A narrative review of advances in pharmacotherapy for depression and suicidal behavior in youth within the era of heightened social media

Background and Objective: While social media has connected its users worldwide to share information and beliefs, the impact of increased access and exposure to digital platforms on the mental health of our children has raised concerns. The pandemic has also had a significant impact on pediatric mental health compounded by isolation, lack of exercise and increased exposure to mobile devices. Pediatric depression, suicide and non -suicidal self -injurious behaviors have significantly increased during the pandemic and there will be long-term effects of these mental health conditions into their adulthood. Unfortunately, there have been no significant advances in depression treatment for children and adolescents although off -label uses of newer antidepressants and second generation antipsychotics have increased. This paper examines the latest evidence on pharmacological treatments explored and applied in children and adolescents for depression, suicidal tendencies, and non -suicidal self -injurious behavior. Agents such as lithium and clozapine have anti -suicidal properties but their use in pediatrics are limited by their adverse effects and monitoring requirements. Second generation antipsychotics (SGAs) and N-acetylcysteine (NAC) have shown promise for reducing non -suicidal self -injurious behaviors. In addition to pharmacotherapy, psychotherapy should always be combined for enhanced benefit in the treatment of depression, suicidality and non -suicidal selfinjurious behavior. Clinicians, educators and family should be aware of primary and secondary suicide prevention strategies to protect our most vulnerable youths. Methods: A literature review was conducted using the PubMed (National Library of Medicine) database and Google Scholar for studies that were published during January 1, 2000 to August 1, 2022. Specific English -language articles that focused on treatment of depression, suicide and self -injurious behavior in youths were selected for inclusion. Articles that solely included adults ( >= 18 years) were excluded from this literature review. Key Content and Findings: Psychotherapy remains first line for treatment of depression, suicide and self -injurious behavior. Pharmacotherapy can be combined for enhanced benefit, especially in those who do not respond to psychotherapy and/or those who are at imminent self -harm. Agents such as lithium and clozapine have anti -suicidal properties but their use in pediatrics are limited by their adverse effects and monitoring requirements. SGAs and NAC have shown promise for reducing non -suicidal self -injuries (NSSIs). Conclusions: Clinicians, educators and family should be aware of primary and secondary suicide prevention strategies to protect our most vulnerable youths.