Antidepressants can be a worrying topic for parents. If your child has depression, you may wonder whether medication is necessary, whether it is safe, or how it could affect your child’s wellbeing. These are common concerns, and understanding the facts can help you make informed decisions.
Medication is not the first treatment for every child. Many children and young people are supported with careful assessment, psychological therapy, family support, school involvement, and advice on sleep, anxiety management, nutrition, and exercise before antidepressants are considered.
When depression is moderate to severe, persistent, or not improving with therapy alone, antidepressants may be recommended as part of a wider treatment plan. This guide explains when they may be used, how they work, possible side effects, and what you should know before treatment begins.
Are Antidepressants Used in Children?
Yes, antidepressants are sometimes used to treat depression in children and young people, but they are prescribed much more carefully than they often are in adults. Whether your child needs medication will depend on their symptoms, overall health, and specialist assessment.
The NHS explains that antidepressants are not usually recommended for children and young people under 18, although they may be used in certain situations alongside other treatments. NICE also advises that antidepressants should not be offered for moderate to severe depression unless they are combined with psychological therapy and supported by careful monitoring of your child’s mental state, progress, and any side effects.
This means medication is usually one part of a wider treatment plan rather than a treatment on its own. Alongside medication, your child may also benefit from psychological therapy, regular reviews, and support at home and school to help with their recovery.
Medication Is Not the First Step for Every Child
Antidepressants are not usually the first treatment for every child with depression. If your child’s symptoms are mild, they may be supported with other approaches before medication is considered.
NICE advises that antidepressants should not be used as the initial treatment for mild depression in children and young people. Instead, your child’s symptoms may be monitored carefully, appropriate support can be offered, and their progress reviewed to see whether they improve or become more severe over time.
Depression affects every child differently, so treatment should always be tailored to their needs. If your child has more severe symptoms, self-harm or suicidal thoughts, major difficulties at school, weight loss, persistent low mood, or has not responded well to therapy, a specialist assessment may be needed to decide whether medication is appropriate.
When Might Antidepressants Be Considered?
Antidepressants may be considered if your child’s depression is moderate to severe, is having a significant impact on everyday life, or has not improved enough with psychological therapy alone. The decision to start medication is always based on your child’s individual needs and circumstances.
NICE recommends that children and young people with moderate to severe depression should be assessed by a specialist child and adolescent mental health service, such as CAMHS. It also advises that antidepressants should only be prescribed after assessment and diagnosis by a child and adolescent psychiatrist.
For some young people aged 12 to 18 with moderate to severe depression, combined treatment with fluoxetine and psychological therapy may be considered from the outset. In other cases, medication may be offered after psychological therapy has not produced enough improvement. For younger children, the evidence is more limited, so the decision requires particularly careful specialist and multidisciplinary assessment.
Before recommending treatment, the specialist will carefully weigh the potential benefits against the possible side effects and safety concerns. You should have the opportunity to discuss the reasons for treatment, ask questions, and understand why medication is or is not being recommended.
What Does “Moderate to Severe Depression” Mean?
Moderate to severe depression means your child’s symptoms are having a significant impact on their everyday life. You may notice that they are finding it difficult to cope with school, friendships, hobbies, or other activities they once enjoyed.
NICE recommends referral to a specialist child and adolescent mental health service, such as CAMHS, for children and young people with moderate to severe depression and for those who are at a high risk of self-harm or suicide.
The severity of depression is not based on one symptom alone. Instead, the clinical team will look at your child’s overall pattern of symptoms, how their daily life is being affected, any risks to their safety, their family and school circumstances, and any other mental or physical health conditions before deciding on the most appropriate support.
Why Specialist Assessment Matters
Before your child starts an antidepressant, they should have a thorough specialist assessment. This helps you understand the cause of your child’s symptoms and makes sure the treatment is based on an accurate diagnosis rather than assumptions.
NICE recommends that antidepressants should only be prescribed after assessment and diagnosis by a child and adolescent psychiatrist. During this assessment, the specialist will consider whether your child’s symptoms could be linked to conditions such as anxiety, trauma, ADHD, autism, eating disorders, bipolar disorder, substance use, physical health problems, or family stress, as these may need a different approach.
If the diagnosis is uncertain, medication may not be the right choice straight away. By carrying out a detailed assessment, the specialist can recommend the treatment that best matches your child’s needs and give you confidence that they are receiving the most appropriate care.
