Treatment for Adolescent Depression
by Dr. David C. Mathis, Licensed Psychologist, Health Service Provider
I hope to briefly address concerns which have been raised by the recent public health advisory issued by the Food and Drug Administration (FDA). The FDA advised drug manufacturers to include a Warning statement about the potential for increased suicide risk when antidepressant medications are prescribed. Last year, the counterpart of the FDA in Britain banned the use of antidepressant drugs known as SSRIs, except for Prozac. Prozac was the first in this new class of drugs and they are now the most widely prescribed psychotropic medications for children. These drugs include Zoloft, Effexor, Paxil, Luvox, Celexa, Lexapro, Wellbutrin, Serzone and Remeron. The best and most recent clinical study, which was commissioned by the National Institutes of Mental Health (NIMH), found an increase risk for suicide if medication ALONE was the treatment for adolescent depression.
We have suspected that once a medication was started that suicidal tendency might increase because the individual felt more energized and thus more likely to act. However, it may also relate to changes in judgment associated with the medication such as a decrease in inhibition. Whatever the reason, there has been growing concern about the increase risk of suicidal actions when medication is initially begun.
However, an encouraging finding from the study is that Prozac AND counseling reduced the risk of suicide and lowered the symptoms of depression. Counseling (psychotherapy), both alone and with Prozac, was found to be a protective element against suicide in adolescents.
As a parent, what should you do if you suspect that your child or adolescent may be suffering from depression? The worst thing is to do nothing. Remember, untreated depression puts an adolescent at even greater risk of suicide. Effective treatment will benefit most people. So, if you have concerns, you can begin by obtaining consultation with a professional (psychologist, physician, mental health worker). In addition, be realistic about the role of medication and expect that more will be needed than a prescription for your child. In fact, effective treatment should, at the minimum, include counseling for the adolescent and will likely include the parents to some degree.
The FDA and NIMH have provided an important service to the public by increasing the awareness of the limitations and risk of medication alone but also the benefit of medication when used in conjunction with psychotherapy.