“Depression interrupts a youth’s normal emotional development, undermines self-esteem, interferes with learning in school and undermines friendships with peers,” says Dr. Graham Emslie, chief of psychiatry at Children’s Medical Center. In short, he says, teen depression is a serious illness. The benefits of taking drugs to fight it far outweigh the potential risks.

The so-called “black box” warning on some antidepressants warns that suicidal thoughts are more likely in the first few weeks of use or when dosages are changed. Psychiatrists say the warning was meant, in part, to alert other doctors to the need for closer monitoring.

“Suicidal thoughts are very common in adolescents,” Dr. Emslie says. “At least one in six thinks about it, and about half of all kids with depression will attempt suicide.” Thankfully, few succeed. “Usually, they won’t tell anybody about it, and that’s what we worry about.”

Studies involving about 4,400 depressed kids led to the new warning. Those who took antidepressants were twice as likely to express suicidal thoughts as those who took placebos (sugar pills). The numbers were small – 4 percent for those on the drugs vs. 2 percent on placebos. No actual suicides occurred, says Dr. Emslie, whose personal research based at Children’s and UT Southwestern Medical Center at Dallas was the first study to show that medication was more effective than placebo in treating depression in children and adolescents.

A recent clinical trial involving approximately 440 adolescents with major depression showed that about 70 percent responded well to a combination of Prozac and talk therapy. That was double the rate for youngsters on placebos.

“The key is, if you think your child might have depression, don’t worry about trying to define what it is, just get it checked out,” Dr. Emslie advises. “Get to a mental health professional and get a comprehensive evaluation. The good news is that if it is depression, we really can help most of these kids.”

• Changes in mood, possibly including sadness and irritability.
• Major changes in behavior, such as aggressiveness or fighting.
• Loss of interest in favorite activities.
• Avoiding friends or family.
• Trouble sleeping or fatigue.
• Changes in appetite or weight.
• Trouble organizing, concentrating or remembering.
• Low self-esteem.
• Thoughts of hurting themselves or others.