The treatment of adolescent depression in the era of the black box warning.
OBJECTIVE
This paper reviews the epidemiology and sequelae of adolescent depression, recent studies of antidepressants and psychotherapeutic modalities for treatment of adolescent depression, and the black box warning from the United States Food and Drug Administration regarding the use of antidepressants in adolescents.


RESULTS
Over the past 4 years, four major randomized placebo-controlled trials of selective serotonin reuptake inhibitors in adolescents have been published. Although each of these published studies concluded that the drug under study was efficacious, the United States Food and Drug Administration and others have offered words of caution. Over the past 2 years, there has been increasing concern that antidepressants may increase suicidal thinking and behavior (not completed suicide) in depressed adolescents. The United States Food and Drug Administration has issued a black box warning asking providers to use caution when prescribing antidepressants in children under the age of 18.


CONCLUSIONS
Adolescent depression is common, socially and economically costly, and a potentially lethal disease. Recent studies of antidepressant use in adolescents have demonstrated variable efficacy and an increased risk of adverse events, including suicidality. The evidence is greatest to support the efficacy of fluoxetine, and thus it remains the only selective serotonin reuptake inhibitor approved by the United States Food and Drug Administration for the treatment of depression in children and adolescents. Psychotherapy is strongly encouraged in any patient for whom medication is prescribed. The risk of adverse events associated with antidepressant use requires caution when these medications are prescribed to adolescents. In an adolescent with depression, however, there is an inherent and greater risk to doing nothing.
Richmond
Tracy K
TK
Department of Medicine, Division of Adolescent Medicine, Children's Hospital Boston, Massachusetts 02115, USA. tracy.richmond@childrens.harvard.edu
Rosen
David S
DS
D000293:Adolescent; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D000075202:Contraindications; D003866:Depressive Disorder / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D017277:Drug Approval; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors