Treating Depression in Children
I had depression as a child. It went undiagnosed, since I grew up in the seventies and no one knew that children could be clinically depressed. I finally was diagnosed and successfully treated at age 27, but by then my childhood, adolescence and young adulthood had been profoundly affected.
I fervently wish that it had been otherwise. My depression made me a detached, shy and lonely child. I had no interest in anything other than reading and participated in very few activities. All in all, not a great childhood.
Fortunately, things have changed for children with depression to a great extent. However, while we now know that children can be depressed and understand more about how it differs from adult depression, we are unfortunately still not quite where we need to be in terms of diagnosis and treatment.
A lot of this has to do with the fact that physically, children are not just smaller versions of adults. Their bodies absorb, metabolize and eliminate drugs differently than adult bodies. In addition, their bodies are still developing, and their brains continue to develop into their early twenties. We don't know at this point what effect psychotropic drugs have on children's development.
If our knowledge of children and psychiatric drugs were Columbus's discovery of America, we're about where he was when he was getting the money together for the trip. Seriously. It's just in the past few years that the medical community started to realize that children react to these drugs differently.
So here I am emphasizing how little we don't know about treating depression in children. Why is that helpful? Because many parents don't realize that this is the case. They put their trust in doctors who may or may not be appropriately cautious about giving children antidepressants. We all want to believe that doctors know what they're doing, especially when our child is in pain.
On the other hand, I don't want to scare you away from antidepressant treatment if that's what your child needs. You may have heard about the FDA's decision in 2004 to require drug manufacturers to put a "black box" warning on antidepressant medication. This was the result of an analysis of pediatric antidepressant trials that showed a higher rate in subjects taking antidepressants than those taking a placebo.
But here's the problem: all the publicity surrounding the trials and the FDA's decision caused the number of pediatric antidepressant prescriptions to decline. Sounds like a good thing, right? Maybe not. At the same time, the rate of adolescent suicides, which had been in decline for a decade, increased by 18%. So it's possible that, tragically, the FDA's decision had the exact opposite effect of what was intended.
So there are no easy answers and no one-size-fits-all solutions. That's why it is vitally important that you educate yourself as much as possible about depression treatment for children. It's true that we have more questions than answers at this point. But being knowledgeable about the questions as well as the answers will help you make the best decision regarding your child's treatment.
Here are some things to keep in mind when you are in the process of having your child diagnosed and treated for depression:
1. Realize that there are no short cuts to successful depression treatment. It can, unfortunately, be a very complicated process. You know how hard it can be for a pediatrican to figure out what antibiotic will clear up your child's recurring ear infections? Finding the right treatment for depression is potentially ten times more complex.
The reason I'm bringing this up is because some doctors, especially those who don't have a lot of experience treating mental illness in children, will be convinced that they can hand you a prescription for antidepressants and that will take care of your child's depression. Believe me, I've seen it first hand. But it is rarely that simple.
2. Your child should be diagnosed and treated by a psychiatrist, preferably a child psychiatrist. Fifteen minutes with your general practitioner or your child's pediatrician doesn't cut it. Even if you have to drive a few hours to see a qualified child psychiatrist, it's worth doing so for the initial diagnosis, at least. Diagnosing mental illness in adults is tough enough; children not only exhibit depression differently, but they are also less able to communicate their symptoms clearly. Someone who is trained and experienced in treating mental illness in children is more likely to diagnose your child correctly.
"...the rule is caution in prescribing antidepressants for children. They should be neither a first choice nor a last resort." - Harvard Health Letter: Should Children Take Antidepressants?
3. In general, medication should not be the first treatment choice for a child with depression, except perhaps in severe cases.
Don't discount psychotherapy or cognitive therapy as primary treatment options. Even though it's impossible to say for sure, I'm fairly certain that in my case, psychotherapy would have been very successful in my case. My depression was probably due to the loss of my father when my parents divorced. Therapy could have helped me work through that and very possibly prevent my depression.
4. Talk to your child about suicidal thoughts. Bring it out into the open. Don't let it be taboo. Let your child know that it's okay to express these thoughts and feelings. This might be the only way you have to know if he or she is considering suicide. You can't deal with it if you don't know about it.
It is very scary when there are no cut and dried answers for treating your child. It makes you feel helpless. But knowing as much as possible about treatment options will help you to make the best decision possible.
Antidepressants for Children: The Pros and Cons
Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers
Did an effort to reduce teen suicide backfire?
Medicating Young Minds: How to Know if Psychiatric Drugs Will Help or Hurt Your Child
Should You Medicate Your Child's Mind? :A Child Psychiatrist Makes Sense of Whether or Not to Give Kids Meds
Straight Talk about Psychiatric Medications for Kids
Published On: July 09, 2007