Childhood Depression and Antidepressants
Do you think your tween or teen is struggling with major depression? Here, parents can learn about medication and therapy options, risks, warning signs and tips for running intervention.
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At some point, most parents will observe it in their kids: Sadness that seems to take a long time to lift, often brought on by a disappointment that, to a child, seems more important than it actually is. But what if those feelings don't subside? What solutions are available to parents when a child's feelings overwhelm them to the point that they're not interacting with others in a normal way?
When major depression – an insidious disorder that strikes kids during key formative years, when they're struggling to develop a positive self-image – occurs, the impact can be more debilitating than parents realize. And more than 2.5 percent of kids and 8 percent of teens do face major depression.
Today, mental health professionals better recognize depression in youth – and are much better prepared to provide effective and long-lasting treatment. However, parents are faced with several questions, including whether antidepressant medication should part of their child's treatment plan.
Almost a decade after the U.S. Food and Drug Administration approved the use of serotonin-enhancing drug Prozac for children 8 years and older, the use of all classes of antidepressant drugs to treat kids remains controversial. For parents, there is both a wealth of information – and misinformation – regarding the drugs and their side effects.
Benefits and the black box
Currently, two medications are FDA-approved for the treatment of depression in youth: The aforementioned Prozac and Lexapro, which is approved to treat children ages 12 years and older. However, a qualified medical professional can prescribe any medication on the market for off-label uses. Doses for children and teens are typically low – in the 10- to 20-milligram range.
Jon Markey, a Berkley-based child psychiatrist, says antidepressants are an effective tool used to fight depression, but they should never be used without proper oversight.
"Antidepressants can be very helpful to children," he says, "but the key is to monitor the patient. A child will need to come in to see their psychiatrist frequently and, the best case scenario, (the plan) always includes ongoing therapy."
Yet in 2003, the FDA issued a caution – followed by "black box" warnings added to antidepressant labels in 2004 – that use of the meds could increase the risk of suicidal thoughts among kids and adolescents. That cast a cloud over using the medications to treat children, says David Rosenberg, M.D., director of child and adolescent research services at the Wayne State University Department of Psychiatry and Behavioral Neurosciences in Detroit.
"There was a drop in the use of antidepressants, (and) there was an increase in suicides," he says. "It was biggest increase that we saw in several years, so clearly, the medication was helping young people."
The FDA study that led to the label showed that of 2,200 children treated with serotonin-enhancing medications, 4 percent experienced suicidal thinking or behavior. Two percent of kids taking a placebo exhibited the same behavior. No child in the study committed suicide.
Risks: By the numbers
Antidepressants do pose some risks, like suicidal ideas and worsening symptoms of depression and irritability, to name a few – though the medical community still debates whether the FDA study established a definitive link between the use of antidepressants and increased suicidal thoughts.
However, a 2007 National Institutes of Mental Health study called Treatment for Adolescents with Depression noted most children respond positively to the medication.
In a clinical trial of 439 kids ages 12-17, NIMH found 71 percent responded to a combo treatment of Prozac and cognitive behavioral therapy after 12 weeks. For meds-only, it was 61 percent – and down to 43 percent for therapy only. By contrast, only 35 percent responded to a placebo treatment.
Medical professionals also point to youth suicide rates, which were trending down after serotonin-enhancing drugs came on the market. The Centers for Disease Control and Prevention's Annual Summary of Vital Statistics found the suicide rate spiked 18 percent in young people 19 years old and under between 2003 and 2004 – after the FDA issued the warning that led to a drop in antidepressant use among children.
Watch and listen
Selective serotonin re-uptake inhibitors, or SSRIs – which include Prozac and Lexapro – affect chemical messengers known as neurotransmitters, which triggers a complex process that can alter mood. But because children's brains are still developing, their response must be strictly monitored by medical professionals – and parents.
Georgia Michalopoulou, Ph.D., chief of staff for child psychiatry and psychology at Children's Hospital of Michigan in Detroit, says this monitoring is vital for all depressed children, especially if a kid is taking medication.
"Parents should watch their child very closely," she says. "Medical professionals need feedback to determine whether the drug is working to treat a child, and they absolutely need to be informed about any changes in the patient's behavior."
No child should ever be prescribed an antidepressant without a thorough medical and psychological work-up – the best way to make an accurate diagnosis. This will determine if a child responds to therapy alone, if their depression is chronic, if there's a family history of depression and if there are substance abuse issues.
That's key because medications for depression may not be effective against other conditions like bipolar disorder, obsessive-compulsive disorder or anxiety disorders, Michalopoulou says. And because all children are unique, there's no cookie cutter fix in terms of medication or therapy.
"Ongoing therapy – talking with children – is an effective strategy when treating depression," she says, "along with medication."
Typically, parents need to take their child to his or her psychiatrist or mental health professional every week for up to one to two months, followed by bimonthly appointments. Once it's determined that a medication is working – and that side effects are minimal or not life-threatening – appointments may get less frequent, Michalopoulou says.