More and more kids and teenagers are feeling sad, hopeless, and anxious these days. Scientists and doctors are working hard to understand how to help them feel better. One treatment option is antidepressant medication, but there’s a lot of confusion about whether these medicines are safe and helpful for young people.

How Many Kids Are Struggling?

The numbers are pretty scary:

• 4 out of 10 high school students say they feel very sad or hopeless for long periods of time

• That’s up from 3 out of 10 students just 10 years ago

• 2 out of 10 teens have seriously thought about suicide

• Girls and LGBTQ+ teens are struggling even more, with over half reporting feelings of sadness or hopelessness

As of 2022, about 4.5% of kids and young adults aged 12-25 were taking antidepressant medications. More doctors have been prescribing these medicines, especially during and after COVID-19.

What Do the Experts Say?

Three doctors and researchers from Stanford Medicine studied this issue carefully. Here’s what they found:

The bottom line: Antidepressants are safe and work well for many kids and teens, but they should always be monitored by trained doctors. Also, medicine shouldn’t be the only treatment – talk therapy is also really important.

How Do Antidepressants Work?

The most common antidepressants are called SSRIs (selective serotonin reuptake inhibitors). Here’s how they work in simple terms:

1. Your brain uses a chemical called serotonin to help brain cells talk to each other

2. Serotonin helps control your emotions and mood

3. Normally, brain cells recycle serotonin after using it

4. SSRIs stop this recycling, so there’s more serotonin available in your brain

5. More serotonin can help improve mood and reduce anxiety

For a long time, doctors thought depression was caused by having too little serotonin in the brain. Some recent studies question this idea, but the evidence is clear that SSRIs work well for many teens with:

• Major depression

• Anxiety disorders

• Obsessive-compulsive disorder (OCD)

When Do Doctors Prescribe Antidepressants?

Dr. Jennifer Derenne from Stanford Medicine explains that antidepressants should only be prescribed when a kid or teen has been officially diagnosed with a mental health condition like major depression or anxiety disorder.

But even with a diagnosis, medicine might not be the first choice.

“Just because someone has depression or anxiety doesn’t mean that we need to jump to meds,” Dr. Derenne said. “There are also evidence-based therapy methods that can be really effective.”

For mild depression: Talk therapy (like cognitive behavioral therapy or CBT) is usually tried first.

For moderate or severe depression: Doctors often use both antidepressants and therapy together right away.

Dr. Cordelia Ross, who works at Stanford’s Pediatric Mood Disorders Clinic, says: “For those with more severe symptoms, I say, ‘We have effective treatments, why not be open to them if you’re suffering?'”

How Do You Know When a Teen Needs Help?

It’s not always easy to tell when normal teenage mood swings become something more serious. Dr. Antonio Hardan suggests looking at three main areas of a teen’s life:

1. Family Relationships

• Are family relationships getting much worse?

• Is the teen pulling away from family completely?

2. School Performance

• Have grades dropped a lot?

• Has the teen lost interest in classes and activities they used to love?

3. Friendships

• Has the teen stopped being social?

• Have they dropped longtime friendships?

If there are big, long-lasting changes in these areas, it might be time to get help from a professional.

Side Effects of Antidepressants

Antidepressants can cause side effects in teens, just like in adults:

• Weight gain

• Stomach problems

• Sleep problems

• Decreased interest in romantic relationships

Most side effects are manageable, and doctors can help adjust medications if needed.

The Black Box Warning: What Parents Worry About

In 2004, the FDA put a “black box warning” on antidepressants saying they might increase suicidal thoughts in teens. Here’s what happened:

• The FDA studied nearly 400 clinical trials

• They found that 4% of teens taking antidepressants had suicidal thoughts, compared to 2% taking fake pills (placebos)

• Important: No teens in these studies actually died by suicide

What happened after the warning:

• Antidepressant prescriptions for kids dropped by more than 30%

• Sadly, teen suicide rates actually went up in the following decade

What doctors say now: Dr. Ross tells parents: “If your child starts this medication and starts to express suicidal thoughts, let me know immediately. That’s an emergency and we take it very seriously. But I don’t anticipate that happening. I expect suicidality and depression to get better on these medications.”

The warning is still there, but many doctors think it has scared people away from treatments that could actually save lives.

How Talk Therapy Helps

Cognitive behavioral therapy (CBT) has been proven to work well for teen depression. It works even better when combined with antidepressants.

What CBT teaches:

• How to recognize negative thought patterns

• How to change those thoughts

• How to change behaviors that make depression worse

• Coping skills for dealing with stress and difficult emotions

The challenges with therapy:

• There’s a shortage of good therapists who work with kids and teens

• Not all therapists are equally skilled

• Therapy requires more work from both the teen and their parents

• Parents need to learn about the strategies being taught and practice them at home

Dr. Hardan explains: “Parent education is very important. It’s not just, OK, I’m dropping my kid off at the therapist and picking them up an hour later.”

Making the Right Choice

Each family needs to make their own decision about treatment. Dr. Derenne says: “Sometimes when people sit down with me, they’re surprised that I’m not just pushing pills. I’m always going to be respectful of families’ views.”

Key points to remember:

• Depression and anxiety are real medical conditions, just like asthma or diabetes

• There are effective treatments available

• Medication can be very helpful, but it’s not the only option

• Therapy is also important and effective

• The best treatment often combines both medication and therapy

• Any treatment should be monitored by trained professionals

The Bottom Line

Mental health struggles in teens are serious and shouldn’t be ignored. The good news is that there are effective treatments available. While antidepressants aren’t right for everyone, they can be life-saving for teens with moderate to severe depression or anxiety.

The most important thing is to:

1. Recognize when a teen needs help

2. Get professional evaluation and diagnosis

3. Work with qualified doctors and therapists

4. Consider all treatment options

5. Monitor progress carefully

6. Remember that getting better takes time

If you or someone you know is struggling with depression or having thoughts of suicide, it’s important to get help immediately. These conditions are treatable, and things can get better.

Original article: “What the science says about antidepressants for kids and teens” by Rachel Tompa, Stanford University

Provided by: Stanford University