Glenn Hirsch, M. D., Medical Director of the NYU Child Study Center is interviewed by AboutOurKids.org
The medication treatment of depressed teenagers has been the focus of recent news articles, television programs and other media. The U. S. Food and Drug Administration (FDA) has mandated that certain medications (SSRIs, or Selective Serotonin Reuptake Inhibitors) carry the strongest possible, or 'black box' warnings, due to a possible connection between this class of medications and suicidal thoughts and/or behavior in some children and adolescents. This decision by the FDA and the resultant publicity have resulted in heightened concerns on the part of parents of youngsters already on medication and those for whom medication is being considered. To help parents make informed decisions and to make sense of conflicting and sometimes sensational reports about medication and teenage depression, we spoke with Glenn Hirsch, M. D., Medical Director of the NYU Child Study Center.
Q: What is the benefit of the FDA decision to require strict warnings on the side effects of antidepressant medication?
Dr. Hirsch: While there are some benefits to the FDA labeling there are also some major problems with it. Knowing the risks of a medication is important. It's critical that parents have access to this information when they decide whether or not to use medication to treat their child's depression. Unfortunately the patient handouts required for these medications do not discuss the risk of untreated depression. As a result many families may refuse medication without being aware of the benefits of treatment.
Q: What is the most reliable source of information? How can parents determine if a youngster is depressed and which treatment is most appropriate?
Dr. Hirsch: When parents are concerned that their teenager might be depressed or school personnel raise similar concerns, it is imperative that they have the teenager evaluated. This evaluation should result in a diagnosis and clearly spelled out treatment options. In most cases, this is best obtained from a child and adolescent psychiatrist, the professional who has the most experience and is knowledgeable about recent research in depression. Consultation with their pediatrician or internist is a reliable source of referral.
Q: With the publicity and emphasis currently being placed on the negative effects of antidepressant medication, such as suicide, how can parents weigh the risks and benefits?
Dr. Hirsch: It's helpful for parents to carefully consider both the short and long term effects of antidepressant medication, as they would with other medications. While all medications and treatment may have some troubling side effects, the results of an untreated illness can be disastrous to one's health
Q: With depression, wouldn't it be safer to avoid bad side effects and not medicate?
Dr. Hirsch: With depression, the long term effects of not administering medication have to be considered. Depression is an extremely serious illness with widespread negative effects in multiple realmspoor functioning in relationships with family and friends, in school performance, in participation and enjoyment of activitiesand can lead to problems in the adult years. Not to be overlooked is the fact that the risk for suicide is high. Parents must consider these possible long term negative effects of depression on the quality and course of the child's life in relation to the risks of medication.
Q: Is there any way to prevent side effects from occurring? Should parents be alert to the manifestation of the possible side effects of antidepressant medication?
Dr. Hirsch: Monitoring is the key to prevention. Frequentinitially weekly visits with the prescribing psychiatrist to evaluate the progress of treatment is mandatory
Q: How can parents judge whether antidepressant medication is effective?
Dr. Hirsch: Progress is not based on lab tests or some obscure measurement. Parents are the best judges of whether medication is effective. They can observe whether the teenager's life is better; whether he/she looks better and is functioning better academically and socially. Sometimes the first signs of response are normalization of sleep and appetite. At times the teenager is the last to realize that he or she is getting better; although functioning may improve, it may take time for their negative thoughts to change.
Q: What can be done for prevention of depression?
Dr. Hirsch: The causes of depression are many. Unfortunately we have no obvious lifestyle changes that can be recommended to prevent someone from getting this illness. However, we need to identify youth who are depressed as soon as possible. Parents are often not aware that their teenager might be depressed; it's easy to dismiss symptoms as a phase or just typical teenage moodiness. But parents should consider be aware of the following warning signs: Depressed or irritable mood, difficulty concentrating, irritability and anger, fatigue, feelings of worthlessness, sleep or appetite problems, social withdrawal, restlessness or slowing down, decreased interest in formerly pleasurable activities, thoughts of death. I would urge parents, if there is any question in their minds, to err on the side of caution and check things out. Depression untreated, more than any other factor, has been shown to be a major cause of suicide. Treatment is available; research has demonstrated that a combined treatment of medication and cognitive behavioral therapy has been effective in treating depression.