Antidepressants Are Usually Combined With Therapy
Antidepressants are normally prescribed alongside psychological therapy. If therapy is declined or cannot be started, medication may sometimes still be considered by the specialist, with particularly careful monitoring. This combined approach gives your child support from both medication and therapy, helping to address different aspects of depression.
NICE advises that antidepressants should not normally be offered for moderate to severe depression unless psychological therapy is provided at the same time. It also recommends careful monitoring, which may include weekly contact with you and your child during the first four weeks of treatment, although the exact schedule should be based on your child’s individual needs.
Medication may help reduce depressive symptoms, making it easier for your child to take part in therapy. At the same time, therapy can help your child understand their thoughts, feelings, behaviours, coping strategies, relationships, and triggers, while ongoing support at home and school remains an important part of recovery.
Evidence Note
NICE guideline NG134 recommends that antidepressant medication for moderate to severe depression should normally be combined with concurrent psychological therapy and supported by careful monitoring. For young people aged 12 to 18, combined fluoxetine and psychological therapy may sometimes be considered as an initial treatment option. For younger children, the evidence for fluoxetine is more limited, so specialist assessment and multidisciplinary review are particularly important.
Which Antidepressant Is Usually Recommended First?
If your child’s specialist recommends an antidepressant for moderate to severe depression, fluoxetine is usually the first medicine considered. NICE recommends fluoxetine because clinical evidence shows that, when used appropriately, its benefits outweigh the risks for children and young people.
Fluoxetine is the antidepressant most commonly recommended by NICE when medication is appropriate for children and young people with moderate to severe depression. Decisions about its use are always made by specialist clinicians after careful assessment. If your child is prescribed fluoxetine, the clinician will explain why it has been recommended and what you can expect from treatment.
This does not mean fluoxetine is the right choice for every child. Before making a decision, your child’s clinician will consider factors such as age, diagnosis, the severity of symptoms, physical health, other medicines, possible side effects, and your child’s individual needs to make sure the treatment is appropriate.
When NICE NG134 was published, fluoxetine was the only antidepressant with UK marketing authorisation specifically for treating depression in children and young people aged 8 to 18. Current licensing information should always be checked before treatment begins. Your specialist should explain whether any medication is being used within its licensed indication or outside it.
What Are SSRIs?
SSRIs, or selective serotonin reuptake inhibitors, are a group of antidepressant medicines. If your child is prescribed an antidepressant, it is most likely to be from this group of medicines.
The NHS explains that fluoxetine is an SSRI and is thought to work by increasing the level of serotonin, a chemical in the brain linked to mood. Although this may help reduce depressive symptoms in some children and young people, depression is much more complex than a simple chemical imbalance.
SSRIs are not an instant solution, and they are only one part of treatment. When your child is prescribed an SSRI, it should be used carefully as part of a specialist treatment plan that may also include psychological therapy and ongoing support.
How Long Do Antidepressants Take to Work?
Antidepressants do not usually start working straight away, so you may not notice an improvement in your child’s symptoms immediately. This can be frustrating, especially when your child is finding daily life difficult.
The NHS explains that fluoxetine can take a few weeks before symptoms begin to improve. During this time, your child may experience some side effects before the benefits of the medication become clear.
This is why careful monitoring is so important during the early stages of treatment. You should know what changes to expect, which symptoms to report, and when to contact your child’s clinician if you have any concerns.
What Parents Should Be Told Before Treatment Starts
Before your child starts antidepressant treatment, you should receive clear and easy-to-understand information about what to expect. Having the right information can help you feel more confident and involved in your child’s care.
NICE recommends that you and your child are told why the medication has been recommended, how long it may take to work, the expected course of treatment, possible side effects, and why it is important to take the medication as prescribed. It also advises that written information should be provided in a format that meets the needs of both your child and your family.
You should feel comfortable asking questions about the benefits, risks, alternative treatments, what to do if your child’s symptoms worsen, and how their progress will be reviewed. Medication should never feel like something you are expected to accept without a full explanation.
