Growing Up on Antidepressants (Or Not)
A few months ago I read an article that raised the question of how growing up on antidepressants might affect a child's psychological development. In Coming of Age on Antidepressants, Dr. Richard A. Friedman tells us that he started considering the issue after talking to a patient, a 31 year old woman who had been on antidepressants since she was 14. Although they had undoubtedly saved her life, she was beginning to wonder what kind of an impact they had had on her psychological development and the development of her personality.
I had two reactions to the article. I think that the questions he's raising are legitimate ones, especially given the casual prescribing of antidepressants for children and adolescents. I think in many cases of childhood depression (please note that this is my opinion as a layperson), therapy would be a much better treatment choice. However, sometimes parents don't have the money for therapy and/or want a quick fix because they're so desperately worried about their child. As a parent, I can understand that position.
But one reason that antidepressant treatment for a child should be carefully considered is that we don't know enough about how a child's brain develops. We only found out recently that our brains don't stop developing at eighteen or twenty, but keep going into our twenties. In fact, some very crucial functions in the frontal lobe aren't completely developed until then, which to me explains why you pay more for auto insurance before the age of twenty-five. Young people have more auto accidents because their impulse control isn't fully developed. I actually look back on some things I did in my early twenties and shudder.
The problem is that we don't know enough about the impact of antidepressants on someone's psychological development. Dr. Friedman ascribes this to the lack of long-term studies by the FDA. This is certainly true. Drug companies tests are only as long as they need to be for FDA approval. You're not going to catch them going above and beyond, and who else has the money to do such a longterm test?
But I'm not sure it's even possible to do a definitive study. How do you determine whether someone who has been on antidepressants since childhood or adolescence would have been different if they hadn't been? I don't believe that you can compare two people in terms of psychological development. There are too many variables. Not to mention that we've never answered the question of what makes someone who they are. If you don't know that, how can you determine how they would have been if something was changed?
So I think that this question is one worth exploring, but at the same time there's another question to consider. What kind of impact does growing up depressed have on a child's psychological development? Most of the same questions that come up when we consider the impact of antidepressants on development come up here.
I'm pretty sure that my life would have turned out differently if I hadn't spent much of the first twenty seven years depressed, but I don't know if my personality would have been different if I had been on antidepressants during that time. I can say with some assurance that my life would have been different because of how different it's been since I started treatment. I have a lot more mental energy and motivation. I can tell you exactly what I would have done differently if I hadn't been crippled by depression.
But even after eighteen years of successful treatment with both medication and therapy, I still can't separate my true personality from the impact of depression. In other words, would I still have been fairly shy if I hadn't grown up depressed?
As I said, I think the question that Dr. Friedman raises is worth examining, but so is the question I have. Although I realize there are no easy answers when so many questions remain, parents who are considering treatment for a depressed child should weigh both sides of this question.