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Depression in Children and Adolescence: Making Safe Medication Decisions
Teens who are depressed may show classic signs of this mood disorder, the key feature of which is a sad or irritable mood lasting two or more weeks. Other signs of depression include pessimism, low energy, the inability to enjoy activities that used to be fun, decreased social interaction, inappropriate anger or irritability, poor concentration, changes in eating and sleeping habits, feeling bad about themselves, thinking about death or suicide, and having unexplained body aches and pains.
In addition, when a teen's performance in school or in extracurricular activities deteriorates, depression may be the reason. Depression in children and adolescents is being recognized and treated more and more, though awareness of adolescent depression still lags behind mental health awareness in the adult population.
Medications and psychotherapy are the mainstays of treatment. The medications used to treat depression in adults are also used for the pediatric population. The most common treatments include selective serotonin and selective norepinephrine reuptake inhibitors. These medications affect brain chemicals that are thought to be involved in maintenance of mood. The common side effects of antidepressants include: nausea, weight gain, fatigue, changes in sleep, dry mouth, blurred vision, constipation, dizziness, agitation, and anxiety. Most of these side effects are mild, and may decrease with use.
In October 2004, because of growing concerns that antidepressant use appeared to be associated with an increased risk of suicidal thoughts and behaviors among children and adolescents being treated for depression, the US Food and Drug Administration flagged antidepressant drugs for further study when used on children. When researchers looked back at studies of these drugs, they found that indeed there was an increased rate of suicide and suicide attempts associated with their use and there appeared to be some differences between specific medications of the same class.
However, interpreting the data accurately and deciding how to weigh the risks and benefits of treatment for individual patients was tricky for many reasons. Perhaps the patients who were being treated with medications had more serious symptoms of depression and were thus more likely to try suicide? How did researchers determine whether a patient in a study was contemplating suicide? What constitutes a suicide attempt and how does a researcher determine whether a patient is thinking about suicide when engaging in risk taking behavior such as drinking too much alcohol, or driving recklessly? How do combinations of psychiatric medications, or treatment changes from one medication to another alter the risk?
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