Antidepressant Treatment at a Glance
| Treatment Point | What Parents Should Know | Why It Matters |
| Not for every child | Mild depression is not usually treated first with medication | Avoids unnecessary prescribing |
| Specialist assessment | NICE says prescribing should follow assessment by a child and adolescent psychiatrist | Helps confirm diagnosis and suitability |
| Usually combined with therapy | Medication should normally be given with psychological therapy | Treats symptoms and underlying patterns |
| Fluoxetine is usually first choice when medication is appropriate | NICE recommends fluoxetine when medication is appropriate | NICE considers it the antidepressant for which trial evidence most clearly shows that benefits outweigh risks in this population. |
| Delayed effect | Improvement may take several weeks | Prevents unrealistic expectations |
| Close monitoring | Weekly early contact may be used in the first four weeks | Helps detect side effects and risk changes |
| Safety planning | Families should know what to do if self-harm thoughts worsen | Supports urgent response |
| Gradual stopping | Antidepressants should not be stopped suddenly | Reduces withdrawal or discontinuation symptoms |
This table is only a guide. Your child’s own specialist should explain the plan clearly.
Monitoring for Suicidal Thoughts, Self-Harm or Hostility
The first few weeks of antidepressant treatment require careful monitoring, as this is an important time to watch for any changes in your child’s mood or behaviour. Although serious problems are uncommon, recognising them early helps keep your child safe.
NICE recommends that children and young people taking antidepressants are closely monitored for suicidal thoughts, self-harm, or increased hostility, particularly at the start of treatment. You should contact the prescribing clinician urgently if you notice any new or worsening symptoms of this kind.
This does not mean antidepressants will cause these problems, but it does mean that any changes should be taken seriously. If your child becomes more agitated, talks about self-harm, seems unusually hostile, or appears to be at greater risk, you should not wait for the next routine appointment before seeking medical advice.
Common Side Effects of Fluoxetine
Like all medicines, fluoxetine can cause side effects, although not every child will experience them. Many side effects are mild and improve as your child’s body adjusts to the medication.
Commonly reported effects of fluoxetine can include nausea, headache, sleep disturbance, tiredness and digestive symptoms. Some children may experience changes in appetite, weight, sleep, anxiety levels or behaviour. Any significant mood or behavioural changes should be discussed promptly with the prescribing clinician. The exact side effects and their frequency vary, so you should read the medicine leaflet supplied with your child’s prescription and discuss persistent or troubling symptoms with the prescribing clinician or pharmacist.
Do not stop or change the dose without advice unless emergency healthcare professionals instruct you otherwise. Report persistent or worrying side effects promptly, and obtain urgent help for severe reactions or immediate safety concerns.
You should let the prescribing clinician know if side effects are affecting your child’s sleep, appetite, school life, or willingness to continue treatment. Sharing these concerns early can help the clinical team decide whether any changes or extra support are needed.
Serious Side Effects Parents Should Know About
Serious side effects from antidepressants are uncommon, but it is important that you know what to look out for. Recognising warning signs early can help your child receive prompt medical attention if it is needed.
The NHS highlights several important warning signs that require medical advice, including severe allergic reactions, serotonin syndrome, unusual mood changes such as mania, worsening suicidal thoughts, or unexplained bleeding. If you think your child is experiencing serious side effects or having thoughts of self-harm while taking fluoxetine, you should contact NHS 111 for advice.
If your child has seriously harmed themselves, taken an overdose, or you believe they are at immediate risk of harming themselves, do not wait for a routine appointment. Call 999 or go straight to A&E so your child can receive emergency care as quickly as possible.
Side Effects and Safety Signs at a Glance
| Possible Change | What You May Notice | What to Do |
| Nausea or vomiting | Feeling sick, being sick, appetite changes | Report if persistent or affecting eating |
| Sleep problems | Insomnia, unusual tiredness or drowsiness | Discuss with the prescribing clinician |
| Headache | New or worsening headaches | Monitor and report if troublesome |
| Behaviour change | Agitation, hostility or marked irritability | Contact the prescribing team urgently |
| Suicidal thoughts | Talking about death, self-harm or not wanting to live | Seek urgent help |
| High mood or overactivity | Unusual excitement, racing thoughts, risky behaviour | Contact the clinician promptly |
| Bruising or bleeding | Unexplained bruises, black or bloody stool | Seek medical advice |
| Allergic reaction | Swelling, rash, breathing difficulty | Seek emergency help |
| Possible serotonin syndrome | Agitation or confusion with sweating, shaking, fever, diarrhoea, muscle stiffness or a fast heartbeat | Seek urgent medical assessment |
This table does not include every possible side effect. Families should read the medicine leaflet and follow the prescribing doctor’s advice.
