Watching a child develop depression must be one of the most challenging times for a parent, particularly if they have never experienced it themselves. While all logic may say that there is no reason for the feelings that their teenager is experiencing, the depths and intensity of their emotions would suggest otherwise. Understanding that this is a biological condition, just like a broken leg or a cancer cell, may help but it doesn't necessarily make you feel better.
In the end, every parent wants to do the best for their child and may turn to anti-depressants as a method for treating this. But what is the evidence for their effectiveness in this age group?
The Cochrane Reviews are considered to be among the highest quality reviews of scientific data. In a tiered system of evidence, Cochrane Reviews are part of Tier 1. Two Cochrane reviews are of interest - one is on tricyclic antidepressants in children and adolescents and the other is on SSRI antidepressants in children and adolescents. (If you'd like to look at these, they are freely available to the public.) Tricyclic antidepressants are older and used somewhat less frequently than SSRI's.
When looking at tricyclic antidepressants, the Cochrane Review summised that they were no more effective than placebo for the treatment of depression in pre-pubertal children and only a moderate effect over placebo was found. Safety and efficacy were both unclear when considering children and adolescents.
http://http//onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD002317/frame.html
When looking at SSRI's, the results were more complex. The use of SSRI's did appear to have a greater effect than placebo in children and adolescents for the reduction of symptoms. However, this was "to a predetermined level deemed a “response”" and it was unclear as to whether "a meaningful outcome for children and adolescents with depressive disorders" was obtained. Further complicating matters is the risks for those children and adolescents with comorbid conditions or suicidal ideation, as they were "largely excluded from the trials". It was also suggested that there was an increased risk of suicidal ideation and attempts related to SSRI's.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004851/frame.html
So what does this mean for parents and teenagers who may find themselves either on these medications or looking at taking them?
1. If you are on them, keep taking them. Never stop an antidepressant (or any other prescribed drug for that matter) without professional medical support and advice
2. If you haven't started, educate yourself and consider all your options. Psychological therapy, nutritional interventions and other natural therapies may be as effective or more effective for this age group
3. If you do decide to take medications, be well informed of the possible side effects. Keep a diary and have a buddy - someone you can trust - to help you monitor your mood management.
4. If you are on these medications, nutritional support may be able to help manage side effects
5. If these medications are being prescribed for a condition other than depression (such as an eating disorder or bipolar) then the evidence is different, so go back to the research and check what is relevant
6. Medications or nutritional therapy are simply addressing the biological aspects - psychological support from a trained and competent professional is also vital
7. If you do experience adverse side effects from any treatment, contact your practitioner IMMEDIATELY for appropriate advice
When it comes to mental illness, we have progressed a long way in the management of the severe expression of these conditions. However, an integrative approach will always be more effective than a single tactic. It's a simple case of two heads are better than one.
It seems blatantly unfair to ask a parent or teen with no biochemical training to determine whether or not a medication is the best path for them. Unfortunately, life is unfair despite what greeting cards may lead you to believe. So the best way to mitigate this is to make sure you have someone you trust listening to you and working WITH you for the best outcome.
In the end, every parent wants to do the best for their child and may turn to anti-depressants as a method for treating this. But what is the evidence for their effectiveness in this age group?
The Cochrane Reviews are considered to be among the highest quality reviews of scientific data. In a tiered system of evidence, Cochrane Reviews are part of Tier 1. Two Cochrane reviews are of interest - one is on tricyclic antidepressants in children and adolescents and the other is on SSRI antidepressants in children and adolescents. (If you'd like to look at these, they are freely available to the public.) Tricyclic antidepressants are older and used somewhat less frequently than SSRI's.
When looking at tricyclic antidepressants, the Cochrane Review summised that they were no more effective than placebo for the treatment of depression in pre-pubertal children and only a moderate effect over placebo was found. Safety and efficacy were both unclear when considering children and adolescents.
http://http//onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD002317/frame.html
When looking at SSRI's, the results were more complex. The use of SSRI's did appear to have a greater effect than placebo in children and adolescents for the reduction of symptoms. However, this was "to a predetermined level deemed a “response”" and it was unclear as to whether "a meaningful outcome for children and adolescents with depressive disorders" was obtained. Further complicating matters is the risks for those children and adolescents with comorbid conditions or suicidal ideation, as they were "largely excluded from the trials". It was also suggested that there was an increased risk of suicidal ideation and attempts related to SSRI's.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004851/frame.html
So what does this mean for parents and teenagers who may find themselves either on these medications or looking at taking them?
1. If you are on them, keep taking them. Never stop an antidepressant (or any other prescribed drug for that matter) without professional medical support and advice
2. If you haven't started, educate yourself and consider all your options. Psychological therapy, nutritional interventions and other natural therapies may be as effective or more effective for this age group
3. If you do decide to take medications, be well informed of the possible side effects. Keep a diary and have a buddy - someone you can trust - to help you monitor your mood management.
4. If you are on these medications, nutritional support may be able to help manage side effects
5. If these medications are being prescribed for a condition other than depression (such as an eating disorder or bipolar) then the evidence is different, so go back to the research and check what is relevant
6. Medications or nutritional therapy are simply addressing the biological aspects - psychological support from a trained and competent professional is also vital
7. If you do experience adverse side effects from any treatment, contact your practitioner IMMEDIATELY for appropriate advice
When it comes to mental illness, we have progressed a long way in the management of the severe expression of these conditions. However, an integrative approach will always be more effective than a single tactic. It's a simple case of two heads are better than one.
It seems blatantly unfair to ask a parent or teen with no biochemical training to determine whether or not a medication is the best path for them. Unfortunately, life is unfair despite what greeting cards may lead you to believe. So the best way to mitigate this is to make sure you have someone you trust listening to you and working WITH you for the best outcome.
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