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Anti-Depressants and Their Link to Adolescent and Teenage Suicide

Two percent of preteens and five percent of adolescents suffer from depression (www. about-teen-depression. com 2004). There are specific signs and symptoms associated with depression, which are helpful in detection of the illness. There are various ways to treat depression, such as medication, group therapy, and/or herbal supplements. There are pros and cons with each treatment, but the worst coincides with the medication suicide. Much research has been conducted, which will be discussed in the paper that has shown a link to antidepressants and suicide.

However, there is also evidence that the suicide rate could be decreased with proper diagnosis and early, supervised treatment for depression, especially when dealing with children and adolescents. Introduction Depression is the newest epidemic sweeping across the world, affecting adults, teenagers, and even children. In fact, surveys have indicated that one in every five teenagers suffer from clinical depression (NMHA 2004). The illness can be found anywhere and appears to make the news each and every day. Depression is a condition that has no preference in its victims, meaning that it will strike people of all ages, races, and backgrounds.

However, research has indicated that the onset of depression is now occurring earlier in life compared to past decades (Klerman and Weissman 1989). Knowing this, depression is a condition that needs to be cured immediately. There are many signs and symptoms commonly associated with depression, although most do vary with each individual. Most symptoms include frequent sadness, feelings of hopelessness, decreased activity, persistent boredom and low energy, social isolation, low self esteem, extreme sensitivity, frequents complaints of illness, poor concentration, and thoughts or expression of suicide (www. focusas. com).

In order to be diagnosed as suffering from depression, patients must have 2 or more of the above symptoms for at least two weeks that cause severe distress or interfere with daily life (Zoloft 2001). The specific causes of depression are not known. It is suggested that depression is actually a result of a combination of certain factors, such as biological and psychosocial factors (Kendler 1995, www. surgeongeneral. gov 2004). Most likely, depression is the result of a chemical imbalance of neurotransmitters in the brain (NYU 2004). These neurotransmitters, such as serotonin, help regulate mood and positive behavior.

While a diagnosis of depression is critical, it is really only half of the battle of fighting the illness. There are still several options for treatment that you must choose from, as well as having to deal with side effects that accompany each treatment. Of all the treatments, antidepressants tend to have the most side effects. Some of the side effects common to all three types of antidepressants are: anxiety, vomiting, confusion, chest pain, blurred vision, irritability, insomnia, sexual dysfunction, weight gain, headache, and nervousness (Cheung et al. 03, Vanderkooy et al. 2002).

Some other, more severe, side effects are difficulty urinating, decreased appetite, heart complications, and suicide (Simon and Stern 2003 – Review). It is the last side effect, suicide, which has recently caused some controversy within the medical field. With recent research showing a correlation between antidepressants and suicide, as well as the FDA ordering warning labels for suicide on antidepressant medication, physicians have to be careful prescribing the drugs, especially to children and adolescents.

Statistics show suicide to be the third leading cause of death among 13-19 year olds, with approximately 6000 suicide deaths each year (Dickinson 1999). Because of statistics like this, the National Institute of Mental Health (NIMH) researchers are vying to find interventions to help prevent suicide among children and adolescents. However, until then, the best prevention appears to lie in early diagnosis and treatment of mental disorders, limiting access to certain lethal agents like medications and weapons, as well as communication between parents and children (Shaffer & Craft 1999).

Discussion Among children and adolescents, the three most frequently diagnosed mood disorders are major depressive disorder, dysthymic disorder, and bipolar disorder (www. surgeongeneral. gov 2004). Major depressive disorder is characterized by one or more major depressive episodes, lasting approximately 7-9 months (Birmaher et al. 1996). The symptoms for major depressive disorder are the same in children as they are in adults. Dysthymic disorder is similar to major depressive disorder, but has fewer symptoms and is more chronic.

This disorder is generally more persistent and, therefore, is more likely to interfere with daily life (Klein et al. 1997). The average duration of this disorder is about 4 years in children and adolescents (Kovacs et al. 1997). Bipolar disorder is a disorder in which episodes of mania alternate with depression (www. surgeongeneral. gov 2004). This disorder generally manifests with depression and then manic episodes months or even years later (Strober et al. 1995). The causes of depression are not exactly clear. There are many theories about the cause and risk factors associated with depression.

Adoption and family studies have concluded that depression runs in families and that most of this is due to genetic factors, not environmental influences (Sullivan et al. 2000). Traumatic experiences, especially abuse or neglect, have been found to interfere with normal emotional and psychological development (Brown et al. 1999). A more recent view of depression is centered around the neurogenic theory of depression. This theory suggests that antidepressants work by producing sustained, or prolonged, activation of cAMP.

This, in turn, leads to increases in levels of neurotrophic factors in the brain, such as brain-derived neurotrophic factor that can reverse the damaging effects of stress in the hippocampus and cerebral cortex of the brain (Reid & Stewart 2001). Treatment for depression via medication comes in a variety of shapes and sizes. There are literally hundreds of drugs that can be used for treatment of depression symptoms. Despite the large number of drugs, all of these medications fall into one of three categories: SSRIs, MAOIs, or TCAs.

SSRIs, or selective serotonin re-uptake inhibitors, are among the most widely distributed antidepressant drugs when it comes to adolescents. However, several studies in 2003 raised a concern about the effectiveness of SSRIs in children (Hayes 2004). An additional study was performed that compared SSRI vs placebo in children aged 5-18 years. It was concluded that, except for fluoxetine, risks from SSRIs outweigh benefits in the treatment of adolescents (Whittington et al. 2004).

