by Cara Gardner

One of the hardest decisions that teens and their parents have to make regarding depression is whether anti-depressants will help dissolve their misery. First, it's important to discern the difference between normal bouts of adolescent angst as opposed to extended episodes of despair. When is the sullen, morose attitude just part of growing up, and when is it a warning sign of something deeper and darker?

"The diagnosis of depression has always been based upon three core groups of symptoms," explains Alan Unis, staff psychiatrist with the Child and Adolescent Psychiatry Program at Sacred Heart Medical Center. "The first is loss of interest, when kids stop enjoying things they normally enjoyed in the past. The second is lack of energy, [when] kids don't have the energy to do things they'd normally do, being more withdrawn. The third shows itself in sleep and appetite."

If a teenager is seriously depressed, anti-depressants are an option. Experts on adolescent behavioral health have good arguments both pro and con. The FDA hasn't approved all anti-depressants for teenagers, but Unis explains there are several kinds that have done well in studies. Anti-depressants are becoming more advanced and are proving to be more effective, as experts learn more through their research. Still, some contend that medicine is diagnosed as a "quick fix," when the focus should be on changing larger patterns of behavior.

Unis says critics of anti-depressants for adolescents believe depressive symptoms usually go away on their own.

"But the other corollary," Unis warns regarding this theory, "is we can't predict who's going to go on to have a more chronic and repetitive pattern of depressive illness. An adolescent who is experiencing depression for six months is really going to suffer, and they tend to make poor decisions when it comes to drugs, alcohol and sexual behavior."

Unis says poor choices can lead to cycles of depression. Anti-depressants, he explains, can help a teenager make better decisions. Early detection, he insists, can stop depression patterns from forming. "We know [a teenager's] depression inhibits their ability to make sound choices. But one point that's really important to make is that drug treatment alone is not appropriate. You have to link it with psychotherapy. The data are pretty convincing that anti-depressants are very effective in diminishing depressive symptoms."

Contrary to popular myths, anti-depressants don't make people immune to suffering and pain. Instead, anti-depressants aid the brain's ability to produce and absorb its own natural chemicals that control the sense of well-being. In fact, a study from Columbia University, published this year, shows that in areas where anti-depressant use was higher among adolescents, the teenage suicide rate went down. Used correctly, anti-depressants can help people regain control over their thoughts, clearing the way toward more positive thinking and coping mechanisms.

Still, many teenagers and parents are hesitant about using anti-depressants because of the social stigma attached to them. Because it's widely misunderstood, some people see depression as a weakness. Many teens report being embarrassed about taking anti-depressants and say they hide it from their peers.

"I try to be very realistic about what it will do and what it won't do," Unis says, regarding how he talks to teens about taking anti-depressants. "It will help their energy level and their overall response to stressful events in their life. It's not going to change the way they feel about themselves, the circumstances in their life. So being very, very realistic, this will help [teens] do the rest of the healing that they need to do."

Publication date: 12/04/03

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