prozac for teenagers-climbing related

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joy bar

climber
Topic Author's Original Post - May 3, 2013 - 05:11pm PT
Soooo

A group of docs want to put my kid on prozac because
she has suicidal thoughts.

My take is my kid needs to learn how to cope with the ups and downs of life without meds.

If she fails at that (and fails at trying to kill herself) then and only then does meds. make sense to me. Plus prozac increases thoughts of suicide in kids, so seems like a strange "cure."

Reading these here forum posts, seems lots of climbers deal with depression.
And lots of the posts are depressing.

so any advice welcome,

cha joy

Robb

Social climber
It's Ault or Nunn south of Shy Annie
May 3, 2013 - 05:15pm PT
My advice,

DO NOT DO IT!!!!!!!

My best friend and paramedic partner offed himself on Prozac!

SRI's and SSRI's are bad news......
JEleazarian

Trad climber
Fresno CA
May 3, 2013 - 05:47pm PT
I wouldn't dismiss the suggestion, but I would be wary. I have been on Effexor, a SSRI, since 2005, and it worked wonders for me. I told my full story in a different thread, if you're interested:

http://www.supertopo.com/climbing/thread.php?topic_id=1133733&msg=1134943#msg1134943

My depression was entirely endogenous, though. There was no external reason for depression. I have had no real depressive episodes since I started medication, but I started when I was first diagnosed at age 54.

I know too many stories of adverse results from teenagers relying on medication for control of depression, including suicidal ideation, that was situational rather than medical. Without knowing why your particular group recommends Prozac, I can't offer any more specific advice, except to say that often the only thing keeping a depressed person from committing suicide is that their depression is so severe, they are unable to undertake any action. Once the antidepressant kicks in, the first -- and, sadly, last -- thing they do is kill themselves.

I would at least seek a second medical opinion before sending meds a teenager's way. There may be a very good medical reason for the recommendation, but the warnings about antidepressants, particularly with younger patients, represent sad experience, so be careful.

John
Tami

Social climber
Canada
May 3, 2013 - 06:00pm PT
I wouldn't be too quick to either embrace or reject medication for a teen.

( I work with teens & have 2 kids in their twenties now )

I am familiar with situations where there has been over-medicating as well as under-medicating. Sometimes telling a kid to bootstrap it doesn't work. Rejecting medications because a person "should live with ups and downs" sometimes isn't an option.

You need to research what the needs of your individual teen are.
Reeotch

Trad climber
4 Corners Area
May 3, 2013 - 06:00pm PT
I concur with the above posts.

Too many doctors are just drug pushers these days.

What kind of doctor was it? And, did they even mention any form of counseling. I'd look for a good therapist first before going straight to the drugs.
FRUMY

Trad climber
SHERMAN OAKS,CA
May 3, 2013 - 06:06pm PT
I agree with Tami.

Getch

Mountain climber
Flagstaff, AZ
May 3, 2013 - 06:07pm PT
How frequent and what intensity are her thoughts? Sometimes depression is caused by an event or situation sometimes it is endogenous, most of the time it is both. Therapy an option? Lots of different types of therapists out there. SSRI's are a very safe medication overall, although they don't know the specific mechanism of action. Is the doc a psych? GP?
Ron Anderson

Trad climber
Soon to be Nipple suckling Liberal
May 3, 2013 - 06:15pm PT
fairly incomplete info.. What Music does she listen to? What TV or movies? Video games? Introvert? Spoiled/bored?
Patrick Sawyer

climber
Originally California now Ireland
May 3, 2013 - 06:27pm PT
This is a tough one.

My partner Jennie takes 10mg Citalopram every morning for depression.

It works, I think, I hope. She is 62 and suffered child abuse (EDIT, by her father).

I do not know much about Prozac. (EDIT even though I am a medical journalist).

But for a teen-ager. I just do not know. The only advice I can offer, for what it is worth, is get a couple of more medical opinions.

I wish you the best.

Cheers

Patrick


EDIT

SRI's and SSRI's are bad news......

Robb, yes and no. Not to be ambiguous, but it really does come down to a good medical person and the individual involved. Of course, we would like to lessen the dependence on drugs, but let's be realistic, yoga is not going to help my partner's condition. I have no answers.
joy bar

climber
Topic Author's Reply - May 3, 2013 - 06:56pm PT
thanks for the great info so far.

cha joy
hossjulia

climber
May 3, 2013 - 07:01pm PT
Prozac is about the strongest one out there, what about something A LOT milder?

