Teen Depression (cont.)

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What is the treatment for teen depression?

If the symptoms indicate that a teen is suffering from clinical depression, the health-care provider will likely strongly recommend treatment. Treatment may include addressing any medical conditions that cause or worsen depression. For example, an individual who is found to have low levels of thyroid hormone might receive hormone replacement with levothyroxine (Synthroid). Other components of treatment may be supportive therapy, such as changes in lifestyle and behavior, psychotherapy, and complementary therapies. Treatment may include medication for moderate to severe depression. If symptoms are severe enough to warrant treatment with medication, symptoms tend to improve faster and for longer when medication treatment is combined with psychotherapy.

Most practitioners will continue treatment of major depression for six months to a year. Treatment for teens with depression can have a significantly positive effect on the adolescent's functioning with peers, family, and at school. Without treatment, symptoms tend to last much longer and may never get better. In fact, they may get worse. With treatment, chances of recovery are much improved.

Psychotherapy

Psychotherapy ("talk therapy") is a form of mental-health counseling that involves working with a trained therapist to figure out ways to solve problems and cope with depression. It can be a powerful intervention, even producing positive biochemical changes in the brain. Two major approaches are commonly used to treat teen depression: interpersonal therapy and cognitive behavioral therapy. In general, these therapies take weeks to months to complete. Each has a goal of alleviating the symptoms. More intense psychotherapy may be needed for longer when treating very severe depression or for depression with other psychiatric symptoms.

Interpersonal therapy (IPT): This helps to alleviate depressive symptoms and helps the sufferer develop more effective skills for coping with social and interpersonal relationships. IPT employs two strategies to achieve these goals:

  • The first is education about the nature of depression. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.
  • The second is defining problems (such as abnormal grief or interpersonal conflicts). After the problems are defined, the therapist is able to help set realistic goals for solving these problems and work with the depressed teen using various treatment techniques to reach these goals.

Cognitive behavioral therapy (CBT): This has been found to be effective as part of treatment for even severe adolescent depression. This approach helps to alleviate depression and reduce the likelihood it will come back by helping the teen change his or her way of thinking about certain issues. In CBT, the therapist uses three techniques to accomplish these goals.

  • Didactic component: This phase helps to set up positive expectations for therapy and promote the youth's cooperation with the treatment process.
  • Cognitive component: This helps to identify the thoughts and assumptions that influence the teen's behaviors, particularly those that may predispose the sufferer to being depressed.
  • Behavioral component: This employs behavior-modification techniques to teach the teenager more effective strategies for dealing with problems.

Medications

The major types of antidepressant medications prescribed for adults are the selective serotonin reuptake inhibitors (SSRIs), the tricyclic antidepressants (TCAs), and the atypical antidepressants. TCAs are sometimes prescribed in adults in severe cases of depression or when SSRI medications don't work but have been determined not to be largely effective in treating teen depression. The monoamine oxidase inhibitors (MAOIs) have fallen out of favor as antidepressants, particularly in adolescents, because of the negative interactions this group of medications can have with numerous foods and medications.

SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group of medicines. Examples of these medications are listed here. The generic name is first, with the brand name in parentheses.

Only fluoxetine (Prozac) and escitalopram (Lexapro) are approved by the U.S. Food and Drug Administration (FDA) for the treatment of teen depression. Any other medications used to treat this illness in teens are therefore considered to be being used "off label."

Although FDA approved for use in teens with schizophrenia rather than for the treatment of depression, atypical neuroleptic medications like aripiprazole (Abilify) and risperidone (Risperdal) are sometimes prescribed in addition to an antidepressant in adolescents with severe depression, who fail to improve after receiving trials of different antidepressants, or in addition to, or instead of, an antidepressant in teens who suffer from bipolar disorder.

Non-neuroleptic mood-stabilizer medications are also sometimes used with an antidepressant to treat teens with unipolar depression who do not improve after receiving trials of different antidepressants. These medications might also be considered in addition to or instead of an antidepressant in adolescents who suffer from bipolar disorder. Examples of non-neuroleptic mood stabilizers that are used for this purpose include divalproex sodium (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal). Of the non-neuroleptic mood stabilizers, Lamictal seems to be unique in its ability to also treat unipolar depression effectively by itself as well as in addition to an antidepressant. It is only used in people older than 16 years of age due to potentially serious side effects.

Atypical antidepressant medications work differently than the commonly used SSRIs. The following medications might be prescribed when SSRIs have not worked: buproprion (Wellbutrin), venlafaxine (Effexor), duloxetine (Cymbalta), or desvenlafaxine (Pristiq).

About one-half of teens who take antidepressant medications get better. It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better. The prescribing physician will likely assess the depressed teen that is receiving the medication soon after it is started to see if the medication is being well tolerated and if symptoms have begun to improve. If not, the doctor may adjust the dose of the medication or prescribe a different one.

After symptoms begin to improve, the prescribing doctor will likely encourage the depressed teen to continue taking the medication for six months to a year since stopping the medication too soon may cause symptoms to return or to get worse. Some people need to take the medication for longer periods of time to keep the depression from returning. Stopping abruptly may cause the depression to return or for serious withdrawal effects to occur, depending on the medication that is being taken.

The side effects of antidepressant medications vary considerably from drug to drug and from person to person.

  • Common side effects include dry mouth, sexual dysfunction, nausea, tremor, insomnia, blurred vision, constipation, and dizziness.
  • In very rare cases, some people of all ages have been thought to have become acutely more depressed once on the medication, even attempting or completing suicide or homicide. Children and teenagers are thought to be particularly vulnerable to this rare possibility. However, when considering this risk, it is important to also consider the risk of the potential serious outcomes that can result from untreated depression.

Alternative treatments

Several nonprescription herbal and dietary supplements are used by some people to treat depression. Little is known about the safety, effectiveness, or appropriate dosage of these remedies, although they are taken by thousands of people around the world.

  • A few of the best-known alternative remedies continue to be studied scientifically to see how well they work, but to date, there is little evidence that herbal remedies effectively treat moderate to severe clinical depression.
  • Medical professionals usually are hesitant to recommend herbs or dietary supplements, particularly in teens, because they are not regulated by the U.S. Food and Drug Administration (FDA), as prescription drugs are, to ensure their purity and quality.
Medically Reviewed by a Doctor on 5/31/2013


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