharmacodynamic factors. Frequently, the management strategy is to reduce the dose or discontinue the medication. SSRIs include a black-box warning with regard to the risk of suicidal ideation in children and adolescents. Although the risk is low, it is very important to monitor for any clue that the patient may be experiencing this side effect. One challenge in treating anxiety disorders is managing the dose to minimize the side effects without reducing the dose to a point where the benefit of the SSRI is lost. At times, side effects outweigh the medication’s benefit and a change in medication is needed. Although FDA approved for depression, once a drug is licensed, it can be used “off-label” based on available evidence for safety and efficacy at the discretion of the prescribing clinician. Teaching Points SSRIs block serotonin reuptake at the pre-synaptic neuron, although they vary in the degree to which they block other receptors. Blocking the serotonin transporter, increases the concentrations of serotonin at the synapse. Blocking the norepinephrine transporter—as is the case with SNRIs—increases the concentrations of norepinephrine (as well as causing a slight increase in dopamine). Side effects are generally mild and dissipate relatively quickly, although some may require dose adjustment or—in some cases—a change in medication. The most common and most problematic side effects are abdominal symptoms, activation, and tiredness/insomnia. Clinicians selecting antidepressant medications to treat pediatric patients need to understand the cause of side effects as well as management strategies, particularly as antidepressant side effects increase the likelihood of discontinuation, slow the trajectory of improvement and potentially limit titration to effective doses. Contacts For COVID related questions, please email covid-19@aap.org. For Mental Health related questions, please email mentalhealth@aap.org. Brought to you by AAP Education. For more educational content visit www.pedialink.org. Special Acknowledgment The AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI.
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[Mental Health](https://www.aap.org/en/patient-care/mental-health-initiatives/) - [Mental Health Education & Training](https://www.aap.org/en/patient-care/mental-health-initiatives/mental-health-resources-for-families/) - [Practice Tools & Resources](https://www.aap.org/en/patient-care/mental-health-initiatives/mental-health-practice-tools-and-resources/ "Practice Tools & Resources") - [Policies on Mental Health](https://www.aap.org/en/patient-care/mental-health-initiatives/mental-health-policies/ "Policies on Mental Health") - [Mental Health Resources for Families](https://www.aap.org/en/patient-care/mental-health-initiatives/mental-health-resources-for-families/ "Mental Health Resources for Families") - [Quality Improvement](https://www.aap.org/en/quality-improvement/) - [Early Childhood](https://www.aap.org/en/patient-care/early-childhood/) - [Gun Safety & Injury Prevention](https://www.aap.org/en/patient-care/gun-safety-and-injury-prevention/) - [Mental Health Initiatives](https://www.aap.org/en/patient-care/mental-health-initiatives/) - [Quality Improvement](https://www.aap.org/en/quality-improvement/) # Antidepressants: Pediatric Mental Health Minute Series [Home](https://www.aap.org/en/) / [Patient Care](https://www.aap.org/en/patient-care/) / [Pediatric Mental Health Minute Series](https://www.aap.org/en/patient-care/mental-health-minute/) / Antidepressants: Pediatric Mental Health Minute Series ![](https://cf-images.us-east-1.prod.boltdns.net/v1/static/6056665225001/ddfa155d-a37b-4a0c-92c0-42213c834660/40a9373e-d2bb-4f5e-bf69-54b0f0a04a69/1280x720/match/image.jpg) ![](https://cf-images.us-east-1.prod.boltdns.net/v1/static/6056665225001/ddfa155d-a37b-4a0c-92c0-42213c834660/40a9373e-d2bb-4f5e-bf69-54b0f0a04a69/1280x720/match/image.jpg) Antidepressant: Pediatric Mental Health Minute Video Player is loading. Play Video Play Skip Backward Skip Forward Mute Current Time 0:00 / Duration 10:44 Loaded: 1\.54% 00:00 Stream Type LIVE Seek to live, currently behind liveLIVE Remaining Time \-10:44 1x Playback Rate Chapters - Chapters Descriptions - descriptions off, selected Captions - captions settings, opens captions settings dialog - captions off, selected Audio Track - en (Main), selected Picture-in-Picture Fullscreen This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color Opacity Text Background Color Opacity Caption Area Background Color Opacity Font Size Text Edge Style Font Family Reset Done Close Modal