Will Antidepressants Change Your Child’s Personality?
Many parents worry that antidepressants might change their child’s personality or make them seem like a different person. This is a common concern, and it is important to discuss it with your child’s clinician if it is worrying you.
The aim of antidepressant treatment is not to change who your child is. Instead, it is intended to reduce the symptoms of depression so your child can take part in everyday life, engage with therapy, and gradually recover.
While most changes are related to improving depression, you should tell the prescribing clinician if you notice unusual changes in your child’s behaviour, mood, sleep, agitation, or emotional expression. As you know your child best, your observations are an important part of monitoring their progress.
Can Antidepressants Make Things Worse at First?
Some children and young people may experience side effects or changes in their mood, behaviour, or anxiety during the first few weeks of antidepressant treatment. This can be worrying, but it does not always mean the medication is unsuitable.
NICE recommends that your child is monitored closely for suicidal behaviour, self-harm, or increased hostility, particularly at the start of treatment. Careful follow-up during these early weeks helps the clinical team identify any concerns and respond promptly if needed.
This does not mean antidepressants should be avoided, but it does mean your child needs close supervision while treatment begins. You should have a clear safety plan, and you should know how to contact the prescribing team if your child’s symptoms become worse or you have any concerns.
What if My Child Misses a Dose?
If your child misses a dose of fluoxetine, follow the instructions provided by their clinician or the medicine leaflet. Usually, a missed dose should be taken when remembered unless it is close to the next dose. Two doses should not be taken together. In that case, you should skip the missed dose and continue as normal. You should never give your child two doses at once to make up for a missed one.
Avoid changing your child’s dose without medical advice. If you find that your child regularly forgets to take their medication, let the clinician know so you can work together to create a routine that is easier to follow.
Why Antidepressants Should Not Be Stopped Suddenly
Your child’s antidepressant should not be stopped suddenly, even if they seem to be feeling much better. Stopping treatment too quickly can cause discontinuation symptoms, sometimes described as withdrawal-like symptoms. These are not the same as addiction but can be uncomfortable and are one reason medication should usually be reduced gradually.
The NHS advises that fluoxetine should not be stopped abruptly and that your child’s doctor will usually reduce the dose gradually over several weeks or months. NICE also recommends phasing out antidepressants over 6 to 12 weeks in children and young people, with the exact schedule adjusted according to any withdrawal symptoms.
If you think your child no longer needs their medication, speak to the prescribing clinician before making any changes. They can review your child’s progress and create a gradual plan to stop treatment safely when the time is right.
How Long Might Treatment Continue?
The length of antidepressant treatment varies from one child to another and depends on how well your child responds, how severe their depression has been, their risk of relapse, and specialist advice. Your child’s treatment plan will be reviewed regularly to make sure it continues to meet their needs.
NICE advises that if your child responds well to fluoxetine, treatment should continue for at least six months after remission. Remission means your child has been free from symptoms and has returned to normal daily functioning for at least eight weeks.
This may be longer than you expect, but continuing treatment after your child feels better can help reduce the risk of depression returning too soon. Your clinician should explain the treatment plan, review your child’s progress, and discuss when it is safe to reduce and stop the medication gradually.
What Happens if Fluoxetine Does Not Work?
Some children do not improve enough with fluoxetine, while others may need to stop taking it because of side effects. If this happens, your child’s clinical team will review their progress carefully before deciding on the next step.
NICE advises that if fluoxetine is not effective or is not well tolerated, another antidepressant may be considered. Sertraline or citalopram can be used as second-line treatments, but only after a thorough reassessment, a suitable trial of fluoxetine and therapy, advice from a senior child and adolescent psychiatrist, and a full discussion of the potential benefits and risks.
Changing medication is a specialist decision, so you should not expect an immediate switch if your child is not improving straight away. Before recommending another medicine, the team may review your child’s diagnosis, how well they have been taking their medication, their engagement with therapy, family and school factors, self-harm risk, and any other health conditions.
Which Antidepressants Should Not Be Used?
Not all antidepressants are suitable for children and young people. The type of medication your child receives should always be chosen by a specialist after a careful assessment of their symptoms and overall health.
