Depression in teens is a common disorder – perhaps much more common than you might suspect – especially for females, as over 1 in 3 teen girls experiences a clinical depression. It is something to be taken very seriously by parents. The consequences are of immediate concern, with profound influence on social relationships, engagement in school, and notably risk for suicide. Furthermore, each time someone experiences an episode of depression, it increases the likelihood of a future depressive episode, which is typically more severe. For all these reasons, it is essential that a teen experiencing depression gets a proper clinical evaluation, and if depression is confirmed, receives treatment. The nature of that treatment, however, is not straightforward.
The role of psychological or “talk” therapy, which can take a variety of forms, is not controversial. Teens can learn many coping strategies and skills that can not only contribute to a lessening of the depression but also help buffer against future episodes. More controversial, however, is the utility of antidepressants, as there have been concerns that they are not only less effective in teens than in adults, but may also be associated with adverse side effects and outcomes, such as an increased risk for suicidal behavior.
A paper recently published in JAMA Psychiatry provides the best guidance on this issue, as it is based on a systematic review of over 30 clinical trials involving nearly 7000 youth. The two primary conclusions, which every parent needs to know, are as follows:
- Overall, the common antidepressants (selective serotonin reuptake inhibitors and selective serotonin-norepinephrine reuptake inhibitors) were beneficial for a range of psychiatric disorders including depression, particularly as compared with placebo.
- These drugs, however, were also associated with significant occurrences of adverse events, including suicidal ideation (thinking about suicide) and actual attempts.
These conclusions, while straightforward, can also be disconcerting. How should you determine if you should put your child on an antidepressant? The answer is to get very vigilant assessment of your child by someone who is trained to make that determination and who is prepared to closely monitor your child’s reactions. This means a physician, ideally either a pediatrician who is well versed in psychopharmacology or a psychiatrist.
There will be a number of considerations that the practitioner will weigh. This will include the length and severity of the depressive episode and prior history of depression and related disorders (such as anxiety). For example, while antidepressants may carry some risk for suicidal thoughts and behaviors, depressive episodes also convey risk. In some cases, there may be a suggestion to begin with psychological therapies and monitor progress.
Most importantly, if a decision is made to start a teen on an antidepressant, parents will have to be very vigilant for any signs of adverse effects, and be ready to act and react quickly in terms of seeking counsel. Anything that a parent observes should be shared quickly with a practitioner. Bear in mind that antidepressants can take 3 to 4 weeks to begin to have a therapeutic effect, so close observation of improvements in depressive symptoms along with adverse side effects will be of utmost importance to provide the practitioner with the most salient information to decide if treatment should continue or be modified (such as terms of dosage and time of day that the drug is administered), or if a different antidepressant is worth considering.
The reality is that both the utility and danger of antidepressants warrant an individual-based approach to every child under the watchful eye of a trained clinician. There can be major improvements that come from usage, some unpleasant side effects that are tolerable, and other effects that are not to be tolerated. A very thoughtful approach is needed to not just weigh out theoretical pros and cons, but to make a number of decisions rooted in vigilant observation of a teen. Parents will play a very important role in this process, and working together with a clinician provides the very best navigation of depression in teens.