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Mood Disorders in Children and Teens: Should You Medicate?

By Cynthia Haines, M.D.

May is National Mental Health Month and, if you have kids, that makes this month a great time to pay attention to their mental and emotional well-being.

In 2007, about five percent of kids between the ages of four and 17 had serious problems with their emotions, concentration, behavior, or ability to get along with other people, according to the Federal Interagency Forum on Child and Family Statistics.

The governmental organization also reports that in 2007, eight percent of youths ages 12 to 17 had an episode of major depression in the previous year. This is defined as having a depressed mood or loss of interest in daily activities for at least two weeks, along with other symptoms such as trouble sleeping or feelings of low self-worth. About 40 percent of these kids with a major depressive episode had visited with a health professional or taken antidepressant medications during the previous year.

However, parents and caregivers have good reason for caution concerning antidepressants or other drugs for mental or emotional problems in kids. In 2004, the Food and Drug Administration required a "black box" warning for antidepressant use in youths. An FDA advisory panel had compiled earlier research and found a doubled risk of suicidal behavior or thoughts (ideation) in children and adolescents taking these drugs, though no actual suicides had been reported. Since the FDA warning, it has been reported that the use of antidepressants in youths has steeply declined.
Yet other reports suggest that doctors are more often prescribing antipsychotic drugs for young patients than they did in the past for schizophrenia and other disorders. These can also bring a variety of side effects, including weight gain and a heightened risk of diabetes.

Weighing the Risks and Benefits

In general, when talking with your child's doctor about the need for any such medications, discuss whether the possible benefits outweigh the possible risks. Keep in mind that mood and mental conditions can also lead to serious consequences - namely, suicide. Suicide is the sixth leading cause of death in kids ages 5 to 14, and the third leading cause in young people ages 15 to 24, according to the American Academy of Child and Adolescent Psychiatry.

Guidelines for primary-care providers regarding adolescent depression that were published in the journal Pediatrics in 2007 recommended using psychotherapy or medication, with careful monitoring and close follow-up. Kids with mild depression may not need to start treatment unless it's been ongoing for at least six to eight weeks, and kids with severe depression, or depression that is not responding to treatment, may need to see a mental health specialist at the outset instead of a primary care provider.

According to the National Institute of Mental Health, psychotherapy ---such as cognitive-behavioral therapy (which teaches the youth new ways of thinking and behaving)--- may be useful for mild depression or to help the health-care provider decide if medications are needed.

But regardless of whether or not a child or teen is taking antidepressant or other psychotropic medication, the inherent risk of suicide persists in the underlying mental health condition itself. Whether it is due to the underlying illness, any contributing or causative effect of a medication, or factors unknown, parents and caregivers should be on high alert for any signs suggestive of suicidal thoughts or impulses, including these offered via the American Academy of Child and Adolescent Psychiatry:


•    Changes in eating or sleep habits
•    Pulling away from family and friends
•    Declining schoolwork
•    Loss of interest in their usual activities
•    Comments about feeling hopeless
•    Giving away treasured possessions
•    Signs of psychosis, such as hallucinations or strange thoughts
•    An unusual burst of cheerful energy


If you're concerned about your child's mental health, the academy urges you to talk to a physician or mental health professional about ways to address the problem. With proper treatment and support, the majority of mental health problems can be managed and even overcome.


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