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How doctors prescribe antidepressants to teens

February 23, 2016 By Kay Walker

Finding the right antidepressant medication requires a trial and error approach. Currently, there exists no test to accurately measure symptoms. So the doctor doesn’t really know what to prescribe. They select one from a list, prescribe it and monitor your teen over 4-12 weeks (this is how long it takes to see benefits and qualify a medication) to see if what they’ve chosen works. If not, they try another medication. This process continues until they find what works.

How doctors prescribe antidepressants:

There are approximately 22 antidepressant medications on the market that have been approved by the American Federal Drug Association (FDA). They fall under four categories, labeled for the brain chemical they target. (each variety is explained below).

For teens you’ll need to be aware of the following – information take from NIMH.com (National Institute of Mental Health):

Recently, there has been some concern that the use of antidepressant medications themselves may induce suicidal behavior in youths. Following a thorough and comprehensive review of all the available published and unpublished controlled clinical trials of antidepressants in children and adolescents, the U.S. Food and Drug Administration (FDA) issued a public warning  in October 2004 about an increased risk of suicidal thoughts or behavior (suicidality) in children and adolescents treated with SSRI antidepressant medications. In 2006, an advisory committee to the FDA recommended that the agency extend the warning to include young adults up to age 25.

In order to choose an appropriate medication for your teen, your doctor may consider these factors:

  • Your teen’s situation. Each case of depression is different, which means so are the symptoms. The doctor will like assess your  teen’s situation and choose an antidepressant that is likely not to amplify a negative issue they are dealing with. For example, if they are severely overweight or have an eating disorder a doctor will try and prescribe a medication that does not have a side effects of weight gain because that will only make the situation worse.
  • Your teen’s lifestyle. Antidepressants have side effects that can unobstrusive but annoying (ie. dry mouth). A doctor may ask you some lifestyle questions to help him discover what a good medication would be. For example, if you are a man trying to have a baby with your wife, taking a low sex drive medication may not be helpful. 
  • Your teen’s current physiology. The doctor will evaluate your teen’s current physiology, this includes taking into account other health conditions you may have.
  • Your teen’s genetics. If you have a family members that take antidepressants the doctor may prescribe the same treatment to your teen. Often genes play a role in how a patient reacts to a medication. If it work for a family member with a similar genetic predisposition then it may be effective for you.
  • Your financial capabilities. If you do not have medical coverage antidepressants can cost up to $350/month.  Some antidepressants are cheaper than others.
  • Your teen’s other medications. Is your teen taking other supplements and/or medications? This will be considered as some medications work negatively together.

How do anti-depressants work?:

The basic premise of an antidepressant is that once you take it the drug passes through your body via your blood and into your brain.  There, it targets a specific brain chemical (or chemicals) that control your mood.

If you read the word “inhibitor reuptake” what that means is that the drugs stops a process where the chemical does not re-enter the brain cell, which it would normally do.  That means, less of the chemical remains in the nerve cell.

The brain chemicals that are targeted by these drugs are called: Dopamine, Serotonin, and Norepinephrine

Selective serotonin re-uptake inhibitors (SSRIs)

These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants.

Common SSRIs by drug name include: Prozac, Selfemra, Paxil, Pexeva, Zoloft, Celexa, Lexapro

Serotonin and norepinephrine re-uptake inhibitors (SNRIs)

Common SNRIs by drug name include: Cymbalta, Effexor XR, Pristiq, Khedezl, Fetzima

Norepinephrine and dopamine re-uptake inhibitors (NDRIs)

One of the few antidepressants not frequently associated with sexual side effects.

Common NDRIs by drug name include: Wellbutrin, Aplenzin, Forfivo XL.

Tricyclics

Not many doctors prescribe tricyclics these days, though they are still effective for many people. They are often used after other drugs haven’t work. They’ve been replaced because they tend to have more side effects.

Cyclic antidepressants block the absorption (reuptake) of the neurotransmitters serotonin (ser-o-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin), making more of these chemicals available in the brain. This seems to help brain cells send and receive messages, which in turn boosts mood.

