Study: Most Depressed Kids Get Antidepressants But NoTherapy

By Marilyn Elias, USA TODAY

At least half of U.S. children who take antidepressants aren't in therapy, a large study suggests, and that delays recovery while greatly increasing the number of kids on the medication who are suicidal.

"Therapy with antidepressants is the standard of care. But is it what's going on in the real world? No," says Sheila Marcus, child and adolescent psychiatry chief at the University of Michigan Medical School.

The report tracks insurance claims for antidepressants from a database of 6.8 million children and teens from 2002 to 2006. The analysis was done by the health care business of Thomson Reuters, a research firm.

BETTER LIFE: U.S. kids more likely than Europeans to take drugs for mental disorders

In the six months after getting at least one new prescription for antidepressants in 2006, just over 40% of children had insurance claims for one or more therapy sessions, says Tami Mark, the Thomson study leader.

The Food and Drug Administration has put the strongest safety warning on antidepressants, saying they could increase suicidal behavior in people 24 or younger.

A government study last year found that depressed kids recover most rapidly with antidepressants and counseling that teaches problem-solving and stress management. Also, 15% of children on Prozac only were suicidal — either thinking about killing themselves or trying to — compared with 8% on Prozac plus therapy and 6% receiving therapy alone.

The low therapy-claim rates in the new study could be partly a result of some parents paying out-of-pocket or not taking children for counseling because of poor insurance coverage, Mark says.

A federal law passed last week requires employers with more than 50 workers to provide comparable benefits for mental health and medical care. "Lack of insurance has been a big barrier for kids with mental illness," she says.

There's also a great shortage of child psychiatrists, Marcus says.

Some children probably went off antidepressants because of side effects or because they improved, so they weren't referred for counseling, says Kevin Kalikow, a child psychiatrist in Mount Kisco, N.Y.

Many parents are embarrassed to take their kids for therapy, says Jana Martin, a child psychologist in Long Beach, Calif.

"If kids take a pill, the parents don't feel it's as bad a reflection on them. The pill helps, but if kids get bullied on the playground, it doesn't teach them how to respond and not get depressed, while therapy does. You can't go take another pill every time someone bullies you."

To Drug or Not To Drug

Lately I’ve been playing with a question I was asked after a workshop I presented on SIV. A psychologist stopped to talk after the training and was arguing the need to have the right to restrain people who self-injure.

I gave him my thoughts about how retraumatizing people who already are living in a world of pain serves no one, including the staff of the institutions in which restraint and seclusion (tying people down to beds and/or locking them in padded rooms) remain prevalent He remained adamant that all SIV must be stopped, that clinicians should not have to tolerate anyone who continues to self-injure. He proposed using psychiatric drugs to achieve this as well, but did admit that there are no drugs, used appropriately, that achieve the result he was after.

It was his next statement that I found interesting. He was adamant that if a psychiatric drug could be created to take away the need to self-injure, that all the people living with SIV would be more than interested in taking it forever. I told him that I didn’t think this to be true, but that I would ask the experts, the people who live with SIV. I believe that SIV is not “all bad” as this psychologist was presenting, that SIV serves a purpose in many people’s lives that helps them cope with the aftereffects of trauma and the struggles of healing.

While living with SIV certainly has its down side, it also has a purpose. And as people come to understand the trauma in their histories the need for SIV abates as healing progresses. A drug that would solve the problem so simply would likely do what so many of the other drugs used previously have done, make a person so numb that they might lose touch with their pain and struggle but also become so numbed as to not feel truly alive. I presumed that the price of permanently drugging oneself out of the need for SIV would be too high to pay. I believe that SIV fades away as we learn to understand, experience, and release the pain, rage and disconnection that it manages. We can learn a great deal about ourselves from the urges to self-injure.

But he made me think and now I am curious. Any thoughts out there?

Ruta Mazelis, Editor of The Cutting Edge

Medication & Dealing With Teen Depression

Both medication and psychotherapy play a part in the treatment of teen depression. Each method of treatment goes hand-in-hand with one another. Even if a troubled teenager is under medication for his or her depression, supporting psychotherapy is vital to his or her treatment. On the other hand if he or she is undergoing psychotherapy, supporting medication is crucial.

Medications like Zoloft (sertraline) or Prozac (fluoxetine) are often prescribed for the disorder because of their effectiveness in restoring a patient’s normal mood, appetite, and sleeping patterns. While the patient is dealing with his or her issues behind the depression in psychotherapy, medication can help him or her deal with the symptoms of the disorder.

All patients are unique individuals

But it is important to consider the fact that all patients are unique individuals. Just because one medication worked for this patient doesn’t necessarily mean that it will be the most beneficial for another patient. If a certain medication prescribed for depression does not show favorable results in your troubled teen, don’t be quick to shun medication in the treatment of your teen’s disorder. A different kind of medication for depression may have a positive effect on your teen’s progress. For some people, the class of drugs called selective serotonin reuptake inhibitors (SSRI’s) are helpful in the treatment of atypical depression, while others prefer monoamine oxidase inhibitors (MAOI’s). Tricyclic antidepressants (TCA’s) are also another class of drugs which are frequently used in the treatment of melancholic depression.

Have realistic expectations

It is important to note that medication for the treatment of teen depression is not a magic pill which can induce wellness with one swallow. Both parent and patient should have realistic expectations of the effectiveness of the drug in relation to a timetable. For most medications, there is a certain period of time that the patient must be taking the medication for it to take proper effect.

