Parents Grapple with How to Treat Depressed Kids
February 25, 2005
by Julie Deardorff, Chicago Tribune

The antidepressant Zoloft did not drive a 12-year-old to murder his grandparents, a jury decided last week, but the news was hardly comforting to parents who have children on the medication.

Antidepressants now come with ominous new governmental warning labels that describe a frightening link between the drugs and increased suicidal thought and behavior in children. Once parents agonized over whether to start their kids on antidepressants. Now they wonder: should they stop?

The controversial labels, issued last fall by the Food and Drug Administration, are supposed to help parents make educated choices, in part because there is little data on safety-and efficacy-of antidepressants in children.

And so far, they seem to be waking people up. Last year the number of American children on antidepressants fell sharply, after increasing for more than a decade.

But some depression experts are alarmed by the drop and say the warning label is a reckless experiment that can discourage treatment and actually lead to more child suicides. They worry that parents will stop medicating children who benefit from the drugs. Abruptly halting treatment can also cause withdrawal reactions that include suicidal tendencies, aggression and dizziness.

"There is no question some children are put on medication who don't need it," said Louis Kraus, chief of child and adolescent psychiatry at Rush University Medical Center. "But for those who benefit and haven't had a complete response, there is a very serious risk (to going off medication)."

The problem is exacerbated by a severe shortage of mental health professionals who can help monitor the effects of the drugs. Family doctors now write 70 percent of the prescriptions for antidepressants. But fearing potential lawsuits, they may avoid treating depressed children, warns the American Academy of Child and Adolescent Psychiatry.

Instead, primary-care doctors are referring patients back to mental health professionals who have monthlong waiting lists. About 7,000 child and adolescent psychiatrists are working in the U.S. despite a need for about 30,000.

So what is a parent to do?

First, ask yourself if the medication your child is taking is working, and how long he has been on it, said child psychiatrist James Beeghly, an associate professor of psychiatry at the University of Iowa. "The greatest risk of suicidal thought is when they first start," Beeghly said. "If the child has been on for a couple of months, they have passed the major risk of suicidal use."

A combination of fluoxetine, or Prozac, and a specific type of psychotherapy called cognitive therapy have been shown to be the most effective treatment for depression in children and adolescents. But don't count out alternative treatments. German researchers have found a specifically manufactured extract from the herb St. John's wort is at least as effective in treating depression as the drug Paroxetine.If the medication is causing side effects or hasn't improved a child's mood, talk to the doctor about whether to continue. But don't quit cold turkey. About 78 percent of patients have a withdrawal reaction when they stop antidepressants, depending on the drug, according to Harvard psychiatrist Joseph Glenmullen, author of The Antidepressant Solution (Simon & Schuster, $24.95), a guide to safe tapering.

Lifestyle changes can help dramatically. About 35 minutes of intense aerobic exercise each day can alleviate mild to moderate depression in adults on par with antidepressants or cognitive therapy, according to a study in the January issue of the American Journal of Preventive Medicine.

A change in diet also is key, said chiropractic neurologist Michael Johnson."It's easy to slap a kid on drugs, but to not do anything nutritionally is insane," said Johnson, author of What Do You Do When the Medications Don't Work? (Jokamar-Jenake, $24.95).

Though the natural substance uridine is still hard to come by-it's found in breast milk and enriched baby food-Harvard researchers have found that when uridine is combined with omega-3 fatty acids, it can prevent signs of depression just as well as antidepressants.

Other ways to use food as medicine include looking for hidden food allergies and eating more complex carbohydrates, which can help boost low serotonin levels. Also, cut out caffeine, sugar and hydrogenated or saturated fats, which increase fatigue and sluggishness.