An increasing population affected by depression is children. Currently, children between the ages of 5 – 8 years old are highly medicated for antidepressants, surmounting to more than three times the amount prior to the 1990s, which also coincides with the introduction of Prozac. Children that are under 5 years old typically are not medicated with anti-depressants (Harvard, Children and Anti-depressants). Some speculated issues that can cause a child to go into depression include: unsafe living situations, basic needs not being met, uninterested or uninvolved parents, parents with substance addictions, bullying or harassment issues at school, feeling “unpopular”, lack of close relationships, or various other reasons not listed.
The National Institute of Mental Health (NIMH) published a recent article in 2011, entitled: “Benefits of Antidepressant Use may Outweigh Risks for Kids,” which recognizes that there is a FDA blackbox warning on anti-depressants, indicating a 3-8% increased risk for suicidal ideation and behavior for individuals taking these medications. However, despite this blackbox warning, the NIMH suggests that physicians should still prescribe antidepressant medications because it is better to treat the child with medication than let the condition go untreated. Another article by Sparks and Duncan, explores the ethics and science behind heavy pharmaceutical medication of children, and a benefit to using anti-depressants in children was described as: “early diagnosis means better prognosis” (page 26, APA pages 7-9).
Rather than an issue of under-medication, is an issue of overmedication and overuse of anti-depressants. One of the major problems with using adult medications for children is that scientists, researchers, and clinicians do not know the specific long-term effects on the brain, the physical body, or the psyche, leading to ease of prescription. Children’s dose requirement is much different from adults, and even mechanisms of biotransformation can be slightly different than adults. Although there are instances where there is a physiological need for additional neurotransmitters, such as serotonin and dopamine in the brain due to decreased production, the question remains: Are we doing more harm than good to our children? The debate of anti-depressants administered to children is a double-edged sword.
Despite whatever age anti-depressants are being used, significant side effects such as increased suicidal ideation, sadness, lethargy, self-infliction of pain, irritability, and anger must be monitored by the parents, the caregivers, and the family of the children and adolescents, and reported immediately to a family physician. Although there is a blackbox warning for increased suicidal ideation for individuals who use anti-depressants, the American Psychiatric Association (APA) states that children with depression are more likely to think about and contemplate suicide, but are less likely to execute the act. If the child is untreated for depression, either through medication or psychotherapy sessions, there is a significantly increased risk for a depressed adult to have thoughts of suicide and actually carry out the act. Having open conversations with children about these thoughts is an important part of success with depressive treatment strategies, whatever they may be (APA, pages 7-9).
At this point in time, the main question is whether or not anti-depressant medication should be allowed in children over 5 years old for treatment of depressed symptoms. The major risk factor identification involves side effects and long term treatments of medication compared to risks of non-medication and future potential harmful events to both the individual, and to society at large.
Anti-depressants have been used for adults in treatment of depression due to the idea that a serotonin deficiency is key to understanding the etiology of the mental illness. This has been currently been extrapolated to the usage in children, as we have statistically seen rises in use of anti-depressants over the years. Length of treatment time may be different for children compared to adults, as well as dosage, and clinical signs and symptoms that present. Evaluation of anti-depressant use in children compared to depressed children without anti-depressant medication needs to be evaluated to determine whether or no anti-depressants should continue to be used as an intervention for children suffering from debilitating depression and inability to function on a daily basis.
As a naturopathic student, and an individual who is interested in public health perspectives, anti-depressant medications should be considered as a last-resort situation. First line preventative measures, such as counseling and other psychotherapy models for depression should be implemented and promoted. By understanding the fact that the community at large needs to benefit from certain types of treatments, individualized healthcare can be pushed to the back burner at times due to cost of care, accessibility, and availability, it is understandable how the pharmaceutical companies have prevailed in “easy and quick fixes”. However, the issue with anti-depressant use in children extends more than just a quick fix. This involves influencing an individual’s long-term functioning within society and mentality, two things that should not be handled lightly. At this point in time, it is respectable to state that our knowledge is limited, and that public health officials are doing the best that they can, with the resources that are available.
References
Association, A. P., and First . Diagnostic and statistical manual of mental disorders, dsm-iv-tr.. 4. Arlington, VA: American Psychiatric Publishing, Inc., 2000.
“CDC Media Relations Press release December 2, 2004.” Office of Enterprise Communications. Office of Enterprise Communication, CDC, 02 December 2004. Web. 22 Jan 2012. .
“Depression.” http://emedicine.medscape.com/article/286759-overview. January 19, 2012.
“Depression: Medline Plus”. January 20, 2012. http://www.nlm.nih.gov/medlineplus/depression.html
National Institute of Mental Health. “Benefits of Antidepressants may outweigh the risks for kids”. 17 Apr 2011. Web. 22 Jan. 2012. .
National Institute of Mental Health. “Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers”. 17 Apr 2011. Web. 22 Jan. 2012. .
“Pediatric Depression”. January 20, 2012. http://emedicine.medscape.com/article/914192overview.
