Antidepressant Debate Baffles Teens' Parents
June 02, 2004
The Palm Beach Post
Continuing controversy over the use of antidepressants in children under 18 has its good points: It has generated more open discussion about medication and the alternatives, and it has produced more awareness that depression exists in this age group.
But with awareness can come confusion, and this seems to be underscored in a survey recently released by Columbia University's Carmel Hill Center for Early Diagnosis and Treatment, Division of Child and Adolescent Psychiatry (see the results here).
The poll of 512 parents, all with children under 18, showed that parents didn't know whether to trust antidepressants, and more than half feared that the drugs are being over-prescribed to young people.
The statistics show how confused parents are.
About one-third of the parents surveyed (31 percent) believed that teenagers who are prescribed antidepressant medications are harmed by their use, and an equal percentage (31 percent) thought the opposite. An even larger percentage (40 percent) were unsure about what they thought.
"Parents are worried that many teens with depression aren't getting treated and many teens without depression are," said Laurie Flynn, director of the Carmel Hill Center.
The debate over the value of these drugs in young people has been intensified by warnings that antidepressants known as SSRIs have been linked to suicide and violent tendencies in children under 18 and that the U.S. Food and Drug Administration has approved only one antidepressant - Prozac - for use in depressed children.
And more children are depressed than we might think.
One in five young people will have one or more episodes of major depression by the time they become adults, studies show, and the majority of children suffering from mental illness do so without anyone knowing.
So, if drugs aren't the answer - and whether they are or aren't is still a matter of concern in the United States - what alternatives are valid?
Even doctors who support antidepressants urge talk therapy with the pill. Beyond that, there is a smorgasbord of options, according to North Carolina psychiatrist Dr. Grace Jackson.
She agrees that it takes "a very motivated person" to experiment with the range of possibilities she suggests, including diet/ nutrition, exercise, energy-based therapies (reiki, healing touch, acupuncture, chi gong), body therapy (massage), and "expressive therapies" (music, art and play therapy). She also includes biofeedback, spirituality, and meditation or prayer on her menu of alternatives.
"My aim is to try to put together a comprehensive treatment plan, look at their entire life, trying not to neglect any aspect of what could be healing," she says.
"I grew to appreciate that pills don't work with most people, or they wear off. And then what?"
So, while many may be conflicted or confused about using antidepressants with teens, there are doctors who espouse alternatives. The difficulty may be in finding one.
One of the things that worries me about articles like this is the implication that the answer is "either-or". I think there is reason to worry about the use of SSRI antidepressants in younger people but the issue of safety is far from settled at this point and we have seen rather imperfect evidence presented on both sides of that issue. It is also undeniable that thousands or maybe millions of people, including teens, have been helped substantially by these medications, and that the best evidence we have currently says that recovery from depression and resistance to relapse is best, at least in adults, when a combination of medication and counselling or psychotherapy is used. -- David Baxter.