Studies with paroxetine and sertraline also concluded that there was an increase risk of suicidal thoughts and weak improvement in depressed mood (Keller et al. 01, Wagner et al. 2003). MAOIs, or monoamine oxidase inhibitors, are another group of antidepressants. However, this group is not commonly prescribed to children suffering from depression because of the risk of hypertension that can arise with consumption of certain foods, such as cheese, and medications (Findling et al. 1999). TCAs, or tricyclic antidepressants, are the oldest group of medications used for depression. Studies have shown that although these antidepressants are effective in adults, they are not useful in children and adolescents (Renaud et al. 1999, Findling et al. 1999).

In addition, TCAs are often associated with adverse effects, some of which are potentially life threatening (Findling et al. 1999). Tricyclic antidepressants also have a higher risk of toxicity when compared to SSRIs (Walsh et al. 1994, Kutcher 1998). So what is it about the antidepressants that cause an interaction in the brain that can lead to suicide? According to Dr. Thomas Kramer, psychopharmacologists seem to have the answer. There are two mechanisms that can potentially cause medications to induce suicidal tendencies. One mechanism, akathisia, causes intense restlessness while taking the medication, which could lead to acts of suicide.

The other mechanism simply involves the road to recovery from depression. Not all symptoms of depression can be treated at once, which results in some patients having an increase in energy prior to the destruction of a negative mindset. This can be very dangerous since the increase in energy can now motivate the patient to act on all suicidal thoughts that accompany depression. As a result of this, patients on antidepressants are seen to be at greatest risk one week to 10 days after starting treatment (Kramer 2004). Upon reviewing all of the research and statistics, several questions came to mind for both parents and physicians.

Should antidepressants still be given to children and adolescents? As a physician, this is a catch-22 in that if you do not treat a child suffering from depression you leave the child at a risk for self-harm, which can be viewed as negligence. However, if you do decide to treat the child with antidepressants, which is by far the easiest mode of treatment, the child could still be at risk for self-harm due to the risk associated with antidepressant drugs and children. As a parent, this scenario is like tossing a one-sided coin, in that with or without treatment your child may be at risk of suicidal tendencies.

Another concern is the dosage of antidepressants being given to children and adolescents. Currently, the lowest dosage for an antidepressant is 20mg per capsule (Feng 2002). This amount is sufficient enough for an adult with mild depression, but this dosage is also being administered to children. Is this dosage really appropriate for the age and/or weight of a child? This dosage may be sufficient for a child suffering from severe manic depression, but a child with minor depression may require a lower dosage. The only way to make the dosage lower is to space out the days on which you take the medication.

The problem with this method is that it could be easy to forget to take your medication every other day, which is extremely hazardous since this could lead to regression of the illness. The last question I have is for both parents and physicians. Are antidepressants becoming a new worldwide trend? It is understandable to seek help for a child who is suffering from many of the symptoms of depression, but there are literally millions of prescriptions being filled for children who are depressed. Is it possible that these drugs are being given out in replacement of good, old-fashioned parenting?

The life of a parent can be very fast-paced and it is hard to not think that these drugs are being administered in replacement of support and concern from a parent, which can also be time consuming. It is much easier to give a child a pill to calm them down, or in this case cheer them up or stop them from complaining or nagging, so that parents do not have to spend any extra time or energy away from work. It is essential to remember that growing up is a tough process. A normal child in perfect health is encountered with problems, bullies, physical changes in his/her body, and many more things.

This process is even more of a struggle for a child suffering from depression. To help your child deal with possible depression, you must first be able to spot some of the warning signs. There are three ways to screen your child for depression: the Childrens Depressive Inventory (CDI), the Beck Depression Inventory (BDI), and the Center for Epidemiological Studies Depression (CES-D) scale.

If your child screens positive on any of these tests, then a comprehensive diagnostic evaluation should be completed by a mental health professional (www. health. com) There are other alternatives to fighting depression besides the use of antidepressant drugs. One alternative is short-term psychotherapy, especially cognitive behavioral therapy (Birmaher et al. 1998). This type of therapy is based on the presumption that people suffering from depression have distorted views of themselves and the world. The goal is to change these views and thought processes of individuals with depression (Mufson et al. 1999). Another option includes attending counseling in conjunction with antidepressant medication.

A study conducted by NIMH compared the efficacy of antidepressant treatment alone versus combination of drug and therapy treatments. Of the 519 participants in the study, the rates of response were 55 percent in the nefazodone group and 52 percent in the psychotherapy group, compared with 85 percent in the combined-treatment group (Keller et al. 2000). Based on these results, it is apparent that this option might be the best scenario for children suffering from depression. Regardless of the treatment option chosen, it is still very important for parents to communicate with their children.

It is also important to communicate with physicians, therapists, teachers, and anyone who can give you insight about the behavior of your child. In order to beat depression, all individuals must be working together to monitor the condition of the child. Depression is not uncommon; however, communication about depression is uncommon. Conclusion In conclusion, the studies performed on antidepressants have shown that there is a slight link to increased depressive behavior and/or suicidal tendencies.

However, the research also concluded that both physicians and parents could drastically reduce these numbers with proper assessment of depression. It was found that the best treatment for depression was actually a combination of both counseling and antidepressant medication. It must be remembered that adolescence is a stressful experience for all teens, especially those suffering from depression. Thus, early diagnosis and treatment, accurate evaluation of suicidal thought, and monitoring access to lethal agents–such as firearms and medicationsmay hold the greatest suicide prevention for depressed teens.

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