Fact sheet 5

Antidepressants for the treatment of depression in adolescents and young adults

Download Fact sheet 5: Antidepressants for the treatment of depression in adolescents and young adults

About depression

Everybody feels sad or down sometimes. Most of the time, this sadness is short-term and doesn’t stop people from getting on with their life.

Depression is more than short-term sadness. It’s a serious illness that causes lasting changes to your thoughts, mood, behaviour and physical health. This can leave people feeling down most of the time and makes it hard to cope from day-to-day.

The good news is that just like physical illnesses, depression can be treated - and with the right treatment, most people recover. The choice of treatment will depend on the person’s situation, as well as symptoms.

Antidepressants and young people

There is much debate among doctors about the benefits of antidepressants for young people. One of the main reasons for the lack of clear recommendations is because we don’t yet know enough about how effective and safe antidepressants are in adolescents and young adults. This fact sheet summarises what we know now, and gives information that may help young people and their families in making decisions about antidepressants.

Are antidepressant medications effective for young people?

Of the various antidepressants available, fluoxetine, which is a type of the selective serotonin reuptake inhibitor (SSRI), has been the most widely researched in young people. Studies suggest that fluoxetine helps to reduce depression when it is moderate or severe in young people, compared with taking a pill that contains no drugs (called a placebo). Combining the SSRI with a psychological therapy such as Cognitive Behaviour Therapy (CBT) or Interpersonal Therapy (IPT) may have additional benefits, but this needs to be looked at further by researchers. A first step would be a discussion with a GP.

Are antidepressant medications safe for young people?

As with most medicines, antidepressants have side-effects such as nausea, headaches, and drowsiness, which are usually mild and short-term. Sexual problems are a side-effect that can cause considerable concern to young people. About 10 per cent of people experience side-effects that lead them to stop taking the medication.

The main concern is about one particular side-effect of SSRIs during the early stages of treatment, which is an increase in suicidal thoughts and urges to act on these thoughts.

These concerns led to a review of all the available scientific studies relating to SSRI use in young people aged under 25 years. The reviews found evidence of suicidal thinking in about 4 per cent of adolescents (13-18 year olds) taking SSRIs (compared with about 2 per cent of those taking the placebo pill). There was a smaller increase in suicidal thoughts and urges in young adults taking these medications.

Young people who have psychological therapy at the same time as SSRI treatment seem to have less of a risk of suicidal thinking.

Concerns about the safety of SSRIs in this age group mean that making a decision to use antidepressants in young people depends a lot on how severe their symptoms are, and involves very carefully weighing up the likely benefits and harms. In particular, for moderate to severe depression, worries about young people having increased suicidal thinking with SSRIs must be balanced against their risk of suicidal thinking if they are not treated.

What treatments are available for adolescents and young adults?

Psychological therapies are the main treatment for depression in young people (aged 13-24 years).
Two psychological therapies have been found to be especially helpful - Cognitive Behaviour Therapy (CBT) and Interpersonal Therapy (IPT). Other types of ‘talking therapy’ may also be useful.
CBT helps you to change the negative thinking that comes with depression. IPT helps people to deal with problems they may be having with family members and friends.
Getting information about depression and how best to recover is an important part of treating depression. Eating well, excercising, managing stress and following tips to improve sleep patterns can also be helpful.
In young people with moderate to severe depression, antidepressant medication may be considered to reduce depression symptoms in the short-term, especially where psychological therapies alone have not worked or are not available.

Should antidepressants be used in this age group?

While there is still debate about the use of antidepressants in young people, research suggests the following:

Antidepressants should not be used for treating adolescents or young adults with mild depression.
In adolescents and young adults with moderate to severe depression, the SSRI fluoxetine can be considered for reducing depression symptoms in the short-term, if psychological therapy has not been effective or is not available, or if the young person’s symptoms are severe.
Treatment with antidepressants may be safer and more effective when coupled with psychological therapy.
Use of SSRIs in young people should only happen as part of a complete treatment plan for that person. This should include careful monitoring for any signs of suicidal thinking or behaviour, and regular checks with his or her doctor, especially in the first four weeks of treatment. Ideally, a parent or responsible adult should supervise the use of antidepressants by adolescents.

What does this mean for a young person with depression?

Everyone is different, so the treatment for depression needs to be worked out to suit you. It can be helpful to involve your parents or a friend when you and your doctor are working out which treatments might be best for you.
If your doctor decides to consider antidepressant medication, he or she will give you information about the medicine and its possible side-effects. Ask questions if there is anything you’re not sure about.
If you do start taking antidepressant medication, it’s important to know that it can take at least two weeks before you’ll start to feel better, and in the beginning, some of your symptoms might feel worse. You will need to see your doctor a least every week until the depression starts to improve. It’s important not to miss your appointments.
During this time, you and your doctor need to look out for any signs that might indicate that you’re one of the people who could experience a bad reaction from this treatment. If you’re worried about anything, talk to your doctor straight away - don’t wait until your next appointment.
When taking antidepressant medication, it’s important to look after yourself and to keep up with other treatments such as psychological therapy. Some over the-counter and herbal medicines, alcohol or other drugs can interact with antidepressants and should be avoided. You can ask your doctor or pharmacist for information on which things you should avoid.
If you decide to stop taking antidepressant medication, it’s best to do so slowly, with supervision by your doctor and regular check-ups. It’s important not to stop taking them suddenly, as this may cause an unpleasant ‘withdrawal’ reaction and make you feel worse. Symptoms include unpleasant mood states, irritability, agitation, dizziness and confusion, which generally stop by themselves after a week or so.

Key points to remember

Getting the right type of help, and getting it early, can make it much easier for you to deal with depression, recover and stay well.
Psychological therapies are the recommended first treatment for young people.
In some cases, a doctor may think that an antidepressant medication may also be necessary, particularly if depression is severe, or it isn’t improving with other treatments.
There is a risk that antidepressants may increase suicidal thoughts and urges, especially in the first four weeks of treatment.
Your doctor should provide you (and your family) with clear information about the pros and cons of taking antidepressant medication if this is considered necessary, and the steps to take in a crisis situation or emergency.
With the right treatment, most young people make a full recovery from depression.

Extra information

Phone help lines and websites

Sources

This fact sheet is based on information from:

beyondblue – www.youthbeyondblue.com and www.beyondblue.org.au
ReachOut.com – www.reachout.com

* beyondblue has developed Clinical Practice Guidelines for Depression in adolescents and young adults. The guidelines were approved by NHMRC in February 2011 - visit www.beyondblue.org.au/guidelines for more information.