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Childhood Depression: Is Medication OK?

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WebMD Health News
Reviewed by Gary D. Vogin, MD

Dec. 12, 2001 -- When a child is depressed, it can affect school performance, friendships, and family relationships. Many parents grapple with the problem on their own; some try family therapy. But antidepressant medications? Not much is known about their safety for children.

A small, new study -- one of a smattering that has looked at this issue -- finds that the popular antidepressant Celexa for adults works well in children, too. Celexa is also known by it's generic name citalopram.

"The results of this study show that citalopram may help to relieve the suffering of youths with depression," says lead researcher Karen Dineen Wagner, MD, PhD, of the University of Texas Medical Branch in Galveston, in a news release.

She reported her findings at a recent meeting of the American College of Neuropsychopharmacology.

Currently, there are no antidepressant medications approved for use in children and adolescents. "Unfortunately, there is very little information available about treatment for depression in children and adolescents," Wagner says.

Previous small studies have looked at two antidepressants -- Paxil and Prozac -- and found them to be safe and effective in children and adolescents. Like Celexa, they are from a drug family known as selective serotonin reuptake inhibitors or SSRIs.

In Wagner's randomized study, Celexa was used in treating 177 children and adolescents for major depression. The patients, aged 7 to 17, took either the drug or a placebo for eight weeks.

Those who received Celexa showed a significantly greater improvement in mood compared to the placebo group, reports Wagner.

But antidepressant medication should only be an adjunct to good therapy, says Janet Weisberg, PhD, a clinical psychologist in private practice in New York.

"The child has to really learn to work through the problems," she tells WebMD. "Medication doesn't cure the problems. If anything, the medication will help make the child more receptive to the treatment."

Childhood depression is usually a self-esteem issue when it is not genetic or biochemically based, says Weisberg.

She advocates first looking at "situational problems" -- working with the child's school, looking at peer problems, family problems, making sure there is nothing going on to create tension or problems for the child. "Then you address the situation," she tells WebMD.

Both family therapy and individual play therapy can be very effective for treating children and in helping them address issues that bother them, Weisberg says.

During play therapy, children work with games, clay, or dolls in exploring areas of life that are creating stress. "Within the context of the play situation -- and in the relationship between therapist and child and parents -- the child has an opportunity to learn how to cope with the things that are distressing him or her," she tells WebMD.

For adolescents, "traditional talk therapy helps kids develop insights and work through feelings, tensions," she says.

Childhood depression may lead to chronic depression in adult years, but not always, says Weisberg. "And that's critical to keep in mind. We don't want to doom these kids."

She admits that medication may also be necessary for providing "emergency relief, when dealing with a child who is potentially suicidal, or someone who might hurt himself or someone else."

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