Antidepressants in children: indications, benefits, and limitations

The clinical applications of antidepressant drugs in childhood behavioral and emotional disorders were reviewed briefly as a means of introducing advances that have emerged over the past decade in the field of pediatric psychopharmacology. Using prepubertal major depressive disorder as a prototype, the benefits and limitations of antidepressant treatment were discussed in a conceptual way that builds on the current state of the evidence. Syndromic depression and major depression as a disorder with a distinct natural history, pattern of familial aggregation, and emerging set of psychobiological correlates can be supported by this evidence, and can be reliably diagnosed in children. Given the long duration of symptoms in depressed children, the degree of functional impairment they experience during and following recovery from an episode, and the high risk of relapse, treatment with antidepressant medication appears warranted despite attendant risks and potential disadvantages. Although psychosocial treatments are not as empirically defensible as drug treatment, there are compelling reasons why they should be used and investigated more exhaustively. Some suggestions regarding research directions and guidelines for clinical practice are offered.