To fully understand their effects on society, a look at antidepressant medications used on children and adolescents is also necessary. Small children and adolescents continuously go through periods of mental and physical development. This makes it difficult for physicians to differentiate between these symptoms based on these factors and those of a depressive state. Adolescents, more so than smaller children, are often more hesitant to disclose their feelings to their parents when they are faced with a stressful situation. This fact is based on the many stigmas placed on teens today. Also identity and role confusion play a part in teenage apprehension with regard to emotional expression. Therefore, it is not too farfetched to believe that adolescents too can be the victims of overstress and depression. Friends, parents and/or caregivers are often an essential tool that physicians and psychologists utilize, because these individuals spend the majority of time with the struggling child and are more likely to notice subtle changes that may occur. The negative effects of antidepressant in citizens under the age of 19 have been largely ignored by the general public due to the misrepresentation of data regarding clinical trials. According to an article by Dr. Yona Amitai and Dr. Henri Frischer, several tests between the years of 1991 and 1995 had inconclusive results that made it impossible to call for a change in the use of desipramine, a TCA used in children and adolescents for the treatment of depressive states (Amitai and Frischer 54). Dr. Amitai and Dr. Frisher, therefore conducted a study to recall the data of deaths from 1983 to 2002 due to five different TCAs (Amitai and Frischer 55). The results showed that 24 deaths resulted for TCAs in children less than 6 years old; 10 of which were caused by desipramine (Amitai and Frischer 55). The results further illustrated 144 deaths were caused by TCAs in children 6 to 19; 56 of which were due to desipramine (Amitai and Frischer 56). These results show a trend of increasing severity of side effects with regard to the use of antidepressants in teens and younger children.