Please educate me about SSRI's for teens

[Greta]

Short Version: we have an appointment on Friday to see our family doctor and discuss the possibility of SSRI's for my 17 year old daughter, who has been diagnosed with an anxiety disorder, and who has fallen into a bit of a depression for the last week or so as well. I'd like to be informed enough to ask the right questions. Aside from the side effects that get listed with the prescription, I'm just wondering if there are any long-term risks or effects we should be aware of. How well have they studied the effects of these medications on adolescent brains?

 

And in case anyone is interested in the long version....

 

I posted awhile back about the fact that my daughter was diagnosed with an anxiety disorder. She's seeing a cognitive behavioral therapist, and we also started an exercise program. She had been pretty sedentary before all of this happened. So we were ramping up on the exercise, and when we hike for two or three hours in the foothills (steep trails) it definitely helps. But then I sprained my ankle, so I can't hike for the time being. Plus once she starts classes again we just won't have that much time. I've tried to get her interested in classes at the gym, but she hates them. And she just doesn't seem to be able to push herself hard enough to get the benefits. She only wants to exercise for 20 or 30 minutes (if it's anything but hiking) and that doesn't seem to be enough to help. Trying to push her to do more has been frustrating for all of us.

 

We were out of state visiting family and her allergies got really bad. The doctor at the urgent care there put her on prednisone to help the allergy symptoms, and I did not know at the time that this is known to make anxiety worse. She's been off of those meds for a little over two weeks now, so I don't know if that could still be affecting her. She also doesn't sleep all that well, and she has near constant diarrhea now. Forgive me for TMI but in case that is important to know, I wanted to mention it. I know we have some other lifestyle factors that need to be improved. She only has a few friends and it seems like they are always busy, so she doesn't socialize much. She spends too much time in front of screens. I think that starting back to classes at the local CC is going to be really good for her, but that's still a month away.

 

She's practically begging for the medication, so I'm not inclined to deprive her of it. But I am worried about the risks and side effects. What would you do in my shoes?

 

Thank you for any help.

[Ottakee]

Meds can be highly effective.

 

That said, has she had stool cultures done? The near constant loose stools is not normal and gut health does affect mental health....so I would want to get to the bottom of that.

 

Is she on a good allergy program now? Has she had testing to figure out allergies? Any food allergies/intolerances?

 

My daughter is on a different type of med but the results have been very good. We did though rule out (and treat) other physical issues first.

[StephanieZ]

I agree to consider serious probiotics. It's harmless and generally very beneficial for all sorts of health concerns, INCLUDING mental health. We take an assortment of 5-6 probiotics and prebiotics. 

 

Also, I'd super-prioritize the outdoor (in sunshine) exercise. Sprained ankles heal quickly. Get her out there for 1 hour + daily if at all possible. 1 hr every day is going to be more helpful than 2-3 hours a couple times a week IME. 

 

Also consider Vitamin D testing and/or supplementation. 

 

So far as the actual SSRIs, know that they aren't miracle cures. They are most helpful in allowing someone to get "over the hump" so they can make healthy life-choices (exercise, sleep, therapy, etc) in order to use those other techniques to deal with their issues enough to facilitate a long term fix/cure. 

 

Every individual is unique. Some respond well to one SSRI and poorly to others. It often if not usually takes a couple/few tries before finding the right match. In my family member's situation, Prozac was a disaster. It rapidly led to lots of free-wheeling and severe negative feelings. ("I'm really angry and don't know why." feelings that were overwhelming, long lasting for several days, and inexplicable.) My family member went off it within a couple weeks due to those scary effects, which resolved very quickly as soon as they went off the meds. Then the family member tried Zoloft, which, for them, worked very well. However, they chose to discontinue after several weeks due to just not wanting to be "on a drug" long term. I didn't like that choice at the time, but I left it up to them, and, ultimately it worked out very well as they continued to improve and responded very well to their weekly therapy and other good life choices. Probably not coincidentally, around that same time, I also implemented serious probiotic therapy, which very effectively treated their long-standing (many months) severe GI issues. I later realized that the probiotic regimen might have well played a part in their improved mental health. All this to say, be on the look out for both improvement OR decline in mental health, and respond/adjust/change as needed. It's to be expected not to find the exact cure on the first try.

