Antidepressants in Children and Adolescents, to Give or Not to Give; When and What???!! Eman Ahmed Zaky * Department of Pediatrics, Child Psychiatry Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt * Corresponding author: Eman Ahmed Zaky, Department of Pediatrics, Child Psychiatry Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt, Tel: 00202-01062978734; E-mail: emanzaky@med.asu.edu.eg Rec date: Aug 01, 2017; Acc date: Aug 02, 2017; Pub date: Aug 05, 2017 Copyright: © 2017 Zaky EA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Abstract Depression in children is not rare; it is estimated to affect 2.8% of those younger than 13 years while such prevalence increases to 5.6% of those aged between 13 years and 18 years. Major depression disorder (MDD) in children and adolescents usually has its negative percussions on its sufferers physically, emotionally, and socially. It results from interplay between biological susceptibility and risky psychosocial and environmental stressors. Keywords: Major Depressive Disorder (MDD); DSM 5; Cognitive Behaviour Therapy (CBT); Antidepressants; Selective Serotonin Reuptake Inhibitors (SSRIs); Suicidality Introduction Depression in children is not rare; it is estimated to afect 2.8% of those younger than 13 years while such prevalence increases to 5.6% of those aged between 13 years and 18 years [1]. Major depression disorder (MDD) in children and adolescents usually has its negative percussions on its suferers physically, emotionally, and socially [2]. It results from interplay between biological susceptibility and risky psychosocial and environmental stressors [3]. Screening for depression may be useful for early picking up and treatment of cases among adolescents while there is no adequate data to indicate the value of such screening among younger children except for those with at least one risk factor for developing the disease [4]. Its defnitive diagnosis is settled by mental health professionals using DSM 5 diagnostic criteria for MDD [5]. Combined cognitive behavior and interpersonal therapy is indicated in all cases of MDD either alone in mild cases or in addition to pharmacotherapy in moderate to severe cases [6]. Te use of antidepressants in children is an issue of debate because of their indications, efcacy, and adverse efects as well as the proper choice of the drug to be given [6-8]. Manifestations of MDD Pediatric suferers from MDD usually manifest with anhedonia, boredom, hopelessness, hypersomnia, and weight changes (overweight or inappropriate weight milestones), drug or alcohol use, and suicidal attempts if they are adolescents while younger children usually present with somatic complaints, irritability, separation anxiety, phobias, and hallucinations. Mental age of the depressed child or adolescent is important as those with lower mental age (whether younger children or those with intellectual disability) may appear unhappy but fail to express their feelings or describe their sadness or depressed mood. Parents are usually more concerned with externalizing manifestations as restlessness and irritability while suferers usually are more agonized with their sadness and unhappiness [5,6]. Indications of pharmacotherapy in pediatric MDD To give or not to give medications in pediatric suferers from MDD is an issue that needs to be dealt with cautiously. Children and adolescents with major depressive disorder are most likely to need pharmacotherapy if their depression is moderate to severe and if they had prior episodes of depression, needed medications for a prior episode, have family history of depression and signifcant response to antidepressants, persistent psychosocial and or environmental stressors, and failed trial of cognitive behavior and or interpersonal therapy [9]. Pharmacotherapy for MDD (antidepressants); an issue of debate Antidepressants are drugs that are used to treat MDD and some other conditions such as anxiety disorders, eating disorders, chronic pain, snoring, migraine, attention defcit hyperactivity disorder (ADHD), addiction, and sleep disorders [10]. It has been hypothesized that depression is linked to hyperactive hypothalamic pituitary adrenal axis (HPA axis) in response to stress which can explain depressive manifestations; antidepressants may be useful in normalization of HPA axis functions [11]. Te knowledge about antidepressants in children and adolescents is progressively increasing; nevertheless, it is still limited in comparison to similar knowledge in adults [8]. Tricyclic antidepressants are no longer indicated for children with MDD because of their limited to none usefulness [12]. Meanwhile, selective Serotonin Reuptake Inhibitors (SSRI) are the drugs of choice for treating moderate to severe depression in pediatric age group; namely fuoxetine, citalopram, and sertraline [13]. Specifcally, fuoxetine is the drug with documented solid evidences of its efcacy in children and adolescents sufering from MDD [13,14]. Lowest doses of the drug must be used at the onset of therapy and titrated according to the response of the patient and the occurrence of side efects. Adverse efects include gastrointestinal manifestations, nervousness, restlessness, and headache [6]. Treatment is recommended to continue for 6 months International Journal of School and Cognitive Psychology Zaky, Int J Sch Cog Psychol 2017, 4:3 DOI: 10.4172/2469-9837.1000e108 Editorial Open Access Int J Sch Cog Psychol, an open access journal ISSN: 2469-9837 Volume 4 • Issue 3 • 1000e108 I n t e r n a t i o n a l J o u r n a l o f S c h o o l a n d C o g n i t i v e P s y c h o l o g y ISSN: 2469-9837