Drug Info

How young is too young for antidepressants? How old is too old?

Donna Christiano writer headshot By | May 19, 2020
Medically reviewed by Gerardo Sison, Pharm.D.

Antidepressants are medications used to treat depression, a condition that often has different symptoms in different age groups. In general, it causes prolonged feelings of sadness and loss of interest in once pleasurable activities. Many people with depression become withdrawn, hopeless, angry, lethargic, and even experience physical symptoms like weight loss/gain or sleep problems. 

Antidepressants are some of the most common prescriptions in the U.S. The Centers for Disease Control and Prevention (CDC) reports that 15.4% of Americans aged 40-59 took an antidepressant in the last 30 days. 

But middle aged adults aren’t the only ones with depression. It occurs in the very young and very old, too. The CDC notes that nearly 2 million children between ages 3 and 17 have depression, often in combination with other mental health disorders such as anxiety and behavior problems. Rates of depression in older people are estimated in the 1% to 5% range, but can be 10 times higher for those who require home health care or hospitalization, according to the CDC. 

“The sooner you catch depression, the better,” says Beth Salcedo, MD, past president of the Anxiety and Depression Association of America and medical director of the Ross Center. “It needs to be diagnosed and treated early. Typically, we try to treat it with psychotherapy, behavior therapy, and family interventions because these methods empower people and give them tools to last a lifetime. But, certainly, medication is an appropriate option. And there’s not an age where I would say this person is too young or too old for antidepressants. There are so many factors that play into whether you give someone an antidepressant.”

What does depression look like in kids?

While they can share similar symptoms, kids typically experience depression differently than adults. “Children are more likely [than adults] to present with sudden mood changes, temper tantrums, and irritability rather than a depressed mood,” says Natasha Nambiar, MD, a medical advisor for eMediHealth. “Difficulty with sleep, weight loss, and anxiety appear more common in younger children, whereas increased eating, weight gain, and slowness in motor activity seem to increase in adolescents.”

Can kids be prescribed antidepressants? 

The FDA has approved antidepressants for children, with use that increases with age. One study from 2018 found that kids in the youngest group of the study (3-5 years old) got just 0.8% of prescriptions for psychiatric drugs (including antidepressants), whereas adolescents accounted for 7.7%. The American Psychological Association (APA) reports that 3.4% of kids 13-19 have taken antidepressants in the last month.

What are the best antidepressants for children?

The Food and Drug Administration (FDA) has only approved two drugs to treat depression in children. Prozac (fluoxetine), a selective serotonin reuptake inhibitor (SSRI)—a drug that helps boost levels of serotonin, one of those “feel good” chemicals, in the brain—is approved for kids as young as 8. Lexapro (escitalopram), another SSRI, is approved for kids 12 and over. 

That’s not to say a doctor won’t prescribe another antidepressant for a child. If a drug is approved by the FDA, doctors are free to prescribe it for whatever reason for whomever they think it will work. This is called off-label use. Some doctors prescribe other SSRI antidepressants—such as Celexa and Zoloft—for use in children. 

“Most of the SSRIs are considered safe for all age groups, and most of the drugs in this class can be widely used,” says Dr. Salcedo. An older class of drugs, called tricyclic antidepressants, are not often prescribed—for the young or old—primarily because they have more side effects and are more dangerous if overdosed.

Regardless of what antidepressant is prescribed, experts say the drugs work best for  moderate-to-severe depression (degrees of depression are based on things such as the number of symptoms, their duration, and how much they interfere with life). They can also work better when used in tandem with therapy, especially talk therapy or cognitive behavior therapy, which helps people change the way they think about certain situations and experiences. 

What does depression look like in the elderly?

Depression in the elderly often masquerades as the normal aging process, and as such, often goes undiagnosed and untreated. “Sometimes depression in the elderly can mimic dementia,” says Dr. Salcedo. “So you might see short-term memory loss, word-finding-difficulty, trouble with names. It’s really important to rule out depression when you see cognitive impairment in the elderly.” Additionally, certain medical conditions (e.g., some vascular conditions that cause blood vessels to stiffen) and the medication used to treat them can contribute to depression. 

According to the National Institute on Aging, other symptoms of depression in the elderly include:

  • Fatigue
  • Problems sleeping
  • Moving or talking slowly
  • Changes in weight/appetite
  • Difficulty concentrating
  • Indecisiveness
  • Suicidal thoughts

Should antidepressants be used in the elderly?

Although antidepressants for elderly patients  need to be chosen carefully due to contributing health factors and possible drug interactions, seniors can and should be treated for any diagnosed depression. Research published in the journal Expert Review of Neurotherapeutics notes higher rates of mental and physical decline, death and suicide in the elderly with untreated depression. What’s more, the researchers also note that when used in conjunction with psychotherapy, antidepressants for seniors significantly improve quality of life and lower death rates.

What are the best antidepressants for elderly patients?

When it comes to antidepressants for seniors, most experts recommend SSRIs or selective norepinephrine reuptake inhibitors (SNRIs), which help increase the brain chemicals serotonin and norepinephrine. These drugs tend to have fewer serious side effects and drug interactions than older antidepressants on the market. They also seem to be just as effective in older people as they are in younger ones, although some doctors suggest starting at half a normal dose and gradually increasing it while watching for side effects and mood improvement. If no improvement is seen after four weeks on a full dose, you may need a different medication.

Commonly used antidepressants and their dosages, by age

Common antidepressant dosages by age group
Antidepressant Child/Adolescent Adult Elderly
Lexapro 10-20 mg daily 10-20 mg daily 10 mg daily
Prozac 10-20 mg daily 10-80 mg daily Your doctor may start with a low dose and gradually increase if necessary. How low depends on age and other health factors.
Celexa Not approved for those under 18, but may still be prescribed in an off-label use. Dosage varies by patient. 20-40 mg daily Not more than 20 mg daily in adults older than 60; higher doses can cause heart rhythm abnormalities

Dosages are not only determined by age. Symptoms, reaction, weight, and other factors play a role in prescribing antidepressants.