Kids and Antidepressants: Why they don’t mix.

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Depression and children, antidepressants for children:

- A frequently misunderstood topic, and Time says it’s one of the most important issues of the medical year [from Depression on that page]

Researchers still don’t understand why severely depressed teenagers are more likely than adults to commit suicide while taking antidepressant drugs like Paxil, but a major study out of UCLA concluded that the drugs do more good than harm. Starting in the early 1960s, the annual U.S. suicide rate held fairly steady at 12 to 14 instances per 100,000–until 1988, when the first of a new generation of antidepressants, the selective serotonin reuptake inhibitors, was introduced. The suicide rate has been falling ever since, to around 10 per 100,000. The investigators estimate that nearly 34,000 lives have been saved [Time 11/29/06]

This post is, of course, not research, but I do have an answer to this question on antidepressants.
– Have seen this answer not once or twice but hundreds, actually thousands of times over the years since 1996 when Adderall came out.

We’re missing the comorbidity because we are thinking categorically.

The Basal Ganglia Seesaw:
One of the most frequently overlooked comorbid conditions with depression in children, and indeed adults, is ADD. [More about the ADD diagnosis in the next post.] Most important for this missive is the fact that serotonin meds can significantly dysregulate [diminish] dopamine [all stimulants effect dopamine].

Serotonin is likely the most important and available treatment for depression [as noted in Time article], and it works, and is safe. More about SSRI side effects later, but for now the suicide rate is falling and SSRIs can significantly help with depression, and depressed kids and adults should take SSRIs until every other comorbid stone is turned over. [Always look for every explanation, not just one.] SSRIs are frequently life savers.

But if the patient has an often unrecognized ADD the SSRI will downregulate, reduce, the already low dopamine in the prefrontal cortex. The SSRI causes a seesaw effect. The most frequent outcome of this dopamine deficiency problem: abundance of thought, cognitive anxiety, increases impulsivity, the mind races [secondary to increased ADD, not bipolar], the patient can’t think, can’t sleep, becomes cognitively less effective, more worried, more sleep deprived and wants to turn their brain off any way they can.

Many who think of suicide every day say on initial interview: “But I wouldn’t do it.” Most reassuring…

Suicidal Thinking Matters

Death is a long term solution to a short term medication problem caused by missing the comorbid diagnosis of ADHD. ADD is subsequently aggravated with the antidepressant, adding to the cognitive abundance and decreased control of thinking. Fix the ADHD at the same time as the depression and the problem very simply, disappears. This is precisely why I made the point on mixing meds for ADD and depression in my third CorePsychBlog post.

I’ve been preaching about this clinical challenge around the country since 1996, and too many just don’t get it.

Moreover, if you treat ADD with an inappropriate bipolar drug, a mood stabilizer, the racing mind often does not stop. Sleep decreases, frontal lobe function deteriorates, impulsivity increases, and suicidal thinking increases. Suicidal and self destructive behavior, cutting, head banging, hair pulling all can increase.

And yes, if the underlying diagnosis is bipolar, and you treat bipolar with a stimulant it may aggravate the bipolar problem. And yes, bipolar can present with ADD and depression, we have seen it on SPECT brain imaging for years. More comorbid conditions require more careful complex interventions.

This ADHD and depression problem is by far the most commonly missed comorbid presentation, and . Let’s work together to address this challenging and easily fixable combination.
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Related articles

• Insight into Depression and Antidepressants (brighthub.com)
• ADD and Depression: A dangerous mix (corepsychblog.com)

Digitally available now at Nook, Kindle, Barnes and Noble.
ADHD Medication Rules – PDF For Your Desktop  
ADHD Medication Rules | Paying Attention To The Meds For Paying Attention – Kindle Version

Tagged as: ADD, ADD Medications, Adderall, Antidepressant, antidepressants for children, Attention-deficit hyperactivity disorder, Basal Ganglia, Bipolar, brain function, brain imaging, comorbidity, Depression, Major depressive disorder, Neurotransmitters, Paxil, Prefrontal Cortex, Psychiatric Medications, Serotonin, SPECT, SSRI, Suicide