Parenting is a Journey
An Adventure of Discovery Not Only of our Children But of Ourselves as Well
When my son was 15 and just starting high school, my family moved to New Orleans for my husband’s job. The culture shock was swift and intense, and we all felt it, but especially my son.
He began to suffer crying jags, intense anxiety and an aversion to his new school. It was more than severe homesickness — he was suffering from depression and anxiety. His new doctor prescribed a low dose of the antidepressant Prozac, which helped a bit, until we moved back to California nine months later, at which point he didn’t need it at all.
I am thankful for the help the drug gave him, and I had no qualms about giving it to a teenager. What I do regret is that I did not take his recovery a step further, and added some cognitive behavioral therapy (CBT) to the mix.
According to the National Institute of Health, a mixture of therapy and medication is the best way to combat anxiety and depression in not only tweens and teens, but adults as well, says Margie Ryerson, a Walnut Creek-based family therapist. Sometimes, just therapy alone is needed to help teens deal with depression and anxiety.
As for drugs? “There is no pure answer,” Ryerson says, when drugs should be administered, except in extreme cases, such as a child is exhibiting suicidal thoughts or actions, or has thoughts of or is exhibiting actions of hurting someone else.
For garden variety anxiety and depression like my son was feeling — which can in itself be crippling for the child and terrifying for the parents — Ryerson suggests a team approach, which starts with the child’s pediatrician or family doctor. They can assess the child — even as young as nine — and recommend counseling or psychiatry, or both.
When a family is choosing a counselor, Ryerson suggests that it might be a good idea to have family therapy, and to let the child in on interviewing several prospective therapists so that they feel empowered in making a choice.
The second tier of treating anxiety and depression, Ryerson says, is seeing a psychiatrist for evaluation, and seeing whether they recommend antidepressants.
“Remember, it’s just a recommendation — you don’t need to give the child antidepressants if you don’t want to.”
But if a parent chooses to give a child medication to fight anxiety and/or depression, she says to be sure to include talk therapy, preferably CBT, as well. CBT is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel.
D. Raymond Hearey, a child and adolescent psychiatric specialist practicing out of Orinda, agrees with Ryerson that drugs alone may not be the most effective way to treat adolescent depression and anxiety.
“Parents should have the child assessed by a psychiatrist, to see if drugs are a good option,” he says. Don’t rely on the child’s doctor to prescribe the medication, he says.
Hearey says there is no “magic age” when it is okay to administer drugs — he has seen children as young as six respond well to medication, while older teens may not. Still, he says he would prefer not to prescribe medication to children and teens if there are other options, like therapy, that will work as well.
“Only use medication when it is needed,” he said, adding that the decision must be made by the psychiatrist, the parents and the child.
The other nebulous area is the particular medication that is prescribed. Hearey says clinically, “there is no right answer,” but that some have shown better results in teens and children than in adults, and vice versa. Again, a psychiatrist will know those areas better than a pediatrician.
Ultimately, like most hard parenting decisions, whether to give your teen antidepressants is a judgement that needs a lot of study, input and faith — and hinges on how well you know your own child.