Types of Anxiety and Depression Medication for Teenagers

Older antidepressants (so-called "tricyclics") targeted both serotonin and noradrenaline, but also affected other nemotransmrtters, unrelated to depression. The most troublesome effects were on the neurotransmitter acetylcholine, resulting in so-called "anticholinergic" side effects (acetylcholine was reduced). These effects included dry mouth, constipation, sedation, and (less commonly) flushing, blurred vision, or urinary retention. In children, there were also several reports of irregular heartbeat with these medications. Therefore, they are currently only used if other medications fail, and always with monitoring of your child's electrocardiogram (a test that monitors the electrical activity of the heart).

Newer medications called "SSRIs" (selective serotonin reuptake inhibitors) do not have these problems, and there is some evidence that they are more effective in teens than the older tricyclics. SSRIs increase only the brain chemical serotonin, and are so-called because they prevent the "reuptake" (removal and breakdown) of this brain chemical. They all work in 70 to 80 percent of depressed children and teens (no one drug stands out), but it is impossible to predict which child will respond to which medication, so some children must try more than one. If another member of the immediate family has done well with a particular drug, however, it is usually worth trying this one in the affected child.

Effective doses in children are highly variable, so most doctors start at a low dose and increase it every couple of weeks as long as the child does not have significant side effects. All these medications take from two to eight weeks to become fully effective after the last dosage increase. Effectiveness usually is evident from improvements in eating and sleeping patterns (early changes), with improvements in mood becoming evident later. Increasing the dose every couple of weeks may result in "overshooting" the optimum dose a bit, given that full benefits may not occur until eight weeks after the last increase. On the other hand, waiting eight weeks between dosage changes would prolong the process unreasonably, so two-week intervals are generally considered good practice. In the hospital (where there is additional monitoring), dosage can be increased more quickly.



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