[Antidepressant medication in children]

When should we use antidepressant medications in children? Antidepressant medication may not be considered as a first-line treatment in children; psychotherapeutic treatments should always be preferentially used. At this age, the efficacy of SSRI is regarded as low to moderate for depression, but moderate to high for Obsessive Compulsive Disorder (OCD) and anxiety disorders. When an antidepressant medication is prescribed, a SSRI should always be used first. In particular, fluoxetine is the most studied SSRI and the only medication who received approval by the French regulatory authority. Sertraline and fluvoxamine which have been approved for OCD should preferentially be used for that purpose. During the first 4 weeks, clinicians should actively monitor the onset of side effects, especially mood swings and suicidal behavior. The onset or increase of suicidal thoughts during SSRI treatment would concern about 1 out of 100 young patients treated. This risk is maximal during the first four weeks following the introduction of the SSRI and should progressively decrease after one month. When used in children, antidepressant medication can only be used in association with psychotherapeutic treatments and psychosocial interventions targeting the maintaining factors perpetuating the cycle of affective symptoms.