Dialog End of dialog window. Close Modal Dialog This is a modal window. This modal can be closed by pressing the Escape key or activating the close button. Antidepressants are medications commonly used to treat depressive and anxiety disorders in children and adolescents. These medications are generally divided into selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). ### Scope in Pediatrics - SSRIs are the first line of psychopharmacologic treatment for anxiety and depressive disorders. - Antidepressant selection should be evidence-based and currently the strongest evidence exists for SSRIs including escitalopram, fluoxetine, and sertraline. SNRIs may be less effective in children and adolescents. - Dosing and titration should be guided by data from clinical trials which suggests starting low, but actively titrating medication to ensure the highest likelihood of success. - Side effects of SSRIs may occur in 1 of 10 children or adolescents. Some side effects relate to blood levels (eg, exposure) while others are related to pharmacodynamic factors. Frequently, the management strategy is to reduce the dose or discontinue the medication. - SSRIs include a black-box warning with regard to the risk of suicidal ideation in children and adolescents. Although the risk is low, it is very important to monitor for any clue that the patient may be experiencing this side effect. - One challenge in treating anxiety disorders is managing the dose to minimize the side effects without reducing the dose to a point where the benefit of the SSRI is lost. At times, side effects outweigh the medication’s benefit and a change in medication is needed. - Although FDA approved for depression, once a drug is licensed, it can be used “off-label” based on available evidence for safety and efficacy at the discretion of the prescribing clinician. ### Teaching Points - SSRIs block serotonin reuptake at the pre-synaptic neuron, although they vary in the degree to which they block other receptors. Blocking the serotonin transporter, increases the concentrations of serotonin at the synapse. Blocking the norepinephrine transporter—as is the case with SNRIs—increases the concentrations of norepinephrine (as well as causing a slight increase in dopamine). - Side effects are generally mild and dissipate relatively quickly, although some may require dose adjustment or—in some cases—a change in medication. - The most common and most problematic side effects are abdominal symptoms, activation, and tiredness/insomnia. - Clinicians selecting antidepressant medications to treat pediatric patients need to understand the cause of side effects as well as management strategies, particularly as antidepressant side effects increase the likelihood of discontinuation, slow the trajectory of improvement and potentially limit titration to effective doses. ## Resources ## For Physicians [Anxiety. Pediatric Mental Health Minute Series. American Academy of Pediatrics.](https://www.aap.org/en/patient-care/mental-health-minute/anxiety/) [Adolescent Depression. Pediatric Mental Health Minute Series. American Academy of Pediatrics.](https://www.aap.org/en/patient-care/mental-health-minute/adolescent-depression/) [Reid et al. Side-effects of SSRIs disrupt multimodal treatment for pediatric OCD in a randomized-controlled trial. J. Psychiatr. Res.](https://www.sciencedirect.com/science/article/abs/pii/S0022395615002952?via%3Dihub) [71, 140–147 (2015)](https://www.sciencedirect.com/science/article/abs/pii/S0022395615002952?via%3Dihub). [Hathaway et al. Antidepressant treatment duration in pediatric depressive and anxiety disorders: how long is long enough? Current Problems in Pediatrics and Adolescent Health Care. 2018;48(2):31-39. PMID: 29337001](https://doi.org/10.1016/j.cppeds.2017.12.002) [Mills and Strawn. Antidepressant tolerability in pediatric anxiety and obsessive compulsive disorders: a Bayesian hierarchical modeling meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry. 2020 (in press).](https://jaacap.org/article/S0890-8567\(19\)32113-6/fulltext) ### Related AAP Policy [Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management](https://pediatrics.aappublications.org/content/141/3/e20174081) [Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management](https://pediatrics.aappublications.org/content/141/3/e20174082) ### Related AAP Resources [AAP Developmental and Behavioral Pediatrics, 2nd Edition](https://shop.aap.org/aap-developmental-and-behavioral-pediatrics-2nd-edition-paperback/) [Mental Health Care of Children and Adolescents: A Guide for Primary Care Clinicians \[Paperback\]](https://shop.aap.org/mental-health-care-of-children-and-adolescents-a-guide-for-primary-care-clinicians-paperback/) [Pediatric Psychopharmacology for Primary Care, 2nd Edition](https://shop.aap.org/pediatric-psychopharmacology-for-primary-care-2nd-edition-paperback/) ## For Families [Anxiety Disorders: Parents’ Medication Guide](https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/anxiety-parents-medication-guide.pdf) ### Additional Information - [Luft et al. Antidepressant-Induced Activation in Children and Adolescents: Risk, Recognition and Management. Curr. Probl. Pediatr. Adolesc. Health Care 48, 50–62 (2018).](https://doi.org/10.1016/j.cppeds.2017.12.001) - [American Academy of Child & Adolescent Psychiatry Resources for Primary Care](https://www.aacap.org/) - [Depression Medicines. FDA Website.](https://www.fda.gov/consumers/free-publications-women/depression-medicines) #### Contacts For COVID related questions, please email [covid-19@aap.org.](https://form.jotform.com/Subspecialty/COVID19InquiryForm) For Mental Health related questions, please email [mentalhealth@aap.org.](mailto:mentalhealth@aap.org) Brought to you by AAP Education. For more educational content visit [www.pedialink.org.](http://www.pedialink.org/) #### Special Acknowledgment The AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI. 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Readable Markdown	Antidepressants are medications commonly used to treat depressive and anxiety disorders in children and adolescents. These medications are generally divided into selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). ### Scope in Pediatrics - SSRIs are the first line of psychopharmacologic treatment for anxiety and depressive disorders. - Antidepressant selection should be evidence-based and currently the strongest evidence exists for SSRIs including escitalopram, fluoxetine, and sertraline. SNRIs may be less effective in children and adolescents. - Dosing and titration should be guided by data from clinical trials which suggests starting low, but actively titrating medication to ensure the highest likelihood of success. - Side effects of SSRIs may occur in 1 of 10 children or adolescents. Some side effects relate to blood levels (eg, exposure) while others are related to pharmacodynamic factors. Frequently, the management strategy is to reduce the dose or discontinue the medication. - SSRIs include a black-box warning with regard to the risk of suicidal ideation in children and adolescents. Although the risk is low, it is very important to monitor for any clue that the patient may be experiencing this side effect. - One challenge in treating anxiety disorders is managing the dose to minimize the side effects without reducing the dose to a point where the benefit of the SSRI is lost. At times, side effects outweigh the medication’s benefit and a change in medication is needed. - Although FDA approved for depression, once a drug is licensed, it can be used “off-label” based on available evidence for safety and efficacy at the discretion of the prescribing clinician. ### Teaching Points - SSRIs block serotonin reuptake at the pre-synaptic neuron, although they vary in the degree to which they block other receptors. Blocking the serotonin transporter, increases the concentrations of serotonin at the synapse. Blocking the norepinephrine transporter—as is the case with SNRIs—increases the concentrations of norepinephrine (as well as causing a slight increase in dopamine). - Side effects are generally mild and dissipate relatively quickly, although some may require dose adjustment or—in some cases—a change in medication. - The most common and most problematic side effects are abdominal symptoms, activation, and tiredness/insomnia. - Clinicians selecting antidepressant medications to treat pediatric patients need to understand the cause of side effects as well as management strategies, particularly as antidepressant side effects increase the likelihood of discontinuation, slow the trajectory of improvement and potentially limit titration to effective doses. #### Contacts For COVID related questions, please email [covid-19@aap.org.](https://form.jotform.com/Subspecialty/COVID19InquiryForm) For Mental Health related questions, please email [mentalhealth@aap.org.](mailto:mentalhealth@aap.org) Brought to you by AAP Education. For more educational content visit [www.pedialink.org.](http://www.pedialink.org/) #### Special Acknowledgment The AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI.
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