 

Also be aware to the increased risk of suicide on SSRI, particularly for teens. IME, when I saw the dramatic negative feelings caused by the Prozac, I could totally see this happening . . . Be in communication and discuss risks/etc with your kid, and don't hesitate to intervene if you see a problem. 

 

 

 

 

[PinkyandtheBrains.]

 

 

There are a few specific SSRIs that are good for anxiety. So certainly talk to the doctor. There is a risk, as with any medication. That risk is slightly higher for teens instead of adults. Anxiety can be so debilitating, getting handle on it now can help set her up for long term success.

 

I do agree with getting the other issues sorted out, that can make a significant difference in mental health issues as well.

[Lady Florida.]

Ds started on them at 18 (he's almost 20). He began with Wellbutrin (not an SSRI) or its generic equivilent and the doctor went over the major side effects with him and what to watch for. She had to up the dose at one point and he started getting leg cramps. At first he didn't connect it with the meds but they were apparently the cause. He's currently on generic Effexor and it does a better job at a lower dose. I would just say to of course watch for the big, known side effects, but if she ends up with a seemingly minor odd complaint, check to see if might be a side effect of the SSRI. 

[dsmith]

My teen has been on Prozac for a few years now. He had no side effects while starting or currently. If she is going to start an SSRI I would suggest starting now, not at the beginning of classes in case there are side effects or a temporary increase in anxiety in the first few weeks. Probiotics are definitely a good thing to try, too. We also use a magnesium supplement called Calm, but if she has diarrhea that may make it worse. A full health work-up is always good. Have you had her thyroid checked? Anxiety was my sister's only symptom aside from moderate weight gain. They found she had Hashimoto's. She was only 16 at the time. 

[Pawz4me]

DS18 has been on fluoxetine (Prozac) for two years for generalized anxiety disorder (co-morbid with ASD) and it's done a world of good for him. He has had some weight gain but in his case that's been a very good thing.

[Greta]

Thank you all so much!

 

I should have mentioned that when all of this started she had blood work and a physical exam, a stool culture, a thyroid panel, a thyroid antibodies test, and a thyroid ultrasound. Everything came back normal.

 

When she was (briefly) feeling better, the diarrhea went away, and then when she started feeling worse again, it came back. So there is a definite correlation there, though I don't know which one is cause and which one is effect (or if both are being caused by something else). I'm definitely willing to try the probiotics, because that's a good thing for general health anyway.

[Ottakee]

Have they tested for Celiac or other food allergies? Sometimes an illness (like her needing steroids) can trigger it.

[maize]

I have one on fluoxetine right now, we have seen no side effects and anxiety/irritability (depression) have improved.

 

Like all parents, I worry about the side effects of medication. I also worry though about the side effects of ongoing anxiety and depression. One huge benefit of SSRI's is that they seem to support neurogenesis and synaptic connections and decrease the tendency for parts of the brain to shrink when a person suffers from chronic anxiety and depression.

 

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155214/

 

https://www.scientificamerican.com/article/unraveling-the-mystery-of-ssris-depression/

[Greta]

Have they tested for Celiac or other food allergies? Sometimes an illness (like her needing steroids) can trigger it.

No, they didn't. I will ask her doctor about that on Friday. Thanks!

 

 

  

I have one on fluoxetine right now, we have seen no side effects and anxiety/irritability (depression) have improved.

Like all parents, I worry about the side effects of medication. I also worry though about the side effects of ongoing anxiety and depression. One huge benefit of SSRI's is that they seem to support neurogenesis and synaptic connections and decrease the tendency for parts of the brain to shrink when a person suffers from chronic anxiety and depression.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155214/

https://www.scientificamerican.com/article/unraveling-the-mystery-of-ssris-depression/

Wow, that is really interesting! Thank you!

