Deciding to put your teenager on antidepressants isn’t one made casually. It’s a joint decision between you, your teen, and their doctor, after weighing the pros and cons.

Antidepressants are a part of treatment for conditions like anxiety and depression. They’re medications that can help regulate chemicals in the brain thought to underlie mood symptoms.

For many people, including teens, antidepressants are an invaluable part of a mental health treatment plan.

But antidepressant use in youth has received mix sentiments among the general public. Concerns about teen-specific side-effects are always prevalent. But many caregivers also don’t “believe in” putting teens on medication because they don’t feel symptoms are related to mental health.

Debilitating depression and anxiety aren’t just a part of the typical teenage experience. They can be impairing conditions, and using antidepressants in the right circumstances can help.

What makes an antidepressant safe isn’t the complete absence of adverse reactions.

“Safe” medications for teens are those that have passed rigorous Food and Drug Administration (FDA) testing in the pediatric population. After proving efficacy and risk below a certain threshold, they’re granted permission to include pediatric use on their labels.

Common antidepressants FDA-approved for use in teens include:

But FDA-approval isn’t the only indicator of safety. According to Dr. Willough Jenkins, a pediatric psychiatrist from San Diego, California, there are other antidepressants safely used off-label in teens.

“The creator of the medication may have chosen not to pursue FDA approval for youth, but that does not mean that it isn’t safe for teens,” she states.

Even among FDA-approved medications, some formulations are preferred to others.

Dr. Julian Lagoy, a mental health clinician from San Jose, California, indicates, “Numerous antidepressants are FDA-approved for teenagers, and in my opinion, the safest ones are Lexapro, Prozac, Zoloft, and Cymbalta.”

Which antidepressant is best for a teen?

There’s no one-size-fits-all antidepressant for teens. Different medications may work better than others depending on the condition being treated.

According to a teen-focused 2020 systematic review, Prozac was the most helpful for major depressive disorder. In addition, Prozac and Zoloft were top-tier for obsessive-compulsive disorder (OCD).

It’s recommended that you speak with a trusted medical professional to determine which medication may best suit your teen’s needs.

As an adult looking back, it’s clear that life as a teenager isn’t easy. It’s a challenging time of juggling school, friends, activities, and physical changes.

It’s natural for all teenagers to have ups and downs as they figure out how they fit in with the world around them.

Because of this natural angst, the symptoms of depression in adolescents can be tough to spot. They’re often subtle and gradual, and can include:

  • persistent feelings of worthlessness or emptiness
  • irritability
  • academic decline
  • change in friend group
  • fatigue
  • memory loss
  • lack of concentration
  • sleep disturbances
  • loss of interest in hobbies and enjoyable activities
  • isolation/social withdrawal
  • decline in hygiene

When should I put my teenager on antidepressants?

Antidepressants are intended to be utilized as a part of dynamic treatment, which also includes psychotherapeutic interventions.

In many cases, they’re only prescribed when non-medication approaches have already been tried.

For caregivers, Lagoy says certain signs suggest antidepressants are a good option for teens, including:

  • the presence of a co-existing mental health condition, like an eating disorder or ADHD
  • a family history of mental health challenges
  • psychotherapy hasn’t made enough of a difference
  • a teen isn’t eating or sleeping well
  • there’s a history of self-harm or suicide ideation

Jenkins adds that, overall, it’s important to openly and honestly communicate with your teen. “Parents may not realize the severity of their child’s illness, which is why a collaborative decision with the child, the parents, and the health care providers is key.”

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The benefit of antidepressants is relief from symptoms of conditions like major depressive disorder, generalized anxiety disorder (GAD), or OCD.

They can alleviate symptoms enough to help your teen take other actionable steps toward improving mental well-being.

Like all drugs, they do have potential side-effects, including:

  • gastrointestinal upset
  • agitation
  • headaches
  • irritability
  • sleep disturbance
  • hyperactivity/impulsivity/mania
  • sexual dysfunction
  • increased bruising/bleeding

In rare cases, certain antidepressants may cause serotonin syndrome, a potentially life-threatening condition caused when serotonin levels become too-high in the body.

All antidepressants also carry a “black box warning” related to suicidality in pediatric patients. This is the FDA’s highest level of warning on medication labels.

According to a 2019 review, a meta-analysis on 23 antidepressant trials which demonstrated a small but statistically significant increase in suicide ideation among pediatric patients.

The warning is considered controversial because the same data showed no increased suicide ideation risk when assessed systematically.

How to monitor your teen during antidepressant use

The FDA recommends close monitoring by caregivers and medical professionals during a teen’s antidepressant use, especially over the first several months.

This includes both physical changes or change sin behaviors, thoughts, or function.

If you’re not sure where to start, the American Academy of Child and Adolescent Psychiatry recommends this evaluation chart.

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Jenkins indicates that small steps can go a long way in supporting a teen with depression. She recommends:

  • being empathetic and patient
  • understanding that failure to complete tasks isn’t from laziness
  • avoiding dismissive statements like, “Just look on the bright side.”
  • encouraging open, nonjudgmental conversation
  • exploring additional support options at school or at home, like extra reminders
  • keeping your home a safe place, without weapons, harmful substances, or situations of abuse
  • being an example of healthy habits related to eating, exercising, and lifestyle
  • educating yourself on your teen’s mental health diagnosis
  • increasing awareness of online activities that may promote cyberbullying
  • encouraging teens to continue with their interests, friends, and hobbies
  • reaffirming you’re dedicated to helping them overcome their mental health challenge
  • supporting the use of professional help

“Let your teenager know you love them and will do everything possible to help them,” says Lagoy. “Children and teenagers know that you care. Their family and loved ones will support them no matter what.”

It’s natural to feel uncertain about putting a teen on antidepressants. While there are many tried-and-true options available, they all come with potential side-effects that sound alarming.

But it can be suspected that antidepressants wouldn’t be available for use in teens if they were dangerous. Under the right treatment plan, antidepressants can be extremely helpful in taking the edge off symptoms of mental health conditions.

They can help your teen feel good enough to engage in the other aspects of treatment, and can help prevent adolescents from being any more stressful than it naturally is.