Yes, Antidepressants Work Differently in Teen Brains

Do antidepressants work differently in teen brains?

We know teen brains are different, that has be proven time and again through neuroresearch. In fact, brains are different until they fully “mature” at around age 25 years.

I have been working with teenagers my whole career, and I started out following the standards of psychiatry without much questioning: put teens on the same medications you might prescribe adults, and dose them similarly. But it didn’t take long before I grew to question standard practice. I was prescribing antidepressants to teens, and too many of them would get better for a couple of weeks, and then spiral into a crisis. Not only would they spiral, but they would all go into basically the same type of spiral, a spiral full of pent up energy bursting to come out as troubled behavior. The pent-up-badness would burst out as aggression toward the parents, drug experimentation, lying, running away in the middle of the night, or in kids who were too cooperative and well-behaved for any of the behaviors above, the behavior bursting forth would be self-harm or a suicide attempt.

At first, I decided I must be seeing a large number of Bipolar teens. The symptoms above are often side effects of antidepressants in Bipolar spectrum illness. But that didn’t make sense. Bipolar Disorders exist at rates in the low single digits (less than 5%), and almost every teen was reacting badly to antidepressants.

I started to veer away from using antidepressants in teens, at the least the standard ones. I tried non-serotonin alternatives like bupropion (Wellbutrin) wherever I could, and treated anxiety with drugs like buspirone and hydroxyzine. I was offering individual and family therapy as an alternative to medications for every patient family who was willing to try it. I was making fewer referrals to the hospital, and trying to find answers in the medical literature to explain what I was seeing, but I didn’t find clear answers, only occasional competing theories that needed to be investigated further.

And then something very important happened in my practice. My youngest child got injured, and I was suddenly away from practice for almost 6 weeks. My psychiatric colleagues generously covered my practice without question; they took over and treated my patients for me while I sat in the ICU with my child and I was unable to offer any insights to the practice. My colleagues must have stared at my handwritten chart notes in confusion, wondering why these patients weren’t receiving the antidepressants they so desperately deserved. The doctor colleagues changed my patients’ care plans, and one by one prescribed the teens antidepressants.

Even though I was on leave, I hadn’t inactivated my emergency call service. I had a pretty stable group of patients, and I didn’t receive frequent enough calls to worry about it. I remember when the calls started coming in: a teen found unresponsive, another had made a serious attempt on her life, another had run away. These were teens I knew well, and their crisis behaviors were a shocking break from normal.

Having already struggled with questions about antidepressants in teens, this 6-week window functioned as a small-scale experiment. I was convinced that antidepressants were acting differently in teen brains. I spoke with colleagues who mostly shrugged and said, “I haven’t seen that.” Only one, Dr. Randall Sellers, a psychiatrist who also treated mostly teens and young adults, passionately agreed. He thought we needed to conduct a research study, but before we put together that study, Dr. Sellers died suddenly from metastatic melanoma.

In the intervening years, research is catching up. Black box warnings for suicidal ideations have been issued for all antidepressants used in teens, and increasingly research articles are recommending cautiously low dosing of antidepressants in teen and young adult brains. Unfortunately, the wheels of change turn slowly, and while we wait for change, another teen was admitted to the hospital yesterday for downing a bottle of pills prescribed by her primary care physician.

Maybe this piece will start a conversation, spark a closer look, or persuade a parent to request caution from a doctor. Antidepressants are often predictable in their effects on adult brains, but teen brains are different and so are their responses to these medications.

Posted on March 27, 2017 by Melissa Deuter.

Casting Light

What do parents do? Why are people so fascinated and confused about what we need to be and do and provide as parents? I read an article this morning that declared parents had a very important role in shaping morality. Elsewhere I read that parents protect children and teens from danger. Yet another article stated that parents are ever present, and that’s the core of what they do.

I think parents do so much more than teach morality, protect, and be present. If it were that simple, why would we read so many parenting articles?

To see the importance of what parents provide, one only needs to look at the darkness people carry when parents fail them. The scars of unhealthy childhood can lead to relationship problems, addiction, even mental illness. A parent’s job is casting light into the life a growing child, rather than darkness.

Parents instill children with a sense of how much (or how little) they matter. When parents are unable to show kids that they matter, those kids grow into adults who struggle with meaninglessness, powerlessness, and feelings of being undeserving.

Parents mirror back to children silent messages about whether the child is “enough.” Good enough. Smart enough. Pretty enough. Strong enough. When parents are unable to show kids that they are enough, children grow into adults who feel like no achievement is sufficient and no success makes them worthwhile.

Parents show children what it is to be in relationship with others. As the first, closest relationships for children, parents carve the template. In this role, parents can show that love is gentle and kind, or that love is unpredictable, hurtful, or dangerous.

Parents shape skill sets for life. The work of parenting produces a ready adult, one who is prepared for independent life on his own. When parents are unable to support the growth of a skill set, children grow into uncertain adults who struggle with problem solving and lack courage to figure things out on their own.

These may seem like daunting responsibilities. But being a good parent doesn’t require perfection.

·      Be loving.

·      Be patient.

·      Tune in.

·      Give freely.

·      Keep the end goal (a healthy adult) in mind.

Posted on March 20, 2017 by Melissa Deuter.

Gratitude

Gratitude can be used to improve your immediate state of mind. Practicing gratitude can leave you less stressed, more connected, and more positive. The use of gratitude can be taught to children of all ages, as a tool to calm down, see things differently, and feel better. 

 Gratitude alleviates:

Worry

Stress

Dissastisfaction

Impatience  

Gratitude brings: 

Connection

Love

More good in one's life

Feelings of peace

Calm

Gratitude shapes perception: 

Toward the positive

Away from lack

To a sense of the plentiful

Practicing gratitude yourself, and teaching it to loved ones, is easy. Simply call up in your mind an image of something for which you are grateful. It can be anything, big or small. And then shift your attention to notice how gratitude makes you feel. Dwell there. Wallow in your gratitude. 

If the exercise if difficult, give yourself a bit of grace. Take a breath and let it go. Try again, with other images. Maybe you are grateful when you imagine the innocent little face of a child you love, or the antics of your adorable pet. Perhaps you're grateful for the trees or the sunshine. Maybe even an object, like your new laptop, or a good book. There are myriad ways to bring up the feelings of gratitude, and one is no better (or worse) than another. As long as you can find a small kernel of appreciation, and then focus there. 

You can carry this exercise anywhere, to comfort and replenish, or to brighten your mood. Gratitude is a gift. Use it. Teach it. 

Posted on March 13, 2017 by Melissa Deuter.