Wes: There has been a growing concern about antidepressants among teenagers following the Food and Drug Administration warning in October about suicidal thoughts in teens taking these medicines. Jenny and I have been watching this story, and I've heard many worries from parents. We wanted to discuss this important issue in this week's column.
Jenny: Should teens be put on antidepressants? For some they help, and for others they only make situations worse. My belief is that a person should see a therapist before they go to their family doctor and ask for antidepressants. Depressed teenagers could have psychological problems that medications might cover up, and a therapist can help reveal and deal with them. To fix a broken bone, a doctor doesn't just put a Band-Aid over the skin, give a patient pain pills and call it fixed. A patient may feel better in the short term with this kind of treatment, but the problem really isn't fixed.
A medicated person may start feeling better and think he doesn't need to talk to a therapist. However, eventually one needs to be able to deal with the realities of life and its hardships. Medication can help a person deal with the problems, or it can help them avoid dealing with them. The average teenager is told by society that there's a drug for every possible ailment, making them believe a pill can make every problem go away. That is a misconception. Of course, in some cases antidepressants allow a person who may be so depressed that he can't even function to open up and work on the problem. But for those people who are stressed out by the problems of adolescence, such as jobs or school, problems with friends and family, or fear of the future, they need to talk about their problems with a professional therapist who can then determine whether medication will help or hinder that process.
Wes: Based on a Columbia University study, the FDA now requires most antidepressants to carry a "black label" warning about possible suicidal thoughts among teens who use them. As we think about this, it is crucial to understand several things: First of all we are talking about an increase in thoughts, not actual suicidal behavior in this study. Second, these increased thoughts were present in only 2 to 3 percent of youth taking these medicines. Third, from other studies, we know that young people are more likely to commit suicide if they are not taking antidepressants because they cannot cope as well with severe depression. Finally, most suicidal thoughts in these studies came in the first few weeks of treatment, and it has long been known that even in nonmedical treatments for depression (psychotherapy, for example) the worst risk for suicide is in this same period.
So what's a parent to do?
First of all, I agree with Jenny that any youth who appears depressed should be seen first in psychotherapy before initiating medication management, preferably at the same clinic as the medication may be prescribed. This allows for the sort of relationship to develop that allows a teen to share suicidal feelings and to have this fed back to the prescriber. Further, at our clinic, we never prescribe these medicines to anyone without a follow-up in two to four weeks -- and at least monthly thereafter -- and we urge parents to work closely with the therapist and prescriber to monitor all effects and side-effects of the medication.
Finally, like Jenny, we urge families and teens not to jump the gun on medication. Teenagers are supposed to be emotional. They are not the Stepford kids, and medicines should not make them so. The National Institute of Mental Health only recommends medication as a first-line course of treatment "for children and adolescents with severe symptoms that would prevent effective psychotherapy, those who are unable to undergo psychotherapy ... and those with chronic or recurrent episodes." And recent research supports medication in tandem with psychotherapy with teens.
Simply put, antidepressants are neither helpful nor dangerous. They are just tools. They should always be considered as a part of the larger treatment picture for a depressed teen, and not without serious professional teamwork.