[datgh]

I have been on Celexa, Zoloft and am now on Paxel.  I had a terrible time with Celexa.  It sent my anxiety through the roof instead of helping it showing me how someone could commit suicide on an SSRI. I stopped taking it after a week and went back to my normal anxious state immediately. Next they tried Zoloft and it helped so so but I also added 20 pounds on it.  I was on it for a couple of years and then weaned off because I felt pretty good. I did great for about 15 years and then the anxiety settled in again. I had been warned  menopause would probably stir up my General Anxiety Disorder and it did. I started Paxil and had relief within a couple of days instead of weeks. It was awesome to finally feel at peace. Main side effect has again been 20 pounds before I managed to put the breaks on. While I feel much better on the Paxil, I am constantly craving food especially carbs. It is a constant mental battle not to give in to the cravings that after two years I am getting tired of. The Paxil also makes me feel very complacent. I just can't seem to get excited about much. I am thinking by next spring my life might be settled enough to try weaning off it but when I started it, it was a godsend.

 

Make it clear to your daughter that she has to be open and honest with her doctor about how she is feeling so they can properly manage her medication. Also warn her that it may take time to find the right dose, medication, etc. Paxil worked quick for me but Zoloft took a while.  I would also continue with the cognitive behavior specialist. I think counseling helped me more than any medication. If your daughter doesn't seem to be making good strides with the councelor, then it is time to try another one. I stayed with one for to long because I kept thinking it was me who wasn't getting better. She moved so I had to switch to a new one. The second one had me feeling better in no time because she was the right fit for me.

 

One last note.  I see your daughter is 17. Once she is 18 the doctor or therapist won't talk to you anymore unless she signs a paper at their offices stating that they can. As soon as she gets close to 18 talk to her about signing so you can help to continue to manage her health care.

Edited July 30, 2017 by datgh

[Bluegoat]

My concerns for my child would be that people who have use SSRIs seem to be more likely to suffer from serious depression later and it may create a chronic situation.  Here is an article describing what seems to happen.  So - I'd personally want to look to other options in a serious way before trying medications.

[kroe1]

I would not take SSRIs myself, so I would not put my teen on them either. In your daughter's case, the correlation between symptoms and diarrhea, to me, seems more like a hormonal problem than a mental one.

 

In regards to her lifestyle, you mentioned she is in front of screens a lot. Is what she is watching or playing increasing anxious responses? She is a little late in the game to start a serious sport, but, she may benefit from a team sport rather than alone at the gym. A lot of teens around here start rowing later in the teen years. Most other sports seem to start at age 2 almost.

 

If she is a gamer, encourage her to network on sites where she can find some online friends. Obviously, this is not as good as IRL friends, but, some good connections can be made. Try sites like Mixer where one can find tamer broadcasters.

 

The other advice in regards to watching the diet, probiotics, etc. may help as well. Keep us posted on what you find helpful and not helpful.

[Pawz4me]

FWIW -- Anxiety/stress sends me running to the bathroom constantly. It's like a constant, massive dose of the strongest laxative.

 

So personally I do not get why people think the diarrhea must be due to something else. Yes, gut health can affect mental health. But the reverse is also very true.

[Bluegoat]

FWIW -- Anxiety/stress sends me running to the bathroom constantly. It's like a constant, massive dose of the strongest laxative.

 

So personally I do not get why people think the diarrhea must be due to something else. Yes, gut health can affect mental health. But the reverse is also very true.

 

Or, they could just be totally unrelated.

[Greta]

 

One last note.  I see your daughter is 17. Once she is 18 the doctor or therapist won't talk to you anymore unless she signs a paper at their offices stating that they can. As soon as she gets close to 18 talk to her about signing so you can help to continue to manage her health care.

 

Thank you so much for sharing your experience, and for pointing this out.  She'll be 18 in less than three months now, and this is something I hadn't thought about!

 

My concerns for my child would be that people who have use SSRIs seem to be more likely to suffer from serious depression later and it may create a chronic situation.  Here is an article describing what seems to happen.  So - I'd personally want to look to other options in a serious way before trying medications.

 

Thank you so much for sharing this.  That is very worrisome.  I'm going to send the article to her and to my husband as well.

 

I would not take SSRIs myself, so I would not put my teen on them either. In your daughter's case, the correlation between symptoms and diarrhea, to me, seems more like a hormonal problem than a mental one.

 

In regards to her lifestyle, you mentioned she is in front of screens a lot. Is what she is watching or playing increasing anxious responses? She is a little late in the game to start a serious sport, but, she may benefit from a team sport rather than alone at the gym. A lot of teens around here start rowing later in the teen years. Most other sports seem to start at age 2 almost.

