Experts say don't stop medication, but get child and family into talk therapy.
By Jeanie Lerche Davis
Reviewed By Brunilda Nazario
If antidepressants aren't always safe for kids, as noted by the FDA, then what is? Parents are confused, frightened: What should we do when a child has depression?
First step: Don't stop the medication. "If your child is taking an antidepressant, don't stop or make changes abruptly," says psychiatrist David Fassler, MD, of the University of Vermont College of Medicine, and author of Help Me, I'm Sad, a book about childhood depression. "Talk to the child's psychiatrist, ask questions, get as much info as possible, so you can make a good decision for your child."
Antidepressants can work extremely well for a depressed child or adolescent, he tells WebMD. "But they are most effective when used with psychotherapy, too. Also, it's extremely important that kids be monitored closely while taking any medication for depression."
Kids with previous suicide attempts are at greater risk for another attempt, says Fassler. Also, kids with a family history of suicide are at high risk.
"We do know that certain interventions appear to reduce the suicide risk," he adds. "For example, cognitive behavioral therapy -- a specific kind of psychotherapy -- involves changing thought patterns and reactions to events in their lives. That can help."
While serious depression has a genetic component, having many stressful events can also increase risk - such as loss of a parent, numerous relocations, exposure to violence or abuse, or chronic illness, says Fassler.
"The most dangerous thing is not to treat these kids at all," he adds. "Research shows that over half of all kids with depression will attempt suicide at least once, and over 7% will die as a result. It's a very serious illness with very serious consequences."
Child Neglect: A Cause for Concern
Avrum Geurin Weiss, PhD, a clinical psychologist in Atlanta, is pleased with the FDA action. "It's about time someone has spoken up on this. There are no clinical trials of these drugs involving children -- yet these drugs are widely prescribed for children."
"I want to be clear, kids do get depressed," he tells WebMD. "I don't want antidepressants outlawed. But please, let's slow down in prescribing them for every child. When a kid is moody, difficult, unhappy, that's normal adolescence."
Too many kids get medication instead of talk therapy, Weiss explains. "The symptoms I'm seeing in depressed children are the result of pretty profound neglect. Putting the child on medication just confounds the situation. You're telling the kid something is wrong with you -- as opposed to something is wrong with your family. You're not really listening to what's going on in the kid's life."
Too many children -- many from affluent homes -- suffer from neglect that is the root of their depression, he says. "I work with a lot of teenagers. The No. 1 issue is the staggering neglect. They live in a nice house, get a car when they're 16, have this, have that. But in terms of being raised by parents, it's astounding how little parental contact there is."
Try a Therapist First
If you think a child is depressed, take them to a therapist -- not to a pediatrician, advises Weiss. "If after two or three months of psychotherapy, you see it's not helping, then -- and only then -- should you try medication."
Giving kids everything they want contributes to children's depression, he adds. "Kids should not be recipients of devotion without doing anything in return. If you give them stuff they didn't ask for, then you ratchet up huge expectations in this world."
Also, doing everything for a child is never a good idea, Weiss tells WebMD. "If they're not active, contributing members in the family, they can get depressed. If a kid doesn't have jobs at home -- if they're too busy with karate and everything else -- it's just not healthy."
If you want a close bond with your child -- and protect them from depression -- spend a good bit of time with them, Weiss advises. "This talk of 'quality time' is a way of saying, 'I don't have time for my kids.' Kids don't talk much at all, and if they do it's because you've spent an afternoon at the mall with them, and you've managed to get a few words from them during that time. If you schedule quality time, you won't get them talking."
Another bit of advice: If you're concerned about your child, don't ask, "Are you depressed?" Weiss tells WebMD. "Talk in English: Are you unhappy? Sad? Having a hard time? Are you having any fun?"
Published Sept. 15, 2004.
SOURCES: psychiatrist David Fassler, MD, University of Vermont College of Medicine; and author of Help Me, I'm Sad. Avrum Geurin Weiss, PhD, a clinical psychologist, Atlanta.
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