Depression in Children and Adolescents

[cJessica]

I am a nursing student at the University of Nevada, Reno. As an assignment for one of my classes, I am to participate in an online discussion group of some type, and post a question, which I will write a paper summarizing my experience. This is my attempt to do so, and so I really appreciate all of your responses.

Depression in children and adolescents appears to be a significant problem. An article in the Psychological Bulletin explains how depression in children and adolescents may result in issues with functioning socially and scholastically, can cause stress within the family, and is something that needs attention when suspected (Weisz, McCarty, & Valeri, 2006). However, treatment may not be quite so easy to achieve due to the FDA classifying antidepressants with a black-box warning for use in children and adolescents in October 2004, as the result of an increased risk for suicide (Goodman, Murphy, & Lazoritz, 2006). Along with the black-box warning are many guidelines that are recommended with prescribing antidepressants to children and adolescents (Goodman, Murphy, & Lazoritz, 2006). An example of one of these recommendations is a visit frequency recommendation, which states that the patient should visit the prescribing physician once a week for the first 4 weeks, every 2 weeks for the next month, at the end of the 12th week taking the drug, and more often if problems arise (Goodman, Murphy, & Lazoritz, 2006). I am curious as to how well these guidelines are followed, especially visit frequency recommendations, and how well patients adhere to this? Also, what are patient's reactions when they are informed of the possible risk of suicide? Does this risk cause reluctance in some patients to take antidepressants? I do not have much clinical experience in this area, but am extremely interested, and am intrigued to know what some of you have seen in your clinical experiences.

Additionally, I was wondering what type of non-pharmalogical interventions you have found to be successful with adolescent and pediatric patients suffering from depression?

Thank you in advance for your time and responses!!

References:

Goodman, W.K., Murphy,T.K. & Lazoritz, M.(2006). Risk of suicidality during antidepressant treatment of children and adolescents. Primary Psychiatry, 13(1), 43-50.

Weisz, J.R., McCarty, C.A., & Valeri, S.M. (2006). Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychological Bulletin, 132(1), 132-149.

[SuesquatchRN, BSN, RN]

If you go out the the www.jama.org site you can get six months for free. And what I've found - writing a paper about increased suicidal ideation in adolescents being treated with SSRIs - is that the claim that suicide risk is incrased is not supported by the statistics.

[lsyorke, RN]

As a parent of a child who attempted suicide on ssri's my view is slightly different. As for the statistics on suicide, they are supported by the clinical trials that have been done, as well as the lack of efficacy of ssri's in children. But that being said, the clinical trials are sorely lacking for children. I've talked to hundreds of parents of children who have had suicidal and violent reactions to ssri's. When the ssri was removed, so where these thoughts(after a period of time for "discontinuation"). Prior to the "black box" warning the suicidality risk was never mentioned, after, it is mentioned with the disclaimer of "this is not a common occurence" rarely. While some children have had positive experiences with ssri's, there is a subpopulation that has VERY bad reactions to these drugs. Every parent should be made aware of the risk so that they are making an informed decision based on risk benefit for their child. I can speak from personal experience that I was never made aware of the risks when I was handed the prescription. My sons next visit after the ssri was 4 weeks later. My claims of "personality changes" were dismissed as "not enough paxil" with ever increasing doses.

I do know that some that have seen psychiatrists recently with their children were not made aware of the risks at all. To deny this risk is putting children in danger. While not everyone will have this reaction parents have the right to be fully informed as per the FDA warning, regardless of the practitioners individual belief. Parents are the ones who are seeing their children everyday and should be told what adverse reactions to watch for... just like any other drug.

You can read the transcript of the FDA hearing that resulted in Black Box warnings here:

http://www.fda.gov/ohrms/dockets/ac/04/transcripts/2004-4065T1.htm

[CharlieRN]

Jessica,

I'm not involved in either research or education so I'm not going to quote studies and papers to you. I do work in admissions screening at a private psychiatric hospital.

Depression in children is probably significantly under diagnosed. Many children are very unhappy. Heck, many are being chronicly abused. Yet they do not "trip alarms" in health care professionals. Children are naturally high energy. They are subject to rapidly changing mental and physical status. They seem to and in fact do "just out grow it". In my opinion they may well be damaged by depression before they outgrow it, but many do out grow the circumstances that depress them.

All anti depressants have a risk of exascerbating suicidality in all age groups. I have heard that this is because they can increase available energy before changing mood or before the person has a chance to change their mind. Children in general are more impulsive than adults.

The recommendation; "An example of one of these recommendations is a visit frequency recommendation, which states that the patient should visit the prescribing physician once a week for the first 4 weeks, every 2 weeks for the next month, at the end of the 12th week taking the drug, and more often if problems arise. " sounds minimal to me. Particularly the once a week for the first couple weeks. I'd like 3 times a week mental status assessment, thou not necessarily by an MD. I would also like to provide the client with a confidential 24 hr phone number so they can call someone if they have impulses to harm themselves.

I'm not really sure I buy the "evil drug" senario at the frequency with which it is reported. It does happen that some people have paradoxical responses to particular meds. It does happen that the "depression" may be a misdiagnosis. Misdiagnosed Bipolar is the most common problem. If you give a bipolar an anti depressent they are quite likely to become more manic. Since mania in children frequently presents as sullen irritablity it can be mistaken for depression.

[Morgan314]

How many children being treated for depression have a parent who is also depressed/anxious? and is the parent receiving any psychoeducation or involved in a parenting group?

[CharlieRN]

How many children being treated for depression have a parent who is also depressed/anxious? and is the parent receiving any psychoeducation or involved in a parenting group?

Or is the parent the cause of the childs depression? Families are units. If one part is sick the whole thing is sick.