Literature related to the gene variant known as the short form of the serotonin transporter in the course and treatment of depression from 1999 to 2020 is reviewed. Depression occurs in some 2-5% of children and adolescents. It occurs frequently in subjects who will ultimately develop bipolar illness (45%) and in young people who have been exposed to maltreatment of deprivation. In the latter group, presence of the short form of the serotonin transporter and similar genetic variants appear to increase the risk of developing depression. In these populations use of antidepressants can adversely affect the course of illness, resulting in increasing depressive symptoms, increasing suicidal ideation, or destabilization of course. Clinicians need to use antidepressants in children and adolescents with caution. The effectiveness of antidepressants in youths is not as well documented or established as that in adults. Serotonin reuptake inhibiting antidepressants should be avoided if the patient has a documented family history of bipolar illness or has the short form of the serotonin transporter (or related genotypes), because these agents have been associated with worsening the course of illness of both of these groups. There is a dearth of data for alternative treatment strategies in pediatric depression.
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