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1 Antidepressants are drugs used, most often, to treat depression. Depression is a complex illness that involves sad and hopeless feelings that do not go away. Doctors sometimes order these drugs for other medical needs. Some of those needs include trouble sleeping, anxiety, bed-wetting, and some types of pain. If a doctor prescribes one of these drugs for your child for whatever reason, you should read the attached Medication Guide from the U.S. Food and Drug Administration (FDA). If your child suffers from depression, this Do you know handout will tell you more about this illness and its treatment. Depression is an illness that includes symptoms from two broad areas. One area is physical symptoms: Feeling sad or down in the dumps Crying a lot Feeling anxious or irritated Loss of energy Feeling tired Trouble sleeping Changes in eating Less interest in things Less able to feel pleasure or have fun Trouble paying attention or thinking The other area involves ways of seeing and thinking about yourself and the world. We will call this second area of symptoms harmful thoughts : Getting down on yourself and thinking you are bad or worthless Having trouble seeing the whole picture tunnel vision Believing there is no hope or nothing you can do to help Thinking death would end the pain or frustration If your child needs help coping with depression, the doctor may want to prescribe an antidepressant. These drugs may help reduce some of the feelings that go along with this illness. Most often, they ease the physical symptoms. Many doctors report that a number of their patients feel better when taking these drugs. The feeling better often means less sadness, less worrying, less irritable feelings, and less crying. It also can mean more energy, better sleep, more interest and pleasure, and an easier time paying attention and thinking. This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician. Copyright 2005 St. Jude Children's Research Hospital Page 1 of 6 Revised 7/05

2 Doctors sometimes order these drugs for other medical needs. Some of those needs include trouble sleeping, problems with wetting the bed, and some types of pain. These drugs do not work for everyone, and most do not work right away. It can take time (3 6 weeks) to see a benefit. For most antidepressants, there are no clear guidelines for which brand to use with which patient. So, the doctor often decides which drug to use based on what has worked for his or her patients in the past. When a patient starts treatment, there may be a trial and error period before the right drug is found. Each brand and type of antidepressant has its own list of possible side effects. The doctor should tell you about all the known side effects for each drug that he or she suggests for your child. In some cases, antidepressants can help reduce the physical symptoms of depression. However, these drugs do not always change or correct the patient s harmful thoughts. For this reason, most research shows that patients need therapy or counseling by a trained mental health worker to get the best relief from depression. Mental health workers can include psychologists, psychological examiners, and psychiatric social workers. Recent research from England reports that depressed children and teens taking antidepressants thought about or attempted suicide more often than those not taking these drugs. In response to this report, the FDA reviewed the results of 24 research studies of children and teens. The patients in these studies were depressed or had other illnesses. Each patient took either a sugar pill or an antidepressant for 1 to 4 months. No one committed suicide in these studies. However, of those taking antidepressants, 4 out of every 100 patients talked openly about thoughts of suicide or hurting themselves. Only 2 out of every 100 patients taking the sugar pills had these thoughts. Researchers do not believe that the antidepressants gave the patients thoughts of suicide. Such thoughts and actions most often come from the depression. But by reducing the physical symptoms, these drugs may give those patients more energy to focus on and act on their harmful thoughts. Again, this is why it is so important to have therapy with a mental health worker as part of the treatment plan. It will allow the patient and mental health worker to talk about and change the harmful thoughts. Some children and teens are at greater risk for suicide. These include those with: Bipolar illness (also called manic-depressive illness); A family history of bipolar illness; or A personal or family history of suicide attempts. If any of these describe your child, tell the doctor before your child takes an antidepressant. This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician. Copyright 2005 St. Jude Children's Research Hospital Page 2 of 6 Revised 7/05

3 Watch closely for sudden changes in your child s moods or actions. Enlist the help of other people in your child s life to watch for these changes. These people could include the doctor, mental health worker, brothers, sisters, teachers, and even the patient. Pay close attention to your child s moods and actions when he starts an antidepressant or when its dose is changed. Do not be afraid to ask your child direct questions. Has he felt so bad that he thought about hurting himself? Has he thought that death might be the only way out of the rut where he feels stuck? Asking such questions does not plant ideas in your child s mind. Instead, it gives the child or teen permission to talk about the ideas that are already there. Warning signs Talk to the doctor or mental health worker right away, if your child shows any of these signs for the first time or if they seem worse. Thinking about suicide Attempts suicide Depressed (new or worse) Anxious (new or worse) Very agitated or restless Panic attacks Trouble sleeping Irritable (new or worse) Acting pushy, angry, or violent Acting on dangerous impulses Extreme increase in movement and talking Other odd changes in behavior or mood Never let your child stop taking an antidepressant without first talking to the doctor. Stopping these drugs suddenly can cause other problems. When to see the doctor After starting an antidepressant, your child should see the doctor on a regular basis. More open talk of suicide is just one possible side effect of antidepressants. Ask your child s doctor to explain all the known side effects of the chosen drug. Also, ask about drugs that your child should avoid when taking an antidepressant. You and your child should talk to the doctor about all treatment options including therapy or counseling with a mental health worker. Be sure to discuss all the risks of treating depression as well as the risks of not treating it. To learn more about depression and the use of antidepressants for children and teens, talk to your child s St. Jude doctor, mental health worker, or pharmacist. In the local area, call If you are outside the Memphis area, dial toll-free STJUDE ( ), and press 0. This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician. Copyright 2005 St. Jude Children's Research Hospital Page 3 of 6 Revised 7/05

