Teen Depression

Written by Diane Dennis for Portland Family Magazine

Recent news reports revealed that there is an association of suicide with antidepressant drug treatment in the children and adolescent population. "Children and adolescents who took the medications are more than 1.7 times more likely to want to or try to harm themselves than are those who received a placebo," writes Ed Lamb, Pharmacy Today. The controversy began when British health authorities declared that antidepressants might sometimes increase the risk for suicidal behavior in children and teenagers. This news has serious implications as, according to the Wall Street Journal, "Prescriptions of antidepressants for all reasons rose 42.6 per 1,000 office visits by children in the period 1990-2001."

But, depression left untreated or undiagnosed can be deadly. The American Academy of Child and Adolescent Psychiatry warns that depression can have deleterious effects as untreated adolescent depression is linked to 500,000 suicide attempts each year. Gordon Smith's bill, The Garrett Lee Smith Memorial Act which Congress passed recently, authorizes 82 million dollars over three years to identify and treat youth at greatest risk for suicide. Smith's son Garrett took his life in 2003 after battling depression for years.

In an attempt to strike a compromise over the need for antidepressant treatment and the association between suicide and antidepressants, the Food and Drug Administration, after data from research provided by independent experts, are expected to recommend strong warning labels on all antidepressants. The controversy lies in a question. Is a warning label enough? While a warning would raise the stakes for doctors deliberating whether to prescribe the drugs, there is no evidence that the right kids will get the right drugs. And, doctors are pressured by consumer demand. There is also no evidence that drug companies would curtail or stop advertising antidepressants through television commercials and glossy magazine ads. In fact, advertising could increase as drug companies compete for more market share to counteract the negative implications of antidepressants.

Although Fluoxetine (Prozac) is the only medication approved by the FDA to treat depression in children and adolescents, many other drugs are being prescribed. According to the San Francisco Chronicle, the top antidepressant prescribed in 2004 was Zoloft. And, four other (unapproved) antidepressants were also prescribed to adolescents and children regularly. So, if the FDA does in fact require warning labels on all antidepressants, it is in a very awkward position of having to warn doctors about using these drugs for purposes that the agency has not approved.

Studies have shown, and many experts agree that pill-therapy alone is not enough when treating mental health problems. One local family therapist who wishes anonymity is fond of saying, "Kids are not like cars. You don't just drop them off to get fixed." She is referring to her long- standing battle cry about the importance of frequent monitoring of these medications in tandem with talk therapy, hopefully for the whole family.

However, with managed care requiring doctors to work longer and faster with less pay, and without parity for mental health insurance coverage, extensive follow-ups and monitoring is not practical as well as cost prohibitive for most families.

Another critical element in this serious dilemma is that once a drug has been given the green light for use in the market, doctors are clear to use it even for conditions not specifically endorsed by the agency. And, just because a drug has been approved for use doesn't mean that doctors have access to all clinical trials involving the drug. After a recent lawsuit, the makers of Paxil, GlaxoSmithKline a British drug maker, agreed to post on its Web site, the results of all clinical trials involving drugs. The suit was filed against the pharmaceutical company because it publicized the results of only one of five trials studying the effect of its antidepressant Paxil in children. According to the New York Times, "The others not only failed to show any benefit for the drug in children but demonstrated that children taking Paxil were more likely to become suicidal than those taking a placebo."

For a long time now the American Academy of Pediatrics has held the position that there is an overmedicating of our youth. This was originally in response to the prescribing of drugs for attention deficit disorder. However, instead of less prescription writing, there seems to be more. The question really becomes, what is a parent to do?

First, recognize the signs of depression. The American Academy of child and Adolescent Psychiatry advises that if one or more of the following signs of depression persist, parents should seek help by asking their physician to refer them to a qualified mental health professional who can diagnose and treat depression in children and teenagers:

Frequent sadness, tearfulness, crying
Hopelessness
Decreased interest in activities: or inability to enjoy previously favorite activities
Persistent boredom; low energy
Social isolation, poor communication
Low self esteem and guilt
Extreme sensitivity to rejection or failure
Increased irritability, anger, or hostility
Difficulty with relationships
Frequent complaints of physical illnesses such as headaches and stomaches
Frequent absences from school or poor performance in school
Poor concentration
A major change in eating and/or sleeping patterns
Talk of or efforts to run away from Home
Thoughts or expressions of suicide or self destructive behavior

For more information visit www.aacap.org.