 

If she is a gamer, encourage her to network on sites where she can find some online friends. Obviously, this is not as good as IRL friends, but, some good connections can be made. Try sites like Mixer where one can find tamer broadcasters.

 

The other advice in regards to watching the diet, probiotics, etc. may help as well. Keep us posted on what you find helpful and not helpful.

 

Thank you!  When you say "hormonal problem", do you mean sex hormones?  Her thyroid has been thoroughly checked, but her symptoms do seem to worsen during her periods.  

 

Her screen time is things that she finds uplifting and fun (she is avoiding some of the games/shows that she used to watch that were more intense), but I still worry that an excess of screen time isn't good.  She also used to really enjoy taekwondo, but that's the only sport she's ever done.  I should talk to her about maybe doing another martial art rather than the classes at the gym.  Also, she and my husband went on a run together yesterday, and I think they're going to start making that a regular thing, so maybe that will help as well.

 

FWIW -- Anxiety/stress sends me running to the bathroom constantly. It's like a constant, massive dose of the strongest laxative.

 

So personally I do not get why people think the diarrhea must be due to something else. Yes, gut health can affect mental health. But the reverse is also very true.

 

 

Yes, I don't have an anxiety disorder, but the times in my life where I've had a short-term experience with stress and anxiety, that was certainly the case for me!

[Lady Florida.]

I have been on Celexa, Zoloft and am now on Paxel.  I had a terrible time with Celexa.  

 

I took Celexa as an off-label drug for my chronic back pain when it was first approved for that. The first dose I took had me sitting on the couch for hours unable to do anything. I kept telling myself I needed to get up and do something but I couldn't make myself move. It was horrible. I never took another dose, even though I was told that side effect would level off eventually. It wasn't worth it to me.

[AngieW in Texas]

Two of my kids did really well on fluoxetine. For one of them, I am quite sure it was the difference between life and death. That kid will need to be on medication for life. My other kid who has taken it, only needed it for a short time because she didn't have as any issues.

 

My other kid did not do well on fluoxetine (actually made anxiety increase), but has done very well on escitalopram. And I am quite certain that escitalopram has been the difference between life and death. This kid also has done really well on trazodone for insomnia (but it didn't work at all for my other two).

 

It takes a long time for these medications to start showing an effect.

 

Fluoxetine can be really good for kids who may not be good at remembering to regularly take their medication because it has a relatively long half-life. It takes about a month for it to completely get out of your system. This can also be bad because a kid who stops taking it doesn't see any problems for a long while after stopping the medication. 

 

 

 

 

[kiwik]

There have been studies on the effect of untreated depression on teens but I think research on SSRI's and teens it less. I don't much like prozac though, I prefer paroxetine.

[kiwik]

There have been studies on the effect of untreated depression on teens but I think research on SSRI's and teens it less. I don't much like prozac though, I prefer paroxetine.

[Mimm]

My concerns for my child would be that people who have use SSRIs seem to be more likely to suffer from serious depression later and it may create a chronic situation.  Here is an article describing what seems to happen.  So - I'd personally want to look to other options in a serious way before trying medications.

 

I tried to help my teen without medication for years and let her (and the rest of the family) needlessly suffer without it. I regret it. I don't know that the OP's child needs medication but if she's begging for it, it seems cruel and awful to deny it.

 

One thing my daughter's psychiatrist said is that if a brain (particularly of a young person) is depressed for a long time, those connections get formed and strengthened and the brain simply wires itself to be depressed and it can take longer to get it to rewire itself. Talk about feeling nice and guilty that I waited to treat her. :(

[Bambam]

Our psychiatrist prefers Prozac for teens as there is more history on it than the newer options.  We've never had any problems with it. It does take a while to take full effect (not sure if other drugs are the same way or not) as in 4-6 weeks. 

 

We tried a variety of things before meds. Nothing worked. It is super hard to get a depressed teen to exercise. They just can't. 

 

To those who have their teens on SSRIs and are feeling guilty because of those people who say they would never, don't. Parents evaluate all the evidence and make the decision that they believe in the best for their situation. No one else knows all the details, so ignore them. 