Achieve a proper balance of medication and psychotherapy

Some parents may still be skeptical of the use of medication to treat disorders which are known for their symptoms of feelings. But many studies have shown that there are certain chemicals that may affect our disposition. Because of these new studies, parents ought to be more open to the use of drugs in the treatment of disorders of this type.

As long as a parent is not relying solely on the medication for the treatment of his or her troubled teen, he or she can expect a smoother transition into wellness for his or her teen with the proper balance of medication and psychotherapy.

[Link: Troubled Teen]

Treatments for self-injury

One danger connected with self-injury is that it tends to become an addictive behavior, a habit that is difficult to break even when the individual wants to stop. As with other addictions, qualified professional help is almost always necessary. It is important to find a therapist who understands this behavior and is not upset or repulsed by it. Call your doctor or insurance company for a referral to a mental health professional who specializes in self-injury.

Cognitive-behavioral therapy may be used to help the person learn to recognize and address triggering feelings in healthier ways

• Because a history of abuse or incest may be at the core of an individual’s self-injuring behavior, therapies that address post-traumatic stress disorder such as EMDR may be helpful (see Helpguide’s article on Eye Movement Desensitization and Reprocessing)
• Hypnosis or other self-relaxation techniques are helpful in reducing the stress and tension that often precede injuring incidents (see Helpguide’s article on Yoga, meditation and other relaxation techniques)
• Group therapy may be helpful in decreasing the shame associated with self-harm, and help to support healthy expressions of emotions
• Family therapy may be useful, both in addressing any history of family stress related to the behavior, and also in helping other family members learn how to communicate more directly and non-judgmentally with each other
• In cases of moderate to severe depression or anxiety an antidepressant or anti-anxiety medication may be used to reduce the impulsive urges to self-harm in response to stress, while other coping strategies are developed.
• In severe cases an in-patient hospitalization program with a multi-disciplinary team approach may be required

[From: Helpguide.Org]

Medication & Teen Depression

While the patient is dealing with his or her issues behind the depression in psychotherapy, medication can help him or her deal with the symptoms of the disorder.

It is important to consider the fact that all patients are unique individuals. Just because one medication worked for this patient doesn’t necessarily mean that it will be the most beneficial for another patient.

If a certain medication prescribed for depression does not show favorable results in your troubled teen, don’t be quick to shun medication in the treatment of your teen’s disorder. A different kind of medication for depression may have a positive effect on your teen’s progress. For some people, the class of drugs called selective serotonin reuptake inhibitors (SSRI’s) are helpful in the treatment of atypical depression, while others prefer monoamine oxidase inhibitors (MAOI’s). Tricyclic antidepressants (TCA’s) are also another class of drugs which are frequently used in the treatment of melancholic depression.

Refer to Role of Medication in dealing with Teen Depression for more information.

[Link: Troubled Teens]

Friday Readers Story

Anonymous said...

I am 19 years old, and I've been cutting myself since I was 15. My boyfriend at the time committed suicide, which I think I read someone else on here has been through, and it is really hard. I was there, when he did it, so I never really got over it. I tried to kill myself twice before my next birthday. I have his name cut into my arm. I met and got into a relationship with another guy, that ended up being an abusive relationship.

That went on for..almost two years. I came out of that with a daughter (born at 25 wks), and several more scars.I recently attempted suicide again and was diagnosed as bipolar, as well as suffering from PTSD, which I now have medication for. I think the reason I do it, (I still do it) is because when I do it, and I bleed, it just..I don't know..gives me a physical reason for the pain, which kind of helps..

But, I am trying, /trying/ to work past it, so I can be there for my kids, and my soon to be husband.I don't know why I felt like I needed to go into that here, but I did..so..I dunno, maybe it'll help someone.
January 19, 2008

Treatment Strategies

Self-injurious behavior can be reduced and eventually extinguished once the adolescent is ready to embrace alternative behaviors designed to promote healthier communication, self-comfort and genuine healing.

Psychotherapy — It is extremely important to work with a helping professional who has an expertise in self-injurious behavior or related disorders. Psychotherapy can provide a non-judgmental and supportive environment where self-injury can be processed openly and the meaning behind the injury can be explored. Trained therapists can provide safer, alternative ways to communicate, self-soothe and cope. The use of journaling, art therapy, relaxation techniques, visualizations, cognitive re-framing and affect management are all recommended and useful.

Appropriate contracts that encourage the teenager to write, draw, exercise and self-soothe before engaging in self-injurious behavior are more effective than contracts that demand the immediate cessation of the behavior. When the self-injury is severe, the teenager is unable to integrate strategies and abide by a safety contract or additional problems such as substance abuse or a threatening eating disorder are evident, inpatient treatment is often required.

In addition to working with a trained therapist some teens are able to utilize resources such as personal journaling and drawing, meditation, spiritual support and healthy self-injurious behavior substitutes such as physical exercise.

Psychopharmacology — When self-injurious behavior connects to untreated depression or anxiety, medication can be extremely useful. Anti-depressants can dramatically reduce the negative feelings and cognitions associated with the cycle of self-harm. Anxiolytics prevent the escalation of panic and generalized anxiety, which decreases the need for dissociation and self-injury. Providing a pharmacological safety net also may allow adolescents to process painful trauma memories without becoming flooded or overwhelmed.

[taken in part: *PRP Online]* Performance Resource Press