Norpramin, Tofranil, Pamelor, Vivactil, Trimipramine, Surmontil

MAOIs Using an MAOI requires a strict diet because of dangerous food interactions. Selegiline (Emsam), a newer MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs

Atypical antidepressants

Oleptro, Remeron, Brintellix, Viibryd

Filed Under: Uncategorized Tagged With: antidepressants, doctors, prescribe, teens

How do doctors diagnose teen depression?

February 23, 2016 By Kay Walker

The most common diagnostic tool used by doctors to help them decide if a patient with symptoms of depression is actually suffering from the full on illness (and not just a passing state of feeling sad that’s caused by a life event) is a questionnaire.

How do doctors diagnose teen depression? Here are the common tests they use:How do doctors diagnose depression?

Currently the most common ones are:

  1. Hamilton Depression Rating Scale (HAMD)
  2. Montgomery-Asberg Depression Rating Scale (MADRS)
  3. Beck Depression Inventory
  4. Patient Health Questionnaire (PHQ-9)

The doctor will likely used one of these tests to assess your teen. Questions are similar in nature for each.  They ask you about symptoms your experiencing – such as: Sleep disturbances, issues with fatigue, suicidal thoughts, feeling uninspired or hopeless, loss of motivation, loss of pleasure.  They will also ask your teen questions to help them understand the severity of symptoms.

Here are some examples of the types of questions you may be asked:

  • Have you lost interest in activities you used to find pleasurable?
  • Ae you experiencing changes in appetite such as eating too much or not feeling like you want to eat?
  • Are you having difficulty concentrating?
  • Having you been experiencing thoughts of suicide, death, or wanting to die?

In most cases, if your teen has felt hopeless for a least two weeks or more and it’s so bad it’s affecting their quality of life – they’re having trouble going to school, socializing, enjoying activities they once thought were pleasurable etc. – these are high indications they have depression.

The diagnostic criteria for depression appears in a medical text for mental illness called the DSM-IV.  (Read the diagnostic criteria here).

The doctor will also likely run some basic biological tests to rule out other potential issues that cause depression. The most common ones are the:

  1. Physical exam. The doctor will likely examine your teen to ensure there is nothing notable wrong with their physiology that could be causing depression symptoms.
  2. Blood tests : A blood sample may be taken and a complete blood count (CBC) will be performed. This helps the doctor find out if they have any hormonal issues or a vitamin deficiency.

How doctors “fix depression”: Antidepressants

If the doctor rules out all other medical issues that could be causing your teen’s depressed mood and suggests a diagnosis of major depression they’ll likely treat them by prescribing an antidepressant medication. Doctors are trained to fix medical problems and this is how they cure depression. It’s the only tool available to them, aside from referring your teen to a different type of specialist.

As the parent, you need to be aware that the problem with this route is that they may skip identifying other potential causes for your depression. They will treat the symptoms without curing them. So, you need to investigate therapeutic forms of treatment – especially for teens – that teach your teen how to proactively deal with negative and uncomfortable emotions.

What you need to understand about antidepressant medications:

Finding the right antidepressant for your teens is like finding the perfect wedding dress. They’ll have to “try on” many to find what works for you.  This is because the current diagnostic criteria that doctors use is based on asking you a line of questions, ruling out other illnesses with basic physical tests, and then making an educated assumption.

 

As you can see, this is hardly an effective treatment. But for now, it’s all doctors have. A questionnaire, some basic tests and a lot of trial and error with antidepressants.

It’s important that depressed teens try all other natural alternatives and therapies first before going on an antidepressant. These medications are serious and may make the symptoms more severe in individuals under 18 years of age.

Filed Under: Uncategorized Tagged With: depression, diagnose, doctors

Teen signs of suicide

February 23, 2016 By Kay Walker

Teen suicide warnings | danger

If you aren’t familiar with the staggering rates of depressed teens and suicides happening each year, take a moment to read these stats before your read about the warning signs below:

  • At least 25% of teenagers in North America this year will suffer from varying degrees of teen depression.
  • 24%  of U.S. high school students have seriously thought about attempting suicide.
  • The ratio of suicide attempts to suicide death in youth is estimated to be about 25:1.
  • More males than females are successful (by a factor of 4 because they use guns over pills).

