Tuesday, September 14, 2004

Children and antidepressants

The parent on the phone is frightened. "What are these pills doing to my child? She says she wants to die."
I'm on call, covering for a colleague (there are no children in my practice). I've seen the news reports about the FDA warnings. Is her child more likely to die with the pills, or without? I try to figure out what else is upsetting the parent and child, and then I say something like this: that meds can affect behavior, that her child needs close monitoring, that her child should be assessed in ER.
Later, I debrief with some child psychiatrists. It turns out that different drug companies have had different definitions of "suicidal behavior," and it's been hard to sort out risks. And studies are sorely lacking. Some symptoms may increase impulsive behavior (I'm thinking of anxiety, panic, increased energy, and restlessness), and sometimes those symptoms are side effects of meds.

A depressed, impulsive, panicky patient may be at more risk of suicide. But untreated patients have increased risk of suicide. The take-home point: suicide is more likely in untreated patients. For most patients, the benefits of the meds outweigh the risks. But treated patients need really close surveillance.


Blogger Alisha said...

You know, I view these "new" findings and warnings to be really scary. If I were a parent or a patient without significant knowledge of antidepressants, I'd be really afraid. In a way, the warnings seem a bit irresponsible. For as long as I've worked in the field of mental health, the psychiatrists I've worked with have always impressed upon me the importance of careful monitoring by psychiatrist and/or therapist when people with severe depression begin new antidepressant medication. Improvement in energy so often preceeds improvement in mood, and depressed mood and increased energy can be a very dangerous combination. Thorough screening of a patient history of suicidal ideation, planning and attempts is so critical, as those who've tried it before are prone to try it again. IMHO, these new warnings further make the case against the treatment of depressive symptoms with psychotropic medications alone as opposed to in conjunction with psychotherapy or other monitoring of symptoms by a professional. Careful screening and diligent monitoring make all the difference. I guess it's often easier to blame the pill.

1:46 PM  
Blogger shrinkette said...

Great points, Alisha. (Now what happens when the hospitals are full, and there's no place where we can monitor these kids and keep them safe?)

5:17 PM  
Blogger Doc said...

I'm afraid that a lot of mildly deprssed but impulsive teens may be getting on these meds. Fortunately, there are a lot of evidence-based treatments for children and adolescents other than the medications, if only the families could afford them.

5:36 PM  

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