Mental Health Care Issues

To Medicate a Child or Not

• Anxiety disorders. There is strong evidence for the efficacy of cognitive behavioral therapy, but SSRIs may be effective for children who do not show improvement with behavioral therapy alone.

• Depression and suicidal ideation and behavior. Evidence suggests that children and adolescents with depressive disorders respond well to a wide variety of psychosocial treatments. Fluoxetine—the only medication that has been approved by the Food and Drug Administration for use in children with depression—can be effective for children who don’t respond, but practitioners should monitor patients closely and inform parents about the risk of suicidal ideation or behavior associated with SSRIs.

There is almost no research on specific treatments for suicidal children and adolescents. Multisystemic therapy has shown some promise in reducing suicide attempts, but these findings need to be replicated. There are no medication studies that have specifically targeted suicidal children and adolescents.

• Bipolar disorder. Both the psychosocial and pharmacological treatments for this condition require more study. The limited research available suggests psychosocial treatments can be effective and do not have adverse side-effects. Researchers need to conduct short- and long-term studies to clarify the risk-benefit ratio for all psychotropics used to treat bipolar disorder in children and adolescents. Read more