Teens who share that they’ve had suicidal thoughts need support immediately. Having those types of thoughts suggests that they are dealing with some life challenges or emotional struggles. If they do not get the relief they are seeking and the situation gets worse, they may start to seriously consider suicide as an option.

Parents of teens should act immediately if they notice any of the following signs:

Major suicide warning signs

  1. Talking about wanting to committing suicide. The more your teen says they want to die the more they mean it. Do not leave them alone. Get help immediately by calling your local crisis support line or going to the emergency room.
  2. Researching suicide. Online parental controls are available for monitoring Internet action. If you see searches that suggest searching for ways to commit suicide you should consider this a state of crisis. Your teen needs help right away.
  3. Talking about feeling hopeless or having no reason to live. Teens are in an in-between stage of life where many have not figured out what they want to do in their adult life. Having a reason to get up in the morning is crucial for overall happiness levels. If you’re teen feels hopeless try and start to guide them towards learning more about themselves and what they want to accomplish in life. This may help them start to get excited about their life and improve their mood.
  4. Talking about feeling trapped or in unbearable pain. Many teens struggle with life situations and emotions but have not yet learned the skills of how to overcome simple challenges. They may communicate this by saying things like “I don’t know what to do” or “my life is over”.  Assist your teen in learning how to take action to get themselves out of tough situations.
  5. Talking about being a burden to others
  6. Increasing the use of alcohol or drugs. Abusing substances can often end your teen in the emergency room as a suicide attempt or they may be successful.  A depressed teen heightens their risk of suicide when they drink.  They may not seriously intend to die but it may happen. Keep tabs on your teens whereabouts.
  7. Acting anxious or agitated; behaving recklessly
  8. Sleeping too little or too much
  9. Withdrawing or feeling isolated. The numbers of teens that don’t communicate and isolate themselves from family members and friends is high. If your teen has trouble communicate seek help immediately.
  10. Showing rage or talking about seeking revenge.
  11. Displaying extreme mood swings.
  12. Art that displays themes of death.
  13. Running away from home.

Filed Under: Uncategorized Tagged With: signs, suicide

Medical and mental illnesses where depression is a symptom

February 23, 2016 By Kay Walker

Here’s a list of medical and mental illnesses (in alphabetical order) where depression occurs as a symptom. If you’re teen seems depressed or is suicidal their may have another issue you may not have considered. This is why it is always important to see a General Practitioner/Family Doctor. They will be able to rule out any other underlying medical concerns that could be related to your depressed mood.Medical and mental illnesses where depression is a symptom

This list has basic descriptions. If you are concerned you may have one of these illnesses you’ll want to do more of your own research, as well as, consult a trained medical professional.

Medical and mental illnesses where depression is a symptom:

Bipolar Disorder

Bipolar disorder is characterized by having extreme mood swings that fluctuate between depression and mania. When you feel depressed you have low energy, you feel hopeless and unhappy and have difficulty with daily activities. This depressed mood fluctuates with mania. During mania you may feel completely euphoric. You’re likely highly productive, and full of energy. Or, you may be completely impulsive and do things like gamble, party and have a lot of sex.  There are different types of bipolar and each has different characteristics.

Borderline personality disorder

Individuals with borderline personality disorder (BPD) suffer from a pervasive pattern of instability in interpersonal relationships, self-image and emotions. They are commonly considered unstable by friends and family members. Their moods fluctuate often and they have a tendency to say things that hurt people’s feelings. They often have a unhealthy self-image, which is related to unhealthy social interactions early in life. Some people with BPD exhibit impulsive and destructive self-injurious behaviors, like: Cutting themselves, attempting suicide and have lots of casual sex.

Brain tumor

Depending on where a brain tumor is situated it may affect an individual’s mood and personality. An individual with a brain tumor will often start to act completely different from their past behaviors.

Eating disorders

The types of eating disorders are:

  • Anorexia – starvation behaviors
  • Bullemia – cycles of eating and purging the body of food
  • Binge eating – starving and then consuming large amounts of food in a short amount of time

While each type of eating disorder has different behaviors associated, they are all connected to unhealthy perceptions and relationships with food, weight and body image.