NICE advises that paroxetine and venlafaxine should not be used to treat depression in children and young people. It also recommends that tricyclic antidepressants should not be used for treating depression in this age group, which is why specialist prescribing is so important.
You should never give your child medication that has been prescribed for someone else or bought without appropriate medical supervision. Although antidepressants belong to the same group of medicines, they are not interchangeable, especially when treating children.
St John’s Wort and “Natural” Remedies
Some parents consider herbal or “natural” remedies because they feel these may be a safer option than prescription medicines. However, natural products are not always safe, especially when your child is already taking medication for depression.
NICE advises that St John’s wort should not be used to treat depression in children and young people. The NHS also recommends that you tell your child’s doctor about any medicines, herbal remedies, vitamins, or supplements they are taking, as St John’s wort can interact with fluoxetine and several other medicines.
Although natural remedies may seem appealing, they are not always the safest choice for your child. Before you give your child any herbal product or supplement, it is always best to speak with their healthcare professional to make sure it is appropriate and safe.
Interactions With Other Medicines and Substances
Antidepressants can interact with other medicines, herbal remedies, supplements, and some substances. Before your child starts treatment, you should tell the clinician about everything they are taking, including vitamins and over-the-counter medicines.
The NHS advises that some medicines and supplements, including MAOI antidepressants, blood-thinning medicines, NSAIDs such as aspirin and ibuprofen, and St John’s wort, may not mix well with fluoxetine. It also recommends avoiding alcohol while taking fluoxetine, as it can increase side effects such as drowsiness.
If your child is a teenager, it is important to have an honest discussion with the clinician about alcohol, cannabis, recreational drugs, or supplements. NICE also recommends asking directly about alcohol and drug use when assessing depression, as this can affect both treatment decisions and your child’s safety.
Antidepressants and Bipolar Disorder
Before antidepressants are prescribed, the clinician will consider whether your child’s symptoms could suggest bipolar disorder rather than depression alone. This helps ensure your child receives the most appropriate and safest treatment.
NICE recommends asking about any family history of unipolar or bipolar depression, particularly in parents and grandparents, when assessing a child or young person with a suspected mood disorder. This information can play an important role in guiding treatment decisions.
You should tell the clinician if there is a family history of bipolar disorder, episodes of mania, mental health-related hospital admissions, or periods of unusually high energy or mood. Sharing these details can help the clinical team decide whether antidepressants are suitable or if further specialist assessment is needed.
Antidepressants and Self-Harm Risk
The risk of self-harm should be assessed carefully before your child starts antidepressants and throughout their treatment. These conversations may feel difficult, but they are an important part of keeping your child safe.
NICE recommends that healthcare professionals speak directly with both you and your child about self-harm and suicidal thoughts. Your child should also be given the opportunity to discuss these concerns privately with their clinician if they wish.
The NHS advises speaking to a GP if your child is self-harming or having thoughts of self-harm, as they can arrange the right support and refer them to children and young people’s mental health services if needed. Although these discussions can be worrying, being open and honest helps your child receive the safest and most appropriate care.
Parents’ Role During Treatment
As a parent, you play an important role in supporting your child’s treatment and recovery. Your involvement can help make treatment safer, more consistent, and easier for your child to manage.
You can help by making sure your child takes their medication as prescribed, attending follow-up appointments, watching for side effects, encouraging therapy, and keeping communication open. You should also avoid stopping the medication suddenly, changing the dose, sharing medication, or giving supplements without medical advice.
Your child may not always tell their clinician everything they are experiencing. By sharing what you have noticed about their sleep, appetite, behaviour, school life, and overall safety, you can provide valuable information that helps guide their care.
Supporting Your Child Without Making Them Feel Watched
Supporting your child means keeping an eye on how they are coping without making them feel watched all the time. Regular check-ins can be reassuring, but they are often more helpful when they feel like a conversation rather than constant questioning.
Instead of repeatedly asking whether the medication is working or whether they are having suicidal thoughts, you could agree on a regular time to talk about how they are feeling. This can make it easier for your child to speak openly and let you notice any changes over time.
You and your child should also agree on which signs need urgent attention, such as worsening self-harm thoughts, severe side effects, feeling unusually agitated, or thoughts of overdose. If your child is an older teenager, giving them appropriate privacy and involving them in decisions can help build trust and encourage honest communication.