4 What is the most important information I should know if my child is being prescribed an antidepressant? Parents or guardians need to think about 4 important things when their child is prescribed an antidepressant: 1. There is a risk of suicidal thoughts or actions 2. How to try to prevent suicidal thoughts or actions in your child 3. You should watch for certain signs if your child is taking an antidepressant 4. There are benefits and risks when using antidepressants 1. There is a Risk of Suicidal Thoughts or Actions Children and teenagers sometimes think about suicide, and many report trying to kill themselves. Antidepressants increase suicidal thoughts and actions in some children and teenagers. But suicidal thoughts and actions can also be caused by depression, a serious medical condition that is commonly treated with antidepressants. Thinking about killing yourself or trying to kill yourself is called suicidality or being suicidal. A large study combined the results of 24 different studies of children and teenagers with depression or other illnesses. In these studies, patients took either a placebo (sugar pill) or an antidepressant for 1 to 4 months. No one committed suicide in these studies, but some patients became suicidal. On sugar pills, 2 out of every 100 became suicidal. On the antidepressants, 4 out of every 100 patients became suicidal. For some children and teenagers, the risks of suicidal actions may be especially high. These include patients with Bipolar illness (sometimes called manic-depressive illness) A family history of bipolar illness A personal or family history of attempting suicide If any of these are present, make sure you tell your healthcare provider before your child takes an antidepressant. 2. How to Try to Prevent Suicidal Thoughts and Actions To try to prevent suicidal thoughts and actions in your child, pay close attention to changes in her or his moods or actions, especially if the changes occur suddenly. Other important people in your child's life can help by paying attention as well (e.g., your child, brothers and sisters, teachers, and other important people). The changes to look out for are listed in Section 3, on what to watch for. Whenever an antidepressant is started or its dose is changed, pay close attention to your child.

5 After starting an antidepressant, your child should generally see his or her healthcare provider: Once a week for the first 4 weeks Every 2 weeks for the next 4 weeks After taking the antidepressant for 12 weeks After 12 weeks, follow your healthcare provider's advice about how often to come back More often if problems or questions arise (see Section 3) You should call your child's healthcare provider between visits if needed. 3. You Should Watch for Certain Signs If Your Child is Taking an Antidepressant Contact your child's healthcare provider right away if your child exhibits any of the following signs for the first time, or if they seem worse, or worry you, your child, or your child's teacher: Thoughts about suicide or dying Attempts to commit suicide New or worse depression New or worse anxiety Feeling very agitated or restless Panic attacks Difficulty sleeping (insomnia) New or worse irritability Acting aggressive, being angry, or violent Acting on dangerous impulses An extreme increase in activity and talking Other unusual changes in behavior or mood Never let your child stop taking an antidepressant without first talking to his or her healthcare provider. Stopping an antidepressant suddenly can cause other symptoms. 4. There are Benefits and Risks When Using Antidepressants Antidepressants are used to treat depression and other illnesses. Depression and other illnesses can lead to suicide. In some children and teenagers, treatment with an antidepressant increases suicidal thinking or actions. It is important to discuss all the risks of treating depression and also the risks of not treating it. You and your child should discuss all treatment choices with your healthcare provider, not just the use of antidepressants. Other side effects can occur with antidepressants (see section below). Of all the antidepressants, only fluoxetine (ProzacTM) has been FDA approved to treat pediatric depression. For obsessive compulsive disorder in children and teenagers, FDA has approved only fluoxetine (ProzacTM), sertraline (ZoloftTM), fluvoxamine, and clomipramine (AnafranilTM).

6 Your healthcare provider may suggest other antidepressants based on the past experience of your child or other family members. Is this all I need to know if my child is being prescribed an antidepressant? No. This is a warning about the risk for suicidality. Other side effects can occur with antidepressants. Be sure to ask your healthcare provider to explain all the side effects of the particular drug he or she is prescribing. Also ask about drugs to avoid when taking an antidepressant. Ask your healthcare provider or pharmacist where to find more information. *Prozac is a registered trademark of Eli Lilly and Company *Zoloft is a registered trademark of Pfizer Pharmaceuticals *Anafranil is a registered trademark of Mallinckrodt Inc. This Medication Guide has been approved by the U.S. Food and Drug Administration for all antidepressants. Revised 1/26/05

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