Teenagers in the developmental period in all aspects of immaturity, by external pressure and other triggering factors easy to develop into depression, anxiety and other mental illnesses, children and adolescents with depression patients in our country is increasing year by year, is one of the main causes of teenage suicide. Although antidepressants have better efficacy in treating children and adolescents with depression and anxiety disorders, studies have shown that antidepressants may increase the risk of adolescent suicide, and the FDA has issued a black box warning. Children and adolescents antidepressants should be used with caution, need to be used under the professional guidance of a doctor, which I summarized the use of antidepressants for children and adolescents need to pay attention to the process of the 8 major problems. 1. Is a suicide warning necessary? FDA report on an extensive analysis of clinical trials suggests that antidepressants may cause or worsen suicidal thoughts or behavior in a small number of children and adolescents, with a slight increase in suicidal thoughts compared to placebo.The FDA requires drug companies to black box warnings on antidepressant drug instructions, including all SSRI drugs. However, newer research suggests that the benefits of antidepressants may outweigh the risk of suicide, that suicide rates in children decrease when taking antidepressants, and that the presence of black box warnings may also be counterproductive as fewer prescriptions lead to an increase in suicidal rates in adolescents, so many experts also believe that these warnings should be removed. 2. Why does it lead to suicidal behavior? Because depression carries a risk of suicide, it is difficult to establish a clear causal relationship between antidepressant use and suicide. Researchers speculate that in addition to a variety of potential causes, in some children antidepressants may also trigger anxiety, agitation, hostility, restlessness, or impulsive behavior, effects that may indicate that a child’s depression is getting worse or even starting to develop suicidal thoughts. 3. Should children be treated with antidepressants? Although the warning about antidepressants and the risk of suicide does not mean that antidepressants should not be used in children, it should be understood that the warning is controversial and that more and more studies are tending to show that the warning does more harm than good. The warning is not intended to scare people away from antidepressants, but rather suggests that the pros and cons of antidepressant use in children and adolescents should be carefully weighed to prevent a real risk of suicide due to untreated depression. For many children and adolescents, antidepressants are an effective way to treat depression, anxiety, obsessive-compulsive disorder, or other mental health conditions. If not treated effectively, a child may have trouble going about their normal daily life. 4. What should I do before using antidepressants? It is important to have a thorough evaluation before starting antidepressants. An evaluation by an experienced psychiatrist should include: ① a detailed review of any potential risk factors that may increase the risk of self-harm; ② an assessment of the possibility of other psychiatric disorders, such as anxiety disorders, ADHD, or bipolar disorder; and ③ an assessment of whether there is a family history of psychiatric disorders or a history of suicide. 5. Which antidepressants can children take? The FDA has approved certain antidepressants for use in children and adolescents with various psychiatric disorders (Table). The recommended starting and maximum doses of these medications vary with age. It is important to know that psychiatrists may prescribe other antidepressants “over-the-counter” depending on the situation. 6. What should I do if I start taking an antidepressant? The FDA recommends that physicians prescribe minimal amounts to minimize the risk of intentional or accidental use. Clinicians, parents, and caregivers should monitor changes carefully. High risk times for suicide attempts and behaviors are: (1) during the first few months (first 8 weeks) of antidepressant treatment, and (2) when the dose is increased or decreased. As a clinician, it is important to remind parents and caregivers that they should monitor their child carefully every day during this period and watch for possible changes throughout the course of treatment.The FDA also recommends close monitoring by their healthcare provider during the first few months of treatment. 7. What signs of danger are present? Signs and symptoms of suicide or self-harm can be difficult to see, and the child may not tell parents directly. Some signs that a child’s symptoms may be worsening or that he or she may be at risk for suicide or self-harm are: (1) talking about suicide or death, (2) attempting suicide or self-harm, (3) acting out in an agitated or restless manner, (4) having new or worsening anxiety or panic attacks, (5) being impulsive and irritable, (6) having increased sadness or depressive symptoms, (7) having extreme increases in talk, energy, or activity, (8) having aggressive, violent, or hostile behavior, (9) having sleep problems or worsening insomnia, (10) being alone, (11) having trouble sleeping, or having insomnia, and (12) being alone with the family. or worsening insomnia, or increased time spent alone. If any of these signs are present, your child’s condition may be getting worse and you need to contact your doctor immediately. Make sure your child stays on antidepressant medication without a prescriber. Stopping antidepressants suddenly may result in intolerable withdrawal reactions or worsening of the condition. 8. What other treatment options are available? Most children’s condition improves with antidepressants. Medication supplemented by psychotherapy may often be more effective. Cognitive-behavioral therapy and interpersonal therapy have been shown to be effective in treating depression by a large body of clinical evidence. For some children with milder symptoms, psychotherapy alone may also be effective.