Antidepressants Health Article

Antidepressants

Medications used to treat depression.

Depression in children and adults is similar to the clinical course in adults. It can be reliably diagnosed by a trained mental health professional through clinical interviews with the child or adolescent and outside observers (parents, teachers). Depression causes significant impairment in school, in the family, and in peer relationships. It is associated with other psychiatric disorders, suicidal thoughts, and suicide attempts. Both psychotherapy and medication can be effective treatments for depression, either alone or in combination.

The two most common types of antidepressants are tricyclic antidepressants (TCAs) and selective serotonin re-uptake inhibitors (SSRIs). Examples of TCAs include nortriptyline (also known by the brand name Pamelor), imipramine (Tofranil), and desipramine (Norpramin). Examples of SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). Clinical studies have shown that some children and adolescents benefit from these medications.

Tricyclic antidepressants (TCAs)

Before using TCAs, it is necessary to have a medical history and examination of the child, including an electrocardiogram (EKG). Not everyone develops side effects when taking TCAs, but the most common side effects include: dry mouth, impaired ability to focus vision at close range, constipation, urinary hesitation, dizziness, weight gain, and sedation. TCAs may produce minor cardiovascular changes such as orthostatic hypotension (low blood pressure when the person stands up, often causing light-headedness), hypertension, rapid heart beat, and minor changes in the electrical activity of the heart, which may show in the electrocardiogram (EKG). Most of these side effects can be minimized by slowly increasing or reducing TCA dosage.

During the treatment with TCAs, patients should be monitored by a physician trained in the management of these medications. It is recommended that he or she perform regular blood pressure, heart rate, and EKG monitoring. TCAs may interact with other medications; therefore, parents should inform their children's physicians that the child is taking a TCA. Finally, the TCAs should not be stopped abruptly because doing so may induce mild withdrawal side effects (malaise, chills, stomachache, flu-like symptoms). Though they are safe if carefully monitored and taken as prescribed, TCAs can be lethal if taken in overdose. Therefore parents must be responsible for storing and administering the medication in order to avoid accidental or intentional overdose.

It is important to report that four to five cases of sudden death have been reported in children taking the TCA medication desipramine. (Biederman et al., 1995). However, it is not clear whether the death of these children was due to the medication or other causes.