Because the long-term effect of antidepressant drugs on developing brains isn't known, giving them to children has always been controversial. It became even more so in 2004, when the FDA announced that a black box warning-the most serious the agency has-must be issued with all those prescribed for children and teens. This is because studies have found that their use of antidepressants correlates to a small, but statistically significant, increased risk of suicidal thoughts or behavior, particularly in those who have just begun treatment. (None of the studies, however, showed an increase in suicide itself.)
In fact, suicide has been an issue ever since the drugs were introduced for adults. Some experts believe that this is because the medication's side effects initially lead to greater hopelessness. Another possibility is that the meds finally give patients the energy to complete (or reveal) a long-planned suicide. Last, some patients treated with antidepressants may actually be suffering from the onset of bipolar disorder, and the medication may deepen, rather than relieve, their symptoms. What does this mean for parents? Basically, the FDA wants their children closely monitored for a worsening of their depression or major changes in behavior. "All treatments have potential risks and benefits," says Dr. Fassler.
"Most clinicians believe that, while it may take time to find the right medication and dosage, the potential benefit of these medications far outweighs the risk."