Patients come to me often with complaints about how the wrong psychiatric medication wrecked their lives. One such long-time patient tells me he believes that all antidepressants are always dangerous, and these drugs are destroying the lives of every person who takes them. He is on the warpath against Effexor and Paxil, because those two meds filled him with restlessness, agitation, and anxiety as a teen. He theorizes that Big Pharma sought to drive him insane so he would need ever-increasing numbers of prescription medications, benefitting the drug sellers. And while I feel certain this is untrue (I keep up with the research, but more importantly I see the patients firsthand who respond positively to these treatments, many whose lives are quite literally saved by their use), there is still truth in his personal experience story. He was harmed by the wrong treatment.
And although I don’t think there is a conspiracy by Big Pharma to ruin lives (I really don’t), the wrong mental health medication can lead to disaster for many. The wrong medication in psychiatry can be prescribed following the strictest guidelines. The patient has depression, the med is FDA approved for use, the dose is standard, and yet the medication can still do harm.
Nowhere does this appear truer than when treating depression in adolescents*. Teen and young adult brains seem to be picky when in comes to antidepressants, and in fact, most of the antidepressants seem risky to me during this stage. When adolescents take common antidepressants, they can become agitated. They act out. They get worse far too much of the time. The block box warning in the physicians desk reference tells us that these meds can cause suicidal thinking, and it’s true, but there is so much more. A teen on the wrong antidepressant may become defiant, start breaking rules, or even be violent toward her parents.
Teens who act out seem to be vulnerable, and may not be good candidates for traditional antidepressants at all. Inhibited, reserved adolescents may tolerate a few of the antidepressants, used cautiously and at low doses, but the list of suitable agents is short.
One agent, Lexapro, concerns me the most because it was FDA approved for use specifically in teens, and I just don’t think it’s safe. Primary care physicians turn to this med for it’s indication in teens, guided by the endorsement from the FDA. Years ago I had a brief stent as a speaker for industry, and I educated primary care doctors about the use of Lexapro (in adults). I still prescribe it to adults over 30 often. Lexapro is a helpful treatment for many people, but I don’t think we should be giving it between puberty and full adulthood (around age 25).
Prescribing antidepressants to teenagers is nuanced and should be done with great care. Some will surely argue that these patients all have an underlying Bipolar Disorder, that they respond negatively to antidepressants because they become “manic” when they take them. But I think that theory will ultimately be proven wrong. Bipolar spectrum illness aren’t prevalent enough to account for the rates of poor response to the newer antidepressant agents during the adolescent stage of life, nor would such an explanation account for patients who become positive antidepressant responders later in life, as their brains age.
Whatever the cause, it seems clear that antidepressant medications work differently in adolescent brains. Parents and prescribers: proceed cautiously. Consult an expert. Psychiatric medications can saves lives, but they come with very serious risks.
*When I use the term “adolescents, this refers to the stage of brain development between childhood and adulthood, often extended up to about age 25.