What Children and Teenagers Should Understand
Your child should receive information about their medication in a way they can easily understand. When you explain what to expect in simple, age-appropriate language, it can help your child feel more comfortable and involved in their treatment.
You and your child should understand why the medication has been recommended, how it may help, how long it could take to work, which side effects to report, what to do if a dose is missed, and who to contact if your child feels worse. Having these conversations can make treatment feel less worrying and more manageable.
NICE recommends explaining the reason for treatment, how long it may take to have an effect, the expected course of treatment, possible side effects, and the importance of taking the medication as prescribed. By involving your child in these discussions, you can help them feel supported and included rather than feeling that decisions are being made for them.
Consent, Confidentiality and Shared Decisions
Decisions about antidepressants should involve your child as much as possible, taking into account their age, maturity, and ability to understand their treatment. This helps them feel included and supports shared decision-making.
NICE recommends that children, young people, and parents or carers are involved in discussions about the possible benefits and risks of antidepressants, particularly when second-line treatments are being considered. This gives you the opportunity to ask questions and make informed decisions together.
Your teenager may also be offered time to speak privately with their clinician, especially about topics such as self-harm, substance use, abuse, sexual health, or family stress. These conversations are usually confidential, but if there are concerns about your child’s safety, the clinician may need to share information to keep them safe.
Antidepressants and School Life
Depression can affect your child’s attendance, concentration, behaviour, and motivation at school. In some cases, antidepressants may also cause side effects that affect sleep, alertness, or stomach comfort, which can make school more challenging.
The school does not always need detailed information about your child’s medication, but it can be helpful for staff to know that they are receiving support for depression. With your child’s agreement where appropriate, the school may be able to provide practical support during this time.
This support could include access to a trusted adult, reduced pressure during difficult periods, help catching up with schoolwork, a quiet space, or awareness of any safety concerns. If medication side effects are affecting your child’s school life, let the prescribing clinician know so treatment can be reviewed if needed.
Antidepressants Are Not a Quick Fix
Antidepressants are not a quick fix, and they will not make all of your child’s difficulties disappear overnight. It can take time before you notice an improvement, and they work best as part of a wider treatment plan.
Your child may still need support with sleep, school, friendships, bullying, family stress, anxiety, physical symptoms, and daily routines. By helping with these areas, you can support your child’s recovery alongside any medication they are taking.
NICE recommends looking at your child’s social, educational, and family circumstances when assessing depression. While medication may ease symptoms and help your child take part in everyday life more comfortably, you should not expect it to solve every factor contributing to their depression on its own.
When Medication May Not Be the Right Choice
Medication may not be the right choice if your child’s depression is mild, the diagnosis is still unclear, or another condition is more likely to be causing their symptoms. It may also not be suitable if your child cannot be monitored safely or if the potential risks outweigh the benefits.
In some cases, treatment may be delayed while clinicians assess for conditions such as bipolar disorder, eating disorders, substance use, trauma, safeguarding concerns, or underlying physical health problems. These assessments help ensure your child receives the most appropriate care.
This does not mean your child is being denied treatment. Instead, the clinical team is choosing the safest and most effective approach, and you can ask what alternative support is available and when medication might be reviewed again.
When Urgent Help Is Needed
Seek urgent professional help if your child is having suicidal thoughts, has self-harmed, feels unable to remain safe or develops a marked deterioration in their mood or behaviour. Contact the prescribing team, your GP, NHS 111 or your local urgent mental health service for immediate advice.
Call 999 or go to A&E if your child has taken an overdose, has seriously harmed themselves, is about to harm themselves, cannot be kept safe or is experiencing a life-threatening reaction to medication.
Do not wait for the next medication review when you believe your child may be in immediate danger. Stay with them where it is safe to do so, remove accessible medicines or other means of harm, and obtain emergency assistance.
When to Speak to a GP
Speak to a GP if you think your child may have depression, if their symptoms continue, or if you are worried about self-harm, sleep, appetite, school, or changes in behaviour. Getting advice early can help your child receive the right support.
The NHS recommends making an appointment with a GP if you are concerned about your child’s mood or overall wellbeing. A GP can assess symptoms, consider whether physical health may be contributing, and discuss any immediate concerns.