Fibromyalgia

Doctors don’t have a clear understanding of what causes fibromyalgia. Though, many researchers believe it’s a problem with the way the brain deals with pain signals. Individuals who suffer from it deal with widespread pain that can occur in the neck, shins, elbows, lower back, hips and knees. Pain and stiffness can be worse in the morning. Individuals with fibromyalgia often experience fatigue, trouble sleeping or concentrating, or have frequent headaches.

Hypopituitarism

Hypopituitarism is a rare disorder where the pituitary glands (an gland found in the brain that secretes hormones into the blood) don’t make enough hormones that are necessary in bodily functions  of: Growth, metabolism, and sexual development. It’s often caused by brain tumors, head injuries, or infections.

Hypothyroidism

Hypothyroidism occurs when the thyroid gland can’t produce enough thyroid hormone. The thyrod gland affects how the body produces energy. The result of low thyroid is a slowing of body processes. Weight gain, fatigue and low mood.

Lupus

Lupus is a chronic autoimmune disease (that doctors do not completely understand). The body attacks healthy tissue in different ways. Symptoms are: Severe exhaustion, joint pain, and a “butterfly rash” on the cheeks and the bridge of the nose. Individuals with lupus may have mild symptoms, while some will develop life-threatening versions of the disease that attack the the kidneys and other organs. Symptoms come and go frequently. They can clear up entirely, disappear from months to years and return again.

Obesity

Individuals with excess weight often suffer from depression. What is less clear whether it’s depression or weight gain that happens first. Eitherway, depression and weight gain go hand-in-hand. Trouble managing food and urges, increased appetite coupled with reduced activity and weight gain can lead to depression and thoughts of suicide. One recent study found that overall, obese individuals have a 20 percent elevated risk of depression.

Pick’s disease

Pick’s disease is a rare type of dementia that affects areas of the brain.  It is similar in nature to Alzhiemers. Though, it has a more major affect on mood and behavior. It often runs in families. It starts between the ages of 40-60. Once symptoms start it takes usually 2-10 years for an individual with Pick’s to become fully disabled.

Porphyria

Porphyria is a rare genetic condition that affects the skin and nerves. It’s caused by low enzyme levels that prevent the body from making an essential protein in red blood cells.  Without it, destructive chemicals build up in the blood and cause damage.

Postpartum

Many new mothers experience the “baby blues” within the first two weeks-four weeks after giving birth. Doctors suggest that all mothers are susceptible to it anytime within the first year of the baby’s life. New mothers deal with major life changes, sometimes loneliness, dealing with new fears, and changes in hormone and lack of sleep. But, postpartum depression is more severe and long-lasting. It occurs when the depression last longer than two weeks. Symptoms are: Sadness, hopelessness, anxiety, loss of energy, loss of interest in things, guilt, changes in appetite, and insomnia. Sometimes a woman may experience negative feelings about her baby or thoughts of harming her child. In rare cases, postpartum psychosis can occur and the woman will experience delusions of hallucinations.  Symptoms that last for more than two weeks or even up to a week should be addressed immediately to prevent unnecessary harm to the mother or baby from occurring.

PTSD

Post traumatic stress disorder is delayed anxiety disorder that occurs 6 months to one year after an event. It can happens commonly to individuals who suffer from a dangerous or traumatic experiences, such as a war, natural disaster, abuse, assault, or accident. Many individuals  who have PTSD experience flashbacks, bad dreams about the event or have difficulty sleeping. They may also feel agitated, guilty, depressed, or emotionally numb. Individuals with PTSD may avoid people or things that remind them of the event.

Premenstral Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome where a woman experience major mood fluctuations that interfere with her ability to do regular activities. It occurs immediately before menstruation and often goes away during her period. It can cause a women to be severely depressed, or irritable. The causes are not fully known, but hormonal changes and fluctuation of the brain chemical serotonin may play a part.

Premenstral syndrome (PMS)

PMS is a common condition that affects many women during the two weeks prior to their period. Symptoms vary from woman to woman. Generally, they include such things as bloating, irritability, fatigue, breast swelling and tenderness, and depressed mood.  The mood may be slightly distressing but will not interfere with a woman’s ability to carry out regular activities.

