When your child is diagnosed with depression, talk therapy is generally the first recommended treatment.
There are times, though, when psychotherapy may not be enough to reduce your child's depressive symptoms.
If medication is being a considered in your child's treatment plan, be mindful of the following:
1. Medication won’t work unless you support its use in your child’s treatment. For some depressed children, the need for antidepressant medication will be a vital part of their recovery. Research shows, however, that public opinion about antidepressants is not consistent with scientific knowledge and clinical experience. Many wrongly believe that antidepressants area addictive, change a child’s personality or become a “crutch” if prescribed. These myths not only misinform, they can prevent children from reaching levels of well-being because parents fear their use. If your child needs antidepressant medication, it’s strongly recommended to understand the neurobiology of depression and how antidepressants work. Just like promoting a positive attitude about psychotherapy, parents need to endorse the use of medication so children will be confident taking them.
2. Medication can only be successful if your child takes it consistently and “as prescribed." One of the biggest causes of relapse of child depression is not being consistent with medication. As a parent, help your child learn the name of the medicine prescribed, the regular time of day or night it’s to be taken, whether it should be given with food, and when the refill date is so no gap in treatment occurs. It’s important to understand that missing doses interrupts the effectiveness of medicine, which in turn will get in the way of therapeutic success. Also vital is learning how to use over the counter medications if your child is on antidepressant medication. Checking with your pharmacist, psychiatrist, nurse practitioner or physician whenever using additional medicines can help avoid Serotonin Syndrome, where too much serotonin arises in the body. For example, when taking SSRI’s, a regular child dose of cough medicine might need to be halved. Along this line is also the significance of educating children not to use alcohol or drugs so substances don’t interfere with, or raise toxic levels of antidepressant medication.
3. Medication can have side effects. Any medicine your child takes poses side effects. From aspirin to cough medicine or antibiotics to vitamins – and antidepressants can have side effects too. Research shows that most children experience mild or moderate levels of side effects and that adjustments in dosage or timing can help manage them. While this is generally the rule, parents should also know that there are many children who don’t report any side effects whatsoever. But it’s the data on serious side effects that, though rare, make antidepressant treatment a scary subject. For some children, the side effects from taking medication don’t outweigh the benefits. In this cases, medication should be stopped as no one should endure headaches, diarrhea or stomach aches if they’re intense and don’t go away with dosage management. There are also emotional side effects, the kinds that leave children feeling dulled or different, which makes it hard for them to want to continue antidepressant treatment. Then there is the rare side effect syndrome called akinesia, where extreme restlessness and agitation heighten violence toward the self or others. This is what the FDA "black box" label warning is about – raising awareness to consumers that antidepressants may increase the risk of suicidal thinking and behavior in some children and adolescents with depression. These are very real issues and require your attention as a parent.
4. A child or teen taking antidepressant medication should never stop it abruptly. Once started, treatment with these medications should not be stopped without working with a medical doctor. Although they are not habit-forming or addictive, suddenly ending an antidepressant can cause a withdrawal-like experience called Antidepressant Discontinuation Syndrome (a temporary event where your child with have flu-like symptoms). Hastily stopping medication can also lead to relapse or recurrence of depression. If you or your child wants to end antidepressant treatment or wishes to have a scheduled break from it, work with your prescribing doctor to do it appropriately. Often, the weaning down period is finished within just a few weeks, without any health concerns.
5. For some children, taking medication long term to manage depression may be a necessity. By and large, the course of taking antidepressants is one year. The treatment starts off with a low dose for children, with an expected six to eight weeks for medicine to reach its full effects. From there, the months that follow allow medicine to slowly shift neurochemistry. Working in concert with medication is talk therapy, and the collaboration helps to reduce depressive symptoms and build skills. Once goals are reached, your child can come off medication. But should depressive symptoms present again, chronic use of medication may be necessary. The likelihood of you being faced with this issue is great as studies show that upwards of 40% of children with depression will have recurrences.
For some parents, the choice to continue medication will be easy, while for others it’ll be tough. The truth is making decisions about medication is part science, part emotion.
Dr. Deborah Serani is a psychologist, professor and an award-winning author of books on depression.