Antidepressant side effects in children and adolescents.

The association between antidepressant treatment and suicidality in children and adolescents has been the subject of a great deal of recent discussion and controversy. Appropriate warnings have been attached to these drugs by governing bodies in the United Kingdom and the United States. However, the data upon which these deliberations have been based derive almost exclusively from clinical trials supported by the manufacturers of the respective drugs; data that are rigorous, in some respects, but which may not capture the clinical realities of antidepressant treatment in real-world settings. Data are presented from a neuropsychiatry clinic where 128 children and adolescents were treated with modern antidepressants over the past 14 months. Behavioral side effects, including suicidal ideation and self-injurious behavior, were not an uncommon accompaniment of antidepressant treatment. The problems, however, were mild and decidedly nonlethal and easily managed in the clinic setting. Ironically, 34 of 36 patients who had developed behavioral side effects to antidepressants were subsequently managed, without further incident, either on an alternative antidepressant or on lower doses of the offending agent.