Discussions on the use of antidepressants for children and teenagers are fairly common throughout the Pembina Valley, with some parents expressing concerns about safety and access.
To help provide clarity, Dr. Aly Dhala, Family Physician at C.W. Wiebe Medical Centre and Boundary Trails Health Centre and Vice President of Medical Services for Southern Health–Santé Sud, explained how these medications work, when they’re prescribed, and what safeguards are in place.
What are SSRIs?
Selective serotonin reuptake inhibitors, commonly known as SSRIs, are a class of medications used to treat depression and anxiety symptoms. Dr. Dhala explains that “the prototype drug was fluoxetine, also known as Prozac. It’s been out since 1987. That’s what they’re used for, to treat anxiety and depression symptoms.”
Dhala added that SSRIs are well-established, with decades of research supporting their use, and are commonly prescribed when depression or anxiety symptoms significantly affect a person’s daily life.
When are antidepressants prescribed to youth?
While therapy is often the first line of treatment, medications may be considered for moderate to severe symptoms. Dr. Dhala notes, “The most common indications would be depression and anxiety symptoms,” and emphasizes that primary care providers can safely prescribe these medications for older teens after appropriate assessments.
In Manitoba, the Mature Minor Consent principle allows physicians to prescribe medication to youth who can understand their condition and the risks and benefits of treatment.
Benefits and risks
One of the common topics spoken alongside SSRI’s, is that of their side-effects. Specifically the risk of increased suicidal thinking.
Dr. Dhala stresses context: “There’s actually evidence to show that the suicidal thinking or suicidal ideation risk is increased the month prior to starting treatment when the depression symptoms are at their worst… the risk of suicidal ideation is relatively low, less than one in 100 would experience those side effects.”
On the benefits side, Dhala says that research shows about 61% of youth see improvements in depression symptoms when taking SSRIs.
“You usually see improvement in mood… improvement in relationships, conversations, and focus in school, reduction in suicidal thinking over time, and just a general better function in someone who’s been diagnosed with depression and anxiety symptoms.”
Other common, usually temporary, side effects can include headaches, upset stomach, or feeling jittery as the body adjusts to the medication.
Related stories:
Monitoring and safeguards
Dr. Dhala did also stress the importance of careful monitoring when it comes to prescribing antidepressants to youth.
“Typically primary care providers will prescribe these medications and do really close monitoring and follow-ups, usually a cadence of two to four weeks initially and then monthly, and then get spaced out over time as symptoms settle.”
This ongoing supervision is in place to help track and mitigate any side effects quickly and ensure the medication is providing the intended benefits.
Dr. Dhala did add that medication is often most effective when combined with non-pharmacological treatments. “Cognitive behavioural therapy is also another way of addressing the symptoms… There’s research to show that the two together are actually your best effect and your best way of treating depression and anxiety symptoms.”
He also encourages families to explore other supports, such as counsellors, mental health services, and virtual therapy options, rather than relying solely on medication.
“There are many ways to access non-pharmacological supports for depression and anxiety. There are counsellors, mental health services, and there are many options for CBT, both in-person and virtual options now. So I encourage people to look at those options,” he said, adding that “A happy child is better than a sad child. And so if you are worried about depression symptoms, have a conversation with your primary care provider.”
He emphasizes that involving the whole family in those conversations tends to lead to better outcomes and stronger support for young people.