My son, and a friend killed themselves on Prozac. He was 23, she was brain injured and mid 30's.

I personally think of it (prozac) as a last resort after other anti-depressants have failed..

Get a second opinion and/or ask for something milder.
John M

climber
May 3, 2013 - 07:04pm PT
If she fails at that (and fails at trying to kill herself)

First question..

What if she succeeds at trying kill herself?

Second question..

What kind of group of doctors? Is there a Psychiatrist in the group? Has she seen a Psychologist?

In my experience, most Psychiatrist and many family doctors lean towards treating with meds. The Psychiatrists are experts in the meds and if you need one, then you need one. But first I would have her see a good Psychologist. Most aren't MDs and so can't perscribe meds, but a good one will know when a person needs more help then they can give.

Suicidal ideation is not a joke. And its not something that most people can just pull themselves up by their bootstraps. 30,000 people kill themselves every year in America. It is the third leading cause of death among adolescents.

The thing is that there are just so many variables. It requires good help and interested parents to figure it out. As JohnE stated, their is depression that has a medical cause and often responds to medication, and then there is situational depression that often responds well to counseling, exercise, and proper diet. And then there are combinations. Either way.. this isn't something to take lightly. With the proper help, many people overcome these types of problems. So there is hope.

If you do take her to see a Psychologist or Psychiatrist, please try to discern whether she likes the doctor or not. Having a good rapport with your doctor is very important. The problem is in knowing when your child is just being a pain, and when the doctor is the problem.

I hope things work out for her and for you.

Edit: I lean towards not treating with meds. But if you need them, then you need them and they do help some people. They also have all kinds of side effects. Which can even be dangerous. So I wouldn't do them lightly. But I also wouldn't deal with this lightly.
joy bar

climber
Topic Author's Reply - May 3, 2013 - 07:14pm PT
Milder anti-depressant?

Any suggestions?
hossjulia

climber
May 3, 2013 - 07:33pm PT
ask your Dr. and do some research, a quick search will revel that Prozac is not recommended for adolescents.

I would be VERY leery of a Dr. who just threw that out there.
SteveW

Trad climber
The state of confusion
May 3, 2013 - 07:44pm PT

I don't agree with Robb

ssri's have done wonders for many people. I would be cautious with
a teen though, as some ssri's have caused teens problems.
Juan Maderita

Trad climber
"OBcean" San Diego, CA
May 3, 2013 - 07:47pm PT
Here's my take, speaking from 35+ years of continuous full-time work treating adolescents and families.

If she is having serious thoughts of suicide (see risk notes below), treatment with an antidepressant medication is part of a good plan. She should also receive weekly psychotherapy. Medication alone might relieve depressive symptoms, but doesn't resolve any underlying problems. Studies show that better resuts are achieved with meds and therapy combined.

prozac increases thoughts of suicide in kids
Typical faulty logic. The key word you left out is "may." Prozac has been known to increase suicidal thoughts in a small percentage of cases.
My observation is that it is more common with an "agitated" depression. Prozac has an activating effect, so someone with depression and anxiety may become more anxious and agitated.

Remember that antidepressants are being prescribed to a depressed and potentially suicidal population. Sure there will be suicides while on meds. Without treatment by medication, many more would suicide.

If there is any family history of Bipolar Disorder (aka: manic depressive illness), be sure to inform the doctors. SSRI's have been known to trigger mania in bipolar patients.

My take is my kid needs to learn how to cope with the ups and downs of life without meds.
If she fails at that (and fails at trying to kill herself) then and only then does meds. make sense to me.
Joy Bar, please re-read your own words. So, you would skip the meds and let her sink-or-swim? And let her attempt suicide just how many times before resorting to meds?
If your choice of wording is intentional, then it appears that you lack empathy and compassion for your daughter (in addition to common sense). I'm guessing that the low empathy is multi-generational. Was your mother warm and nurturing, or was she tough and unsupportive? Many parents who don't get emotional support as children are in denial of their childhood pain. They go through life pretending that they didn't need it. Consequently, they are unable or unwilling to provide it to their own children. Your daughter is hurting due, in part, to your lack of caring and support when facing life's problems.

Family therapy is indicated in almost all cases when an adolescent is depressed. Your daughter is at risk until you make sure that she has meds and therapy, and until you learn how to provide the support that she needs. Ask the therapist to be directive with you and listen carefully while in "learning mode."

