Approximately thirty percent of my clients are being treated with medication for their anxiety, depression, or ADHD. Not all children or adolescents require medication to treat anxiety or sadness. But when it comes to those who may, it is often a scary decision for parents. I believe reliable education is the best way to combat fear. I say reliable because we are getting a lot of education in our news and media that is often not accurate, skewed, or of rare catastrophic incidences.
Depression is a serious disorder which affects 5 – 12% of adolescents; the range correlates with the increase in age. It causes problems in mood, thinking, and behavior at home, in school, and with peers. Research shows that depression is treatable in adolescents with certain antidepressant medications called Selective Serotonin Reuptake Inhibitors (SSRI).
Should I be worried about possible harmful side effects?
You may be fearful of your child starting an antidepressant medication. In the news, we often hear the worst-case scenarios or isolated incidents. In a FDA review, out of 2200 children treated with an SSRI, 4% of those experienced suicidal thinking or behavior but none of them committed suicide. However, in the current research, with children who have followed through and committed suicide, none have been noted to have been on an antidepressant. Given these statistics, it is my belief antidepressants are still a safe and effective way to treat depression and anxiety but, must be monitored closely by a qualified physician. Close monitoring is especially important for the first 4-6 weeks of treatment. There are very few side effects but, for some reason, there is a rare occasion of it triggering agitation and abnormal behavior in some individuals. If a physician tells you to return for a follow-up in one month or longer, please request for a follow-up sooner – such as in two weeks’ time. I also recommend asking for a referral to a Psychiatrist for antidepressant and other psychotropic medication management.
Here is a list of commonly prescribed SSRI:
When should I see an improvement in my child’s symptoms?
Most adolescents (60%) will improve within 4 weeks on an antidepressant. Be forewarned, there can be a small percentage of people who have “treatment emergent” side effects that usually last about a week. This is the body and brain’s way of adjusting to the effects of the medication. I have often heard these effects described as shaky, jittery, or agitated. Many people swear off the medication before these effects subside saying it is making them more anxious. Unless severe, try to be patient and give the emergent effects at least 10 days to subside.
It takes approximately 4 weeks to get the therapeutic level in the bloodstream which is why it should be taken everyday rather than “if you need it.” It is unlike many medications such as Benzodiazepines (Xanax, Valium) which treat anxiety quickly and for a few short hours or ADHD meds which are stimulants and last typically for 8-12 hours. Although the effect on your child’s depression may not be seen right away, the effect on your child’s anxiety may be seen within the first week or two. There is no way to know which medication your child will respond best to. For whatever reason, your child may respond well to one SSRI and not at all to another. It is important to consider this up front and be prepared to possibly try more than one medication. However, because you do not often see immediate results such as with medications used to treat other conditions, time is required as well. Physicians often follow the “slow and low” protocol, starting with a low dose and slowly increasing to reach the desired effect.
Will my child get better with only counseling?
This may vary from child to child depending on the severity of symptoms and debilitating effects of his or her illness. It is an important thing to consider. Should you try medication alone or in conjunction with counseling? A study performed by the National Institute of Mental Health (NIMH) found that after 12 weeks of treatment, 43% of adolescents improved with therapy alone, 61% improved with medication alone, and 71% percent improved with the combination of medication and therapy. The mark of that improvement was much greater as well.
Will my child need to be on an antidepressant forever?
Once symptoms of depression subside, your child should stay on the medication for 6-9 months for optimal prevention of relapse. If your child has chronic depression or a complex/difficult to treat case, it is suggested to continue for a full 1-2 years past remission. A study followed adolescent patients who had taken Zoloft and continued to take it for one full year after feeling well; 38% of those remained well without a relapse of depression as opposed to NONE of the adolescents who stopped the medication when symptoms subsided and were given a placebo instead. Thus, continuing to take an antidepressant once symptoms subside gives you the best chance at being rid of depression long-term.
(The above information was compiled from information found from The Child Mind Institute and The National Institute of Mental Health. Please see a physician for more information and safety guidelines on these medications.)