If needed, the GP can refer your child to children and young people’s mental health services for specialist assessment and support. Although a GP may not start antidepressant treatment, they can help your child access the most appropriate care.
When to See a Paediatrician
A paediatrician may be helpful if your child’s depression is accompanied by physical symptoms such as headaches, stomach aches, tiredness, changes in appetite, sleep problems, or concerns about growth and development. These symptoms can sometimes affect your child’s overall wellbeing.
A paediatrician can assess whether an underlying physical health condition may be contributing to your child’s low mood. They can also work closely with mental health professionals to help coordinate your child’s care.
Although a paediatrician plays an important role, they do not replace a child and adolescent psychiatrist when antidepressant treatment is being considered. Instead, they form part of a wider team supporting your child’s physical and emotional health.
When CAMHS or Specialist Mental Health Care Is Needed
Specialist mental health care may be needed if your child’s depression is moderate to severe, continues for a long time, involves self-harm or suicidal thoughts, or does not improve with initial support. Getting the right assessment early can help your child receive appropriate treatment.
NICE recommends that children and young people with moderate to severe depression should be assessed by a specialist child and adolescent mental health service, such as CAMHS. It also advises that antidepressants should only be prescribed after assessment and diagnosis by a child and adolescent psychiatrist.
CAMHS (Child and Adolescent Mental Health Services) or another specialist mental health service can assess your child’s diagnosis, level of risk, therapy needs and whether medication is suitable. You do not have to make decisions about antidepressants on your own, as this is a specialist decision.
Myth vs Fact
| Myth | Fact |
| Antidepressants are used for every child with low mood | Medication is not recommended for every child and is not the initial treatment for mild depression |
| Antidepressants work immediately | Fluoxetine may take a few weeks before symptoms start to improve |
| Medication replaces therapy | NICE usually recommends antidepressants only with concurrent psychological therapy |
| Any doctor can casually start antidepressants in a child | NICE says prescribing should follow assessment and diagnosis by a child and adolescent psychiatrist |
| Fluoxetine is risk-free because it is commonly used | It can cause side effects and requires careful monitoring |
| Stopping suddenly is fine once the child feels better | Antidepressants should be reduced gradually with medical advice |
| Natural remedies are always safer | St John’s wort is not recommended for depression in children and young people and can interact with medicines |
| Side effects mean the medicine must be stopped immediately | Some side effects settle, but families should contact the clinician for advice rather than stopping suddenly |
| Talking about self-harm makes it worse | Asking directly and calmly helps identify risk and get support |
Key Takeaways
- Antidepressants are not recommended for every child with depression.
- Mild depression is usually managed without medication initially.
- Fluoxetine is generally the first antidepressant recommended when medication is appropriate.
- Medication should usually be combined with psychological therapy.
- Careful monitoring is essential during the first weeks of treatment.
- Never stop antidepressants suddenly without medical advice.
- Seek urgent help if suicidal thoughts or serious side effects develop.
- Treatment recommendations and licensing differ according to your child’s age.
- Fluoxetine may be used off-label in some younger children, which the specialist should explain clearly.
FAQs:
1. Are antidepressants safe for children?
Antidepressants may be appropriate and effective for some children when specialist prescribed and monitored carefully. They are not suitable for every child with depression, and treatment decisions are based on the severity of symptoms, the child’s overall health and the potential benefits and risks. Medication is usually combined with psychological therapy.
2. Which antidepressant is usually prescribed first for children with depression?
When medication is appropriate, fluoxetine is generally the first-choice antidepressant recommended by NICE for children and young people with moderate to severe depression. It has the strongest evidence for effectiveness and safety in this age group when used under specialist supervision.
3. How long does it take for antidepressants to start working?
Antidepressants do not work immediately. It may take several weeks before symptoms begin to improve. During this time, regular follow-up appointments are important to monitor your child’s progress, side effects and overall wellbeing.
4. Can antidepressants make my child’s depression worse at first?
Some children and young people may experience increased anxiety, agitation or changes in mood during the early stages of treatment. Because of this, close monitoring is recommended, particularly during the first few weeks. Contact the prescribing clinician immediately if your child’s symptoms worsen or they develop thoughts of self-harm or suicide.