Get more info from the doctor about the level of suicidality. Lower risk (for the moment) is if it is simply feeling "life isn't worth living" or "I just wish I would die in my sleep and not wake up." Does she have a plan as to how she would kill herself? (higher risk) Does she have a plan as to when? (shows intent and extreme risk, indicating hospitalization). Is it conditional (if this, then that)? Has anyone close to her suicided, or are any of her friends contemplating suicide? Do some reading up on risk assessment and discuss it with doctors/therapist.

It's very likely that there are multiple underlying psychosocial stressors, both past and present which contribute to the depression: history of trauma, victim of physical or sexual abuse, witness to DV, unresolved grief, marital separation/divorce, bullying, academic stress, etc. Any major issues should be dealt with and resolved in therapy.

Daily aerobic exercise, positive social activities, and sunlight are beneficial at reducing depression. Get her involved in organized sports like soccer or basketball. If you can't pry her out of the house, some teens will do a video dance game (DDR). Get her out and moving. Get control of the electronics. Virtual friends (Facebook etc.) are not a substitute for quality activities with non-depressed friends.

If you are having problems with her behavior, such as, poor compliance, disrespectful communication, or find yourself threatening to punish or restricting her, then you have an ineffective punishment system. Teens will respond very well to a reward system. Punishment usually results in teens getting angry (externalizing) or depression (internalizing). Teens who feel powerless, sorry for themselves, and picked-on (victim script) will feel empowered to make good things happen with the help of a reward system. My model for such a behavior modification system gets fantastic results in a matter of weeks.
Juan Maderita

Trad climber
"OBcean" San Diego, CA
May 3, 2013 - 08:00pm PT
Lots of Prozac bashing here and elsewhere. Of the "modern" antidepressants, it is the first (late 1980s). So, it is very well studied. Often the first choice when prescribing an antidepressant. Then, if it is ineffective or has undesireable side effects, another med is tried.
Don't think of one antidepressant being "stronger" than another. They are just chemically different and work on the neurotransmitters in different ways.
Prozac has an activating effect; it seems to help depressed patients with lethargy get of the couch and get moving, or out of bed in the morning. It may increase anxiety for those who have significant anxiety combined with depression.
Zoloft seems to be neutral in the activating - calming continuum.
Paxil is good at reducing anxiety for those with mixed anxiety and depression.
All are SSRI's, and have their nuances.
Are the "docs" psychiatrists? Psychiatrists should have a better "feel" for what is the best choice of meds. Some pediatricians and general practioners are well versed, others not so much.
joy bar

climber
Topic Author's Reply - May 3, 2013 - 08:05pm PT
thnx for the very useful information, I can self-parse the life diagnosis based on a few words. I assume you don't make medical decisions based on a sentence of communication? Eh sorry for that. Uncalled for. Your advice is very appreciated.

My daughter is a runner, so no issue there, though they say she is anorexic.

There appears to be no "trigger" which is why I believe we can do our best,
but sometimes our best is not good enough.

edit-seen a stable full of docs-broad spectrum of education
yes anxiety also-so good advice there-thnx

edit-edit- I too like Tami's advice which is what am doing here.


GhoulweJ

Trad climber
El Dorado Hills, CA
May 3, 2013 - 08:15pm PT
Tami
FTMFW
Juan Maderita

Trad climber
"OBcean" San Diego, CA
May 3, 2013 - 08:24pm PT
I'll cut you some slack if you agree that it was a poor choice of words in your OP. Okay? :)

She's a runner? Hmmm, don't see highly active teens get depressed so often, even with my patients who have horrific backgrounds of abuse/neglect.

In the absence of major psychosocial stressors the treatment might lean more toward medication. Finding the right med or combination of antidepressants could take a few tries. Again, look at family history for clues.

Also, rule out OCD. OCD tends to be genetic. She runs a lot and anxious. Running may be a way to cope with an overflow of thoughts and anxiety (great strategy, btw). OCD is often hard to diagnose as patients often don't want to divulge how crazy they feel inside (they aren't crazy, they are just overthinking). If the doc/therapist doesn't interview with specific questions, it may never come to light. Of the major psychiatric disorders, OCD has the longest time from onset of symptoms to diagnosis.
People with OCD are always stressed at trying to cope with the disorder. That frequently results in depression and feelings of wanting to give up, and suicidal ideation.
SSRI's are the most effective at treating OCD, in double to triple the dosage that is typical for depression.
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