Treatment of Major Depression in Adolescents: Weighing the Evidence of Risk and Benefit in Light of Black Box Warnings

Abstract

This article is a review of the risks and benefits associated with selective serotonin reuptake inhibitors (SSRIs) in light of recent advisory guidelines issued by the U.S. Food and Drug Administration and the Medicines and Healthcare Products Regulatory Agency of the United Kingdom. This article also makes recommendations for integrating SSRIs into a treatment plan for adolescents with major depressive disorder. This study aims to provide an overview of the evidence in the literature to inform clinicians who are concerned by reports linking SSRI use with increased incidence of suicidal ideation in adolescents with major depressive disorder. Salient literature from 2004 to 2006, as well as case study based on the author's clinical experience. Practitioners need to be aware of cautionary guidelines issued by the U.S. and U.K. authorities; however, this awareness does not preclude continued use of SSRIs. There are risks and benefits associated with SSRIs, but they remain an effective tool for use in the treatment of adolescents with depressive symptomatology. SSRI use should be part of a comprehensive treatment plan, which includes patient and family education regarding side effects of these drugs.