5. Will antidepressants change my child’s personality?
The aim of antidepressant treatment is to reduce the symptoms of depression, not to change your child’s personality. As depression improves, many children begin to feel more like themselves again. Any unusual behavioural or emotional changes should be discussed with the treating clinician.
6. Can my child stop taking antidepressants once they feel better?
No. Antidepressants should never be stopped suddenly without medical advice. The dose usually needs to be reduced gradually over several weeks or months to minimise withdrawal or discontinuation symptoms and reduce the risk of relapse.
7. Are antidepressants used on their own or with therapy?
For most children and young people with moderate to severe depression, antidepressants are recommended alongside psychological therapy rather than as a stand-alone treatment. Therapy helps children develop coping strategies and address the underlying causes of their depression.
8. What are the most common side effects of fluoxetine?
Common side effects include headaches, nausea, stomach upset, changes in appetite, sleep disturbances, dizziness and tiredness. Many side effects improve as the body adjusts to the medication, but persistent or troublesome symptoms should be discussed with the prescribing clinician.
9. What should parents do if their child misses a dose?
If your child misses a dose, they should usually take it when they remember unless it is nearly time for the next scheduled dose. They should not take two doses together to make up for the missed one. If missed doses happen frequently, speak to the prescribing clinician for advice.
10. When should urgent medical help be sought while a child is taking antidepressants?
Seek urgent medical attention if your child has suicidal thoughts, has self-harmed, taken an overdose, develops severe allergic reactions, experiences symptoms of serotonin syndrome, or you believe they are at immediate risk of harming themselves. In an emergency, call 999 or go to the nearest Accident and Emergency (A&E) department immediately.
Final Thoughts: Supporting Your Child’s Recovery
Depression in children can often be treated successfully with the right combination of support, and antidepressants are only one part of the treatment plan for a small number of children and young people. When medication is recommended, it should follow a thorough specialist assessment, be used alongside psychological therapy wherever possible, and be supported by careful monitoring to help ensure treatment is both safe and effective. If you are concerned that your child may be experiencing depression or would like a comprehensive paediatric assessment of their physical and emotional wellbeing, you can contact London Paediatric Clinic to discuss the most appropriate next steps.
References:
- National Institute for Health and Care Excellence (NICE) (2019, reviewed 2024) Depression in children and young people: identification and management. NICE guideline NG134. Available at: https://www.nice.org.uk/guidance/ng134
- National Institute for Health and Care Excellence (NICE) (no date) Depression in children: moderate to severe depression. Clinical Knowledge Summary. Available at: https://cks.nice.org.uk/topics/depression-in-children/management/moderate-to-severe-depression/
- National Institute for Health and Care Excellence (NICE) (no date) Depression in children: fluoxetine prescribing information. Clinical Knowledge Summary. Available at: https://cks.nice.org.uk/topics/depression-in-children/prescribing-information/fluoxetine/
- NHS (2025) Fluoxetine: an antidepressant medicine. Available at: https://www.nhs.uk/medicines/fluoxetine/
- NHS (2025) Antidepressants. Available at: https://www.nhs.uk/medicines/antidepressants/
- NHS (no date) Depression in children and young people. Available at: https://www.nhs.uk/mental-health/children-and-young-adults/advice-for-parents/children-depressed-si…
- NHS (no date) Where to get urgent help for mental health. Available at: https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/
- Medicines for Children (no date) Fluoxetine for obsessive compulsive disorder, depression and bulimia nervosa. Available at: https://www.medicinesforchildren.org.uk/medicines/fluoxetine-for-obsessive-compulsive-disorder-ocd-…
- electronic Medicines Compendium (eMC) (no date) Fluoxetine 20mg Capsules: Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/11909/smpc
- Neavin, D.R., Joyce, J. and Swintak, C. (2018) ‘Treatment of major depressive disorder in pediatric populations’, Diseases, 6(2), article 48. Available at: https://www.mdpi.com/2079-9721/6/2/48
- Walter, H.J., Abright, A.R., Bukstein, O.G. et al. (2023) ‘Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders’, Journal of the American Academy of Child & Adolescent Psychiatry, 62(5), pp.479–502. Available at: https://pubmed.ncbi.nlm.nih.gov/36273673/
- Dwyer, J.B. and Bloch, M.H. (2019) ‘Antidepressants for pediatric patients’, Current Psychiatry, 18(9), pp.26–42. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6738970/