Based on these findings, the FDA recommends that caregivers monitor children being treated with antidepressants for sudden behavioral changes, and immediately notify their doctor if such changes occur. These behavioral signs include:
- Agitation
- Irritability
- Anxiety
- Panic attacks
- Insomnia
- Aggressiveness
- Impulsivity
- Hyperactivity in actions and speech
- Worsening of depression
- Increased thoughts of suicide
The FDA’s guidelines for medication usage recommend that patients see their doctor regularly after initiating drug treatment. The recommended schedule is:
- Once per week for 4 weeks (1st month)
- Every 2 weeks for the next month (2nd month)
- At the end of week 12 following the start of drug treatment (3rd month)
- More frequently if changes in mood or behavior occur
- Patients should also be closely monitored if their drug dosage is changed.
Research continues on antidepressant medications’ suicide risk for adults. It appears that drug-related suicide risk may be age-dependent with the risk decreasing as people age. At this time, the FDA recommends that adults who receive antidepressants follow the standard warnings included with antidepressant medications. Adults should be observed for increased depression or suicidality during the first few months of treatment or following a change in medication dosage. Patients should immediately contact their doctor if depression symptoms worsen or if suicidal thoughts or behavior increase.
Selective Serotonin-Reuptake Inhibitors
Selective serotonin-reuptake inhibitors (SSRIs) are now the first-line treatment of major depression. They work by increasing levels of serotonin in the brain. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil, Asimia, Seroxat), fluvoxamine (Luvox), citalopram (Celexa, Cipramil), and escitalopram (Lexapro, Cipralex). There are no significant differences among SSRI brands in effectiveness for treating major depressive disorder, although individual drugs may have different side effects or benefits for specific patients. At this time, fluoxetine is the only one of these drugs to be approved for children over age 7 and adolescents.
Because they act specifically on serotonin, SSRIs have fewer side effects than older antidepressants, which have more widespread effects in the body.
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