Treatment Medications		The FDA's formal "Black Box" warnings were issued in October, 2004, after about a year of suspected increased suicidal ideation in adolescents who were taking SSRIs. This is the strongest caution to practitioners regarding medications. These recommendations have made many pediatricians nervous about the use of SSRIs. However, they are NOT a contraindication to prescribing medication for depression. You have to weigh the risk of not treating the child at all and letting their depression or anxiety continue versus the risk of increased suicidal ideation while on medication. The TADS study showed a clear correlation between treatment with SSRIs and resolution of depression. 60% of adolescents showed a positive response to Prozac or the generic fluoxetine alone, without CBT. This is a significant improvement, proving that treatment with an SSRI is definitely something worth doing. You usually start with 10 mg a day of Prozac and slowly increase. Prozac has a very long half-life. The maximum dose is 40-80 mg/day. An adequate trial is at least 4-6 weeks to see if there is any therapeutic response. Paxil was the drug that instigated the TADS study. It is dosed similarly to Prozac and is more sedating. It is actually a better drug for anxiety than depression. Fluoxetine is the only FDA approved drug for depression in adolescents. If medication is used, it will not be for a brief period of time. It is usually continued for 6-12 months to achieve a therapeutic effect. You should avoid frequent dose changes during that time. The FDA recommends weekly face-to-face follow-up for the first month after starting an SSRI, something not practical for many primary care practices. You may end up handling this follow-up on the phone and in conjunction with a psychiatrist. Return to top of page