 

btw, my teen went off them (their choice), but within a year, they decided they needed to go back on them. I did start the question that led them to this decision because I saw the drift back, but I also knew they needed to see the need. They now see the WORLD of difference. They laugh now. They enjoy life. So much different from the pit they were in before. 

 

 

[G5052]

If you've checked if there is a physical cause and tried exercise, diet, etc.then it's time to consider medication in addition to counselling.

 

Yes, there are risks, but consider the risks if the anxiety and depression became ingrained. How will this look in ten years?  Many of the depressed teens I've known who didn't get treated up ended up in a bad place in adulthood.

 

Make sure that go to an attentive psychiatrist who treats teens. If at all possible, get a recommendation from your counsellor or primary care physician. Be prepared for a difficult adjustment. Some have very few problems, and some have a tougher time. There are certain side effects that mean that you MUST taper down on the medication and go off. Other side effects will fade over time or be tolerable. So make sure that you know what you might experience.

[Greta]

Thank you all so much for the advice and help.  I guess my feeling at this point is:  she's only a few months away from being a legal adult, so really this is her decision.  I want to make sure that she makes an informed decision, but ultimately it's her call because she is the one who will live with the consequences either way.  So I'm going to talk to her about everything that was mentioned here, have her read the articles that were linked, talk to her doctor with her, and let her make the call.

 

Thank you again.  This has been so helpful.

[maize]

Thank you all so much for the advice and help. I guess my feeling at this point is: she's only a few months away from being a legal adult, so really this is her decision. I want to make sure that she makes an informed decision, but ultimately it's her call because she is the one who will live with the consequences either way. So I'm going to talk to her about everything that was mentioned here, have her read the articles that were linked, talk to her doctor with her, and let her make the call.

 

Thank you again. This has been so helpful.

I would be cautious with this approach if her depression/anxiety are significant. A depressed and anxious brain is not optimal for reasoning through difficult decisions with. Anxiety can make potential side effects seem disproportionately large, depression can lead a person to think nothing will help anyway. Basically, illness in the brain causes all kinds of sub-optimal functioning. She needs someone else with a clear head that she trusts to counsel with about these decisions.

 

Since she is almost an adult you might want to focus your efforts in putting outside counselors in place in the form of a good psychiatrist and therapist. And yes, do anything you can once she hits 18 to get her to sign permission for you to discuss her health with those people.

Edited July 31, 2017 by maize

[Pawz4me]

I tried to help my teen without medication for years and let her (and the rest of the family) needlessly suffer without it. I regret it. I don't know that the OP's child needs medication but if she's begging for it, it seems cruel and awful to deny it.

 

One thing my daughter's psychiatrist said is that if a brain (particularly of a young person) is depressed for a long time, those connections get formed and strengthened and the brain simply wires itself to be depressed and it can take longer to get it to rewire itself. Talk about feeling nice and guilty that I waited to treat her. :(

 

Agreed. We only put off getting DS on medication for 12-18 months, but in hindsight I really wish we'd done it sooner.

[Greta]

I would be cautious with this approach if her depression/anxiety are significant. A depressed and anxious brain is not optimal for reasoning through difficult decisions with. Anxiety can make potential side effects seem disproportionately large, depression can lead a person to think nothing will help anyway. Basically, illness in the brain causes all kinds of sub-optimal functioning. She needs someone else with a clear head that she trusts to counsel with about these decisions.

 

Since she is almost an adult you might want to focus your efforts in putting outside counselors in place in the form of a good psychiatrist and therapist. And yes, do anything you can once she hits 18 to get her to sign permission for you to discuss her health with those people.

 

 

Yeah, that is a good point.  I feel so conflicted about it because daughter wants the meds, husband (who has been on and off of antidepressants for most of his adult life) doesn't want her to take them.  He thinks she needs to give the therapy and lifestyle interventions more of a chance first.  So I'm not sure what to do.

 

This bad spell hit her in March, and that's when she had all the medical tests done.  It took awhile to get her first appointment with her therapist, a full month from when this started.  So she's basically had just a little over three months of therapy and intervention.  Is that long enough to really say "this isn't working, she needs meds"?  

