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Does my child need an antidepressant? - (10/1/2019)

By Dr. Ron Gasbarro

Mrs. Johnston was in the pharmacy to get a few refills for her family. She said to the pharmacist, “My daughter is now 13, but lately she seems more moody and bad-tempered. Patty loves sports but hasn’t played outdoors in weeks. And she has trouble sleeping. Is Patty depressed, or is it one of those adolescent phases most of us go through? Does she need an antidepressant?”

Depression in children is a severe condition that can cause changes in thinking, mood, and behavior. Until the 1970s, medical professionals thought the disorder occurred only in adults. That is because the symptoms of child and adolescent depression can differ from those seen in adults. Adults with depression may suffer from a lack of energy. Depression in younger people might result in unusually lower grades and overall poor school performance. Adults who are diagnosed with depression can withdraw from friendships. In child depression, the patient can withdraw from favorite activities like a sport or playing a musical instrument.

Approximately 11% of young people will have a depressive disorder by age 18, according to the National Institute of Mental Health (NIMH). The remainder of those who are moody, irritable, or feel misunderstood is not clinically depressed and does not need an antidepressant. However, the first step in treating potential depression is to get a professional diagnosis. Consulting with a psychologist can be helpful in two ways. First, psychologists do not prescribe medications so there is no fear of rushing to medicate. Second, a psychologist can refer the child to a psychiatrist if s/he feels there is an organic basis for the child's feelings and behaviors.

“Isn’t it just easier to start Patty on antidepression medication?” Mrs. Johnston asked the pharmacist.  According to researchers, an imbalance of brain chemicals, called neurotransmitters, is responsible for depression. When the US Food and Drug Administration (FDA) approves a drug for depression, it is to treat the chemical disparity within the brain, not the behavior associated with it. Furthermore, getting the correct diagnosis takes time because the clinician has a limited period to observe the patient’s personality.  

The pharmaceutical industry has not studied all antidepressants in children. Therefore, the FDA cannot approve some of these drugs for use in patients whose brains are still developing. The FDA requires that all antidepressants include a stern warning about the increased risks of suicidal ideation and behavior in children, adolescents, and adults up to age 24. The young person starting on such a drug must be monitored carefully and consistently for changes in behavior. Such surveillance is particularly crucial in the first few months of therapy or if the dose is increased or decreased. 

Talk therapy, including cognitive behavioral therapy (CBT), is effective against depression in young people. Regular exercise and adequate sleep can also help. Very few children require medication for their moodiness. Hence, resist a prescription for an antidepressant the first time you take the child to the doctor. Find out all you can about the medication. That’s what the pharmacist is trained to do. Mrs. Johnston said she would keep a diary of Patty’s behavior for the next few weeks. If problems persist, she will take Patty to a psychologist for an initial assessment. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com.

 


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