When to use antidepressant medication in youths

The development of antidepressant agents has been underway since their first use in the 1950s. Types of agents include monoamine oxidase inhibitors, tricyclic antidepressants (TCAs), and selective serotonin reuptake inhibitors (SSRIs). The utility of these agents in adult populations has led to multiple approved indications by the Food and Drug Administration. Although there are only two approved indications in pediatric age groups-major depressive disorder (MDD) and obsessive-compulsive disorder (OCD)-physicians have been prescribing antidepressants to children and adolescents in increasing numbers. In previous years, the TCAs had documented cardiotoxic potential, and there were several sudden unexpected deaths associated with their administration in youths. In December 2003, Great Britain's drug regulatory agency contraindicated the use of four SSRIs in childhood populations. This decision was based on the increased rates of developed suicidal thinking or gestures observed in the pooled data of >4,000 pediatric aged subjects treated with an antidepressant versus placebo. In October 2004, after careful consideration, the FDA placed a black box warning on all antidepressants, alerting clinicians to the potential of developing similar behaviors upon receiving these agents. These findings underscore the importance of using the increasing evidence base of well-designed, double-blind studies to guide the usage of these antidepressants in conditions where efficacy is established. This article reviews that body of literature in conditions such as MDD, OCD, attention-deficit/hyperactivity disorder, selective mutism, and anxiety disorders.