Depression: Prozac for Kids?

by Dr. Isadore Rosenfeld

Overall, 6 percent of children and teenagers in the United States take medication for depression, attention-deficit hyperactivity disorder, and other behavioral and emotional problems. Many of the drugs, especially the antidepressants, are the same as those given to adults, but have not been approved by the FDA for children. The best known of these is Prozac (fluoxetine).

Here's What's New

After reviewing all available data, the FDA now believes that there is enough evidence of Prozac's effectiveness to warrant its approval for treating depression in children older than age 7. However, parents of these children should know that Prozac can have such adverse effects as nausea, fatigue, dizziness, difficulty concentrating, and nervousness. And they should bear in mind an additional adverse effect unique to kids and teenagers: They may grow more slowly and gain less weight. Researchers are trying to determine whether these children eventually catch up.

What's true for Prozac doesn't necessarily apply to other drugs classified as selective serotonin reuptake inhibitors (SSRIs). For example, the FDA has ruled that Paxil (paroxetine) should not be taken by anyone younger than age 18 because it is associated with a possible increased risk of suicidal impulses.

The Bottom Line

Depressed children and teenagers may be treated with Prozac if their doctors believe the symptoms are serious enough to justify it. Such therapy is safe, according to the FDA. But if your child is taking Prozac, make sure a pediatrician closely monitors his or her weight and growth.

What the Doctor Ordered?

Antidepressants -- Another Cause of Upper Gastrointestinal Bleeding
As we get older, blood vessels in the stomach and, to a lesser extent, the small intestine, become more vulnerable to irritation and bleeding. That's why older people who regularly take aspirin and/or a nonsteroidal anti-inflammatory drug (NSAID), such as Motrin (ibuprofen) or Aleve (naproxen), have a higher incidence of these complications.

Here's What's New
Researchers in Denmark have found that the selective serotonin reuptake inhibitors (SSRIs), the newest antidepressants, are associated with a significantly increased risk of gastrointestinal bleeding. These drugs, the best known of which are Prozac (fluoxetine) and Paxil (paroxetine) but there are many others, are widely used throughout the world. A study of 26,000 patients taking SSRIs concluded that these drugs caused more stomach bleeding when taken alone and were especially risky when combined with either aspirin (5.2 times the incidence of bleeding) or an NSAID (12.2 times the risk). The researchers believe that some interaction between the antidepressant and the blood platelets accounts for this adverse effect.

The Bottom Line
If you're taking an SSRI, watch for evidence of bleeding from your intestinal tract -- especially if you're older and also taking aspirin or an NSAID. Look for black stools, which indicate the presence of blood, and have them routinely checked by your doctor. (Note that iron supplements also can make stools black.) Report any stomach pain to your doctor; there are other categories of antidepressants that can be prescribed.

Are Antidepressants Safe during Pregnancy and Breastfeeding?

As many as 15 percent of women of childbearing age are chronically depressed. Some even become suicidal. When such depression leads to alcohol or drugs, it can have especially serious long-term consequences for a woman and her baby during pregnancy or breastfeeding.

Normal brain function depends on an adequate supply of certain chemical "messengers," such as serotonin and norepinephrine, which transmit signals from one part of the brain to another. People with major depression have lower levels of these substances. The newest antidepressants, called selective serotonin reuptake inhibitors (SSRIs) have dramatically improved the mood and quality of life for thousands of depression sufferers by raising serotonin levels in the brain.

Will pregnant women and nursing mothers who need these drugs harm their children by taking them?

Here's What's New
Even though these drugs can be passed to the fetus via the bloodstream, research indicates that the newer SSRIs such as Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Celexa (citalopram), and Effexor (venlafaxine), do not increase fetal risk of major birth defects or death. However, to avoid withdrawal symptoms in newborns, some doctors recommend that these medications be tapered or discontinued 10 to 14 days before the patient's due date.

Doctors at the University of Bergen in Norway analyzed breast milk from 23 women who were taking an SSRI for depression while breastfeeding their babies. Blood samples from the mothers and children revealed that the drug was not present in breast milk or the babies' blood in appreciable amounts. The researchers conclude that these antidepressants are safe to take while nursing. In fact, they are especially useful in treating postpartum depression.

The Bottom Line
If you're seriously depressed while pregnant or breastfeeding, you may benefit from taking an SSRI at the lowest effective dose. But as with any medication, it's important for your doctor to monitor its use. You should also receive appropriate counseling and emotional support. Although some SSRIs, such as Prozac, may result in higher blood levels in the nursing infants than others (Paxil and Zoloft have the lowest concentrations in breast milk), none are high enough to harm the child.

Dr. Isadore Rosenfeld's legions of fans follow his regular column in Parade magazine and his popular Sunday-morning television series Sunday Housecall on FOX News Channel. In addition to his numerous scientific publications and medical textbooks for doctors, he has written nine New York Times bestsellers. He is a distinguished member of the faculty at New York-Presbyterian Hospital/Weill Medical College of Cornell University and attending physician at New York Presbyterian Hospital and Memorial Sloan-Kettering Cancer Center.

Reprinted from "Breakthrough Health 2004: 157 Up-to-the-Minute Medical Discoveries, Treatments, and Cures That Can Save Your Life, from America's Most Trusted Doctor!"

Copyright © Isadore Rosenfeld, M.D. Permission to publish granted to Pregnancy.org.