“The Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families.” American Psychiatric Association . 1-15. American Psychiatric Association , Print. (/em>
An increasing population affected by depression is children. Currently, children between the ages of 5 – 8 years old are highly medicated for antidepressants, surmounting to more than three times the amount prior to the 1990s, which also coincides with the introduction of Prozac. Children that are under 5 years old typically are not medicated with anti-depressants (Harvard, Children and Anti-depressants). Some speculated issues that can cause a child to go into depression include: unsafe living situations, basic needs not being met, uninterested or uninvolved parents, parents with substance addictions, bullying or harassment issues at school, feeling “unpopular”, lack of close relationships, or various other reasons not listed.
The National Institute of Mental Health (NIMH) published a recent article in 2011, entitled: “Benefits of Antidepressant Use may Outweigh Risks for Kids,” which recognizes that there is a FDA blackbox warning on anti-depressants, indicating a 3-8% increased risk for suicidal ideation and behavior for individuals taking these medications. However, despite this blackbox warning, the NIMH suggests that physicians should still prescribe antidepressant medications because it is better to treat the child with medication than let the condition go untreated. Another article by Sparks and Duncan, explores the ethics and science behind heavy pharmaceutical medication of children, and a benefit to using anti-depressants in children was described as: “early diagnosis means better prognosis” (page 26, APA pages 7-9).
Rather than an issue of under-medication, is an issue of overmedication and overuse of anti-depressants. One of the major problems with using adult medications for children is that scientists, researchers, and clinicians do not know the specific long-term effects on the brain, the physical body, or the psyche, leading to ease of prescription. Children’s dose requirement is much different from adults, and even mechanisms of biotransformation can be slightly different than adults. Although there are instances where there is a physiological need for additional neurotransmitters, such as serotonin and dopamine in the brain due to decreased production, the question remains: Are we doing more harm than good to our children? The debate of anti-depressants administered to children is a double-edged sword.
Despite whatever age anti-depressants are being used, significant side effects such as increased suicidal ideation, sadness, lethargy, self-infliction of pain, irritability, and anger must be monitored by the parents, the caregivers, and the family of the children and adolescents, and reported immediately to a family physician. Although there is a blackbox warning for increased suicidal ideation for individuals who use anti-depressants, the American Psychiatric Association (APA) states that children with depression are more likely to think about and contemplate suicide, but are less likely to execute the act. If the child is untreated for depression, either through medication or psychotherapy sessions, there is a significantly increased risk for a depressed adult to have thoughts of suicide and actually carry out the act. Having open conversations with children about these thoughts is an important part of success with depressive treatment strategies, whatever they may be (APA, pages 7-9).
At this point in time, the main question is whether or not anti-depressant medication should be allowed in children over 5 years old for treatment of depressed symptoms. The major risk factor identification involves side effects and long term treatments of medication compared to risks of non-medication and future potential harmful events to both the individual, and to society at large.
Anti-depressants have been used for adults in treatment of depression due to the idea that a serotonin deficiency is key to understanding the etiology of the mental illness. This has been currently been extrapolated to the usage in children, as we have statistically seen rises in use of anti-depressants over the years. Length of treatment time may be different for children compared to adults, as well as dosage, and clinical signs and symptoms that present. Evaluation of anti-depressant use in children compared to depressed children without anti-depressant medication needs to be evaluated to determine whether or no anti-depressants should continue to be used as an intervention for children suffering from debilitating depression and inability to function on a daily basis.
As a naturopathic student, and an individual who is interested in public health perspectives, anti-depressant medications should be considered as a last-resort situation. First line preventative measures, such as counseling and other psychotherapy models for depression should be implemented and promoted. By understanding the fact that the community at large needs to benefit from certain types of treatments, individualized healthcare can be pushed to the back burner at times due to cost of care, accessibility, and availability, it is understandable how the pharmaceutical companies have prevailed in “easy and quick fixes”. However, the issue with anti-depressant use in children extends more than just a quick fix. This involves influencing an individual’s long-term functioning within society and mentality, two things that should not be handled lightly. At this point in time, it is respectable to state that our knowledge is limited, and that public health officials are doing the best that they can, with the resources that are available.
References...
Association, A. P., and First . Diagnostic and statistical manual of mental disorders, dsm-iv-tr.. 4. Arlington, VA: American Psychiatric Publishing, Inc., 2000.
“CDC Media Relations Press release December 2, 2004.” Office of Enterprise Communications. Office of Enterprise Communication, CDC, 02 December 2004. Web. 22 Jan 2012.
“Depression.” http://emedicine.medscape.com/article/286759-overview. January 19, 2012.
“Depression: Medline Plus”. January 20, 2012. http://www.nlm.nih.gov/medlineplus/depression.html
National Institute of Mental Health. “Benefits of Antidepressants may outweigh the risks for kids”. 17 Apr 2011. Web. 22 Jan. 2012.
National Institute of Mental Health. “Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers”. 17 Apr 2011. Web. 22 Jan. 2012.
“Pediatric Depression”. January 20, 2012. http://emedicine.medscape.com/article/914192overview.
“The Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families.” American Psychiatric Association . 1-15. American Psychiatric Association , Print. (/em>