[Ravin]

Side effects are things to watch out for, not to assume will happen and use as a reason not to go with meds. DD has had very different reactions compared to my best friend who has taken meds for anxiety her entire adult life. For instance, DD is doing very well on zoloft and abilify, with no weight gain issues or apparent side effects. My friend very quickly gained weight on abilify and had to be taken off of it for that reason even though it was doing what it was supposed to do as well and helping her.

 

Any medication has benefits and risks.

 

That said, my only other recommendation is if possible, take her to a psychiatrist who specializes in or substantially focuses on treating adolescents, rather than having a general practitioner prescribe meds.

[Bluegoat]

I tried to help my teen without medication for years and let her (and the rest of the family) needlessly suffer without it. I regret it. I don't know that the OP's child needs medication but if she's begging for it, it seems cruel and awful to deny it.

 

One thing my daughter's psychiatrist said is that if a brain (particularly of a young person) is depressed for a long time, those connections get formed and strengthened and the brain simply wires itself to be depressed and it can take longer to get it to rewire itself. Talk about feeling nice and guilty that I waited to treat her. :(

 

I think you can only do your best based on all the probabilities.  It could easily have gone the other way.  So - hard not to feel guilty, but it really isn't something that warrants it.

 

My dad's been on serious psychiatric meds for many years, and more than anything it has made it clear to me how much of psychiatry, and especially the use of meds,  is really a very young profession - so often they are really guessing at what works, what symptoms are related, why the drugs work, or seem to work.  And sometimes the outcomes aren't what people imagine they will be.

[Bluegoat]

Side effects are things to watch out for, not to assume will happen and use as a reason not to go with meds. DD has had very different reactions compared to my best friend who has taken meds for anxiety her entire adult life. For instance, DD is doing very well on zoloft and abilify, with no weight gain issues or apparent side effects. My friend very quickly gained weight on abilify and had to be taken off of it for that reason even though it was doing what it was supposed to do as well and helping her.

 

Any medication has benefits and risks.

 

That said, my only other recommendation is if possible, take her to a psychiatrist who specializes in or substantially focuses on treating adolescents, rather than having a general practitioner prescribe meds.

 

I don't know - wouldn't that kind of assume that side effects with likely be temporary and short-term?  If they could potentially have permanent effects, that starts to make the calculation a little different.

[G5052]

I don't know - wouldn't that kind of assume that side effects with likely be temporary and short-term?  If they could potentially have permanent effects, that starts to make the calculation a little different.

 

You'd have to discuss this with a psychiatrist, but yes, the medications can be scary. They will usually tell you to monitor the individual carefully.

 

Serotonin syndrome is the most common concern: http://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/home/ovc-20305669

[Bluegoat]

We don't even really know how anti-depressants work. Most people think 'Oh, it's the serotonin!' but nope, not so much. Promoting neurotrophins is the next best hypothesis, and that actually makes loads of sense....especially in the context of people who need meds before CBT or ACT can be effective. Their neurons need those neurotrophins to help their brain start to learn new patterns of thinking. 

 

For mild or moderate anxiety, other physical causes should be ruled out, a course of CBT sessions started (12 minimum) and lifestyle changes made, including daily moderate to high intensity exercise. Mindfulness should be learned and practiced. 

 

Once you get past that into severe anxiety...all those bets are off. Untreated anxiety does predispose for depression, and there are huge risks to health and life associatated with moderate to severe depression too. 

 

For me, its a bit like what happened when I could no longer breathe properly, and my specialist said 'we will put you on this course of prednisone for a year, and it will have several pretty bad side long term side effects, but you will be able to breath again - so up to you, but alive with side effects, or dead without.' 

 

Risk benefit analysis doesn't suppose there is an option with no risk. Sometimes you are choosing between two high risk options, in which one is still clearly the best choice.

 

This is all true, however - I guess I don't feel that there is much general acknowledgment or understanding that SSRIs aren't just a simple, go-to drug with no downsides.  Even among many medical people.  I find the way people talk about them, and the way they are prescribed, worrying.  As far as individual cases go, people who are there have to decide what makes sense, but they need the information to be able to do so. 

 

There have been some pretty disturbing trends around numbers of people needing treatment for depression long term.  Which is a little crazy when you think how positive medical people were when the new drugs started being available, they thought they were going to be this amazing tool in fighting depression and mental illness.