Schizophrenia

Schizophrenia is a serious, chronic mental illness. People who have schizophrenia often hear voices, see things that aren’t there, or believe that the world is plotting against them. It can occur between the teen years and age 40. Doctors don’t understand exactly what causes schizophrenia, but it can run in families. It can also be brought on through regular substance abuse that over time causes changes in brain chemistry. There is no cure for schizophrenia. Therapy and medications can help treat symptoms and many people can live happy lives with this illness.

Substance Abuse

Mood is highly affected mental drinking alcohol or taking drugs, (including some prescription drugs). While a substance will bring a mood up and make an individual feel better immediately after taking in, it also brings their mood down further as the substance wheres off. The symptoms are the same as depression or mania: depressed mood, lack of interest in activities, fatigue, feelings of worthlessness, sleep problems, talkativeness, distractedness, or suicidal thoughts.

SAD

Seasonal depression, or SAD, is depression that occurs every year during a change of season. SAD can cause problems ranging from sadness and sleep problems to anxiety and moodiness. SAD is most common in fall and winter when the weather turns cold, people spend more time indoors and they weather can be grey and rainy. In this case, symptoms will improve during spring and summer months. In rare cases, people have SAD in spring and summer and their symptoms improve in the fall. Doctors are unclear what causes said.  It could be related to light, hormones, lack of vitamin D from the sun or changes in body temperature. SAD is treated with light therapy, antidepressants, and psychotherapy.

If you feel depressed your first step is to get a diagnosis and rule out all other issues that could be affecting your mood. And, most importantly, make sure you take small daily actions to live a great life that you love to wake up.

Filed Under: Uncategorized Tagged With: depression, illnesses, medical, mental, symptom, where

The difference between depression and sadness

February 23, 2016 By Kay Walker

The word “depression” is one of the most commonly misused words in the english language.  People use it incorrectly when they are trying to explain feeling sad.  But sadness and depression are two very different things. Below, each is defined and key differences are highlighted to help illustrate how sadness and depression differ.

As a parent with a depressed teen, it’s crucial you recognize the difference. It can be difficult making the distinction when you’re teen is shut down and doesn’t communicate well.

Understanding the difference between depression and sadness

Sadness defined: 

SADNESS is a normal human emotion that is characterized by a state (or states) of feeling unhappy.  It is not constant, meaning it comes and goes. One moment you can feel sad, an hour later after being with a friend you may feel happy.

Being sad is a healthy response to unpleasant life events. It’s valuable because it can help you decipher what you want or don’t want.  It also helps you feel and understand the reverse emotional state, which is happiness.

Sadness occurs in frequency on a scale that ranges from brief and fleeting moments of sad feelings to severe lengthy periods related to major life traumas. For example, the death of a loved one can make you feel sad for months.

Depression defined:

DEPRESSION is a medical condition that affects mood.  It’s unclear what specifically causes it, though experts agree it is a physical issue where a variety of factors related to both internal and external processes lead to a neurological chemical imbalance. The most current research suggests that individuals with depression have a 25% smaller brain region for regulating emotion (called the hippocampus).

It is often difficult for individuals who have not experienced depression to understand it, because it’s not something that can be seen or measured. It’s not like other physical ailments, like a broken leg.

Characterizing someone with depression as “sad”, suggests they have the ability to control their mood. That is not the case. They are physically unable to be happy.

Key differences:

  • Depression is debilitating. The low mood is so pervasive that it interferes with an individual’s ability to do normal things like: Go to work, concentrate on basic activities like watching a movie, take care of themselves or their family, or want to get out of bed.  When you’re sad you can still do basic tasks even if you don’t feel happy.
  • Sadness fluctuates. Depression is constant.
  • People with depression feel sad.  People who are sad do not necessary get depression.
  • Individuals with depression have no ability to change their mood. No matter what actions they take, they often still feeling an underlying feeling of emptiness and their mental processes feel slowed.
  • Depression makes you feel like you don’t want to live. Sadness makes you feel low but still hopeful. You can recognize that you have a life to live for.
  • Sadness doesn’t produce significant weight changes or prolonged periods of sleep changes.
  • Sadness does not involve psychotic events like delusions or hallucinations.
  • Depression requires multiple forms of treatment that involve nutrition, exercise, self care and many times, medication.

Filed Under: Uncategorized Tagged With: between, depression, difference, sadness

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