Time-to-effect of fluoxetine in children with depression

Question I prescribed fluoxetine to a 16-year-old female patient presenting to my clinic with severe major depressive disorder who did not respond to psychotherapy. Is fluoxetine an effective treatment of depression in this population, and how long should she expect to wait before noticing an effect?Answer For depression in children and adolescents, fluoxetine has the most evidence for efficacy when compared with other selective serotonin reuptake inhibitors; however, it is not approved by Health Canada for this patient population. Available evidence has shown that most of its clinical benefit is seen within the first 2 weeks. Lack of response by week 4 might suggest a need for reevaluation. However, more research is needed to elucidate the optimal length of the initial treatment period. There is conflicting evidence regarding the risk of suicidality in this population, so close patient monitoring is required when using fluoxetine in children and adolescents.