Academic journal article Journal of Early Childhood and Infant Psychology

The Use of Antidepressant Medications in Early Childhood: Prevalence, Efficacy, and Risk

Academic journal article Journal of Early Childhood and Infant Psychology

The Use of Antidepressant Medications in Early Childhood: Prevalence, Efficacy, and Risk

Article excerpt

The number of young children (birth to age 5) prescribed psychotropic medications to treat emotional, behavioral, and/or psychiatric disturbances has increased significantly over the past 2 decades. Prescription rates for young children receiving psychotropic medications, including psychostimulants, antipsychotic medications, and antidepressants, doubled from the late 1990s to the early 2000s (Delate, Gelenberg, Simmons, & Motheral, 2004; Gleason et al., 2007). As of 2002, the prevalence rate for antidepressant use among children birth to 5 years old was .10 to .23%. The prevalence rate jumps to 1.4% among children 6 to 12 years old (Delate et al., 2004; Vitiello, Zuvekas, & Norquist, 2006). Since the early 1990s, there has been a 3- to 5-fold increase in prescriptions of antidepressants for children aged 2 to 19 years (Leckman & King, 2007; Zito et al., 2003). Antidepressants are the second most prescribed psychotropic medication for preschool children (psychostimulants are the most prescribed), and prescription rates have doubled over a 4-year period (Zito et al., 2000). Antidepressants have been prescribed to treat a variety of emotional, behavioral, and psychological disorders of childhood, including depression, anxiety, ADHD, selective mutism, autism, and enuresis. Although the prevalence of antidepressant use among young children remains much lower than with older children or adolescents, research indicates that behavioral adverse effects (i.e., irritability, aggression, agitation, hyperactivity) from antidepressant use are more common for younger children (Zuckerman et al., 2007). This finding calls into question the feasibility of antidepressant use in early childhood given adverse effects and lack of empirical support (Luby, 2007).

Despite a dearth of scientific data on treatment efficacy and adverse effects, prescription rates of early childhood psychopharmacology are increasing. This underscores the urgent need for additional research in this area (Luby, 2007). Further, evidence suggests that young children coming from families with the greatest economic need are more likely to be medicated for behavioral and/ or emotional symptoms. For example, Zito and colleagues (2007) reviewed Medicaid insurance records from 2001 and compared the results to similar records from 1995. They found that 2.3% of Medicaid-insured preschoolers received psychotherapeutic medications in 2001, double the rate in 1995, and this increase was largely due to increases across ages 2 to 4 for psychostimulant, antipsychotic, and antidepressant medications. Of the psychotherapeutic medications prescribed, 20.5% were antidepressants (Zito et al., 2007). These results are alarming when considering how little is known about the efficacy of antidepressant medications in early childhood, especially adverse effects, and potentially permanent changes to neurobiological and developmental structures. It is important that mental health professionals working in early childhood carefully consider the available research on treatment strategies for emotional and behavioral symptoms, including a thorough understanding of developmental psychopathology, differential diagnosis, and empirically valid treatment strategies that minimize adverse effects.

Depression in Early Childhood

Major depressive disorder (MDD) in childhood is characterized by intense and persistent sadness, which can alternately manifest as irritability in children. Other symptoms include loss of interest in daily activities, diminished self-esteem, sleep and/or eating dysfunction, feelings of hopelessness, and increase in suicidal ideation. An estimated .8% to 1% of preschoolers meet the criteria for MDD, which increases to 2% in the latency childhood years and 4.5% in adolescence (Silva, Gabbay, Minami, Munoz-Silva, & Alonso, 2005). This means that more than one million youth in the U.S. are diagnosed with MDD (Silva et al.).

Although the diagnosis of MDD has been validated for children as young as 3 years old, the clinical presentation of MDD in early childhood differs slightly from that of older children (Dopheide, 2006). …

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