Depression and teens

Learning that your teen has depression can be terrifying for a parent – concerns range from getting the right treatment to general safety. It was estimated in 2013 that 8 percent of high school students attempted suicide one or more times in the previous 12 months, according to the Centers for Disease Control and Prevention.

And now, a reanalysis of data in The BMJ last week found that Paxil, one of the most prescribed antidepressants on the market, is ineffective and even harmful for treating major depression in adolescents.

The new findings are in contrast to the original study from 2001. Researchers of the original industry-funded study found Paxil, just one of a group of serotonin re-uptake inhibitors, was safe and effective. The reanalysis showed that a number of adolescents from the original study did experience increased thoughts of suicide. But the suicidal thoughts were simply counted as generic adverse events and not clearly presented in the results.

For a long time, there have been some indications that these medicines may raise the rates of thoughts of self-harm in adolescents. This led the U.S. Food and Drug Administration in 2007 to issue a “black box” warning about increases in suicidal thoughts. In December 2014, the warning was revised to state that attempts at self-harm decreased in patients ages 24 and older with anti-depressant use, but there was no change on the warning for adolescents.

During this nearly decade long discussion, most psychiatrists and many other mental health professionals felt that the warnings were too strict. As a result, they thought many teens were not getting the help that they needed – while others worried that these medicines were possibly harmful. 

What has followed in the wake of this latest reanalysis are stories in the press which have raised the issue of the safety and effectiveness of some antidepressant medications for adolescents.  

 

Learning that your teen has depression can be terrifying for a parent – concerns range from getting the right treatment to general safety. It was estimated in 2013 that 8 percent of high school students attempted suicide one or more times in the previous 12 months, according to the Centers for Disease Control and Prevention.

And now, a reanalysis of data in The BMJ last week found that Paxil, one of the most prescribed antidepressants on the market, is ineffective and even harmful for treating major depression in adolescents.

The new findings are in contrast to the original study from 2001. Researchers of the original industry-funded study found Paxil, just one of a group of serotonin re-uptake inhibitors, was safe and effective. The reanalysis showed that a number of adolescents from the original study did experience increased thoughts of suicide. But the suicidal thoughts were simply counted as generic adverse events and not clearly presented in the results.

For a long time, there have been some indications that these medicines may raise the rates of thoughts of self-harm in adolescents. This led the U.S. Food and Drug Administration in 2007 to issue a “black box” warning about increases in suicidal thoughts. In December 2014, the warning was revised to state that attempts at self-harm decreased in patients ages 24 and older with anti-depressant use, but there was no change on the warning for adolescents.

During this nearly decade long discussion, most psychiatrists and many other mental health professionals felt that the warnings were too strict. As a result, they thought many teens were not getting the help that they needed – while others worried that these medicines were possibly harmful. 

What has followed in the wake of this latest reanalysis are stories in the press which have raised the issue of the safety and effectiveness of some antidepressant medications for adolescents.  

 

So the question for parents is what should they do for their possibly depressed adolescent? 

 The American Academy of Child and Adolescent Psychiatry presents a well-reasoned, thoughtful way to approach depression for parents. First, a mental health professional should evaluate to determine if it is truly depression or a reaction to something that has happened. Grief and loss are normal human responses. For example, the death of a beloved grandparent, loss of friends due to a move, or a break up with a significant other can result in irritability or a few nights of poor sleep p but this does not mean clinical depression.

After taking a detailed history, a licensed mental health professional will recommend treatment if the patient meets the criteria for depression.

  • First line treatment, as AACAP recommends, should be cognitive or interpersonal psychotherapy for mild to moderate depression.
  • For moderate depression that does not respond to psychotherapy or severe depression, medication should be considered as an additional treatment, not a stand-alone intervention. 

The research outcomes are very clear for cognitive therapy in particular. Learning how to more objectively assess situations and solve problems is an effective treatment for depression. The results for patients are usually good or better than medication. Combined psychotherapy with medication for more severe cases usually results in faster improvement and a lower dose of medication. Problems come up when medication only is prescribed with no other treatment, especially if a good diagnostic evaluation has not been done. 

Sometimes depression is presented as simply a “chemical imbalance” of low serotonin levels, and medications are presented as a way to fix that. However, there are many ways to improve one’s chemical balance including psychotherapy, exercise, better diet, and a routine sleep schedule. A healthier lifestyle in general can help enormously. 

With this said, the answer for parents is complex when it comes to teens and anti-depressants. No individual responds exactly the same way and for any one patient, the medications can be a great help and for others not so much. Like all medications, anti-depressants have positive effects and negative side effects, and both need to be monitored. 

Depression is a real disorder, requiring a comprehensive treatment plan that includes psychotherapy, some lifestyle changes, and potentially medication. If your child is depressed, work with your primary care provider to identify a mental health provider skilled at working with adolescents to make sure that your child receives the comprehensive treatment they need.

Read more at Philly.com Depression News

 

 

 

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