Antidepressants, Psychotherapy and Your Teen

Parents should likewise always respond to a teenager's threat of suicide or self-harm by bringing the child immediately to a physician, mental health professional or emergency room in a secure way or to call 911.

If this is not done, some adolescents might learn to use the threat of suicide to manipulate their parents -- negotiating with children in the context of such threats rewards them in a sense for this behavior (somewhat like the problem of negotiating with a terrorist).

Parents should indicate to their children that suicide or self-harm would be viewed no differently (by the parent) than if they were to murder or harm their brother or sister; allowing harm to self is just as inappropriate, tragic and intolerable as allowing harm to a sibling.

Finally, parents should remain vigilant for any and all signs of drug or alcohol use, or subtle forms of self-injurious behavior (such as "cutting" or making deep scratches on their skin).

Helping Teens Beat Depression

Any treatment plan for depression should include psychotherapy, with or without the addition of antidepressant medication.

Psychotherapy is an important tool that is misunderstood by many parents. Used effectively, it can help teens review and revise the negative thoughts and false assumptions that may underlie their depressive condition.

Through support, understanding and sometimes building an enduring therapeutic relationship, psychotherapy often helps a child build an identity that can offer both comfort and context to his or her situation.

Medications are also extremely important and helpful to a majority of adolescents to whom they are prescribed.

A recent pooled analysis of 27 trials of antidepressant medication treatment involving more than 5,000 children and adolescents revealed that the actual risk for worsening of suicidal thinking or behavior was 1 percent -- lower than many previously reported estimates.

None of the children in these trials actually committed suicide during the course of the respective studies, and a significant proportion were substantially improved by medication treatment, indicating that the use of antidepressant medications in children is safe and that the potential benefits generally outweigh the risks.

Of course, like any medication for any medical condition, antidepressant medications carry risks, including the highly publicized potential risk of an increase in suicidal thoughts (not actions), which can occur early in the course of antidepressant treatment with some medications.

Physicians are trained extensively to weigh these risks against the risk of not adequately treating the depression -- which, again, includes death.

The catastrophic outcome of death by suicide cannot be prevented in every case. The choice to live or die ultimately rests with the individual. This is a good thing in that it reflects a fundamental "freedom of will."

But major depression has insidious ways of disrupting the decision-making process by distorting the assumptions upon which complex life decisions are made.

Everyone involved needs to know (and believe) that overcoming depression is possible, even if it takes a while. The alternative -- not overcoming depression -- is never an acceptable option.

Dr. John Constantino is associate professor of psychiatry and pediatrics at Washington University School of Medicine, and Dr. Richard D. Todd is professor and director of the Division of Child Psychiatry at the Washington University School of Medicine Department of Psychiatry.

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