You might have heard that antidepressants may cause suicidal thoughts in teens and young adults. And it’s an ironic twist because antidepressants are used to treat depression, which is one of the main contributors of suicidal thinking and attempts. Yet, research shows that antidepressants can help teens and young adults who are suffering from depression and other forms of mental illness.
How Antidepressants Work
Antidepressants work well because they adjust the chemicals in the brain. There are various forms of antidepressants that affect the brain in different ways. Here is a list of four types of antidepressants:
1. Monoamine Oxidase Inhibitors – MAOI’s
These were the first class of anti-depressants to be developed. They increase levels of norepinephrine, serotonin, and dopamine by inhibiting an enzyme called monoamine oxidase. However, this drug has several side effects when used with other medication, which limits their usefulness with patients who take other forms of medication. They interact with other drugs that also increase levels of serotonin and norepinephrine, constrict blood vessels, or also inhibit monoamine oxidase. Some experts believe that MAOI’s are misunderstood among medical professionals and can be better utilized to help treat patients. Currently, the following MAOI’s are approved by the FDA:
– Isocarboxid (Marplan)
– Phenelzine (Nardil)
– Selegiline (Emsam)
– Tranylcypromine (Parnate)
2. Tricyclic Antidepressants – TCA’s
This type of anti-depressant has been used since the 1950’s. They work by increasing the levels of norepinephrine as well as serotonin, but to a lesser degree than MAOI’s. Because TCA’s also block other neurotransmitters as well, they are sometimes used to treat other mental illnesses, but for this reason, they also come with additional side effects. In some cases, TCA’s worked to ease depression for a patient when other medications have failed. However, because of the side effects, prescribing medical professionals tend to choose to prescribe other medications that have fewer side effects.
The following TCA’s are approved by the FDA:
– Imipramine (Tofranil)
– Nortriptyline (Pamelor)
– Protriptyline (Vivactil)
– Trimipramine (Surmontil)
3. Selective Serotonin Re-uptake Inhibitors – SSRI’s
In 1965, Joseph Schildkraut found that depression was connected to the absence of norepinephrine. Norepinephrine is both a neurotransmitter in the brain and a hormone that is released in the body during times of stress. As a neurotransmitter, it activates in the brain arousal and alertness, which in turn, can ease depressive symptoms. SSRI’s have fewer and milder symptoms than other anti-depressants. SSRI’s are incredibly effective, but they do come with side effects. For instance, when SSRI’s are taken with other drugs that increase serotonin levels, which can cause confusion, high blood pressure, tremors, and hyperactivity. SSRI’s are considered to be an improvement over Monoamine Oxidase Inhibitors (MAOI’s) and Tricyclic Antidepressants (TCA’s).
4. Selective Serotonin Re-uptake Inhibitors – SNRI’s
These anti-depressants are the new class of anti-depressants. They differ from SSRI’s in that they increase levels of both serotonin and norepinephrine in the brain. They have similar side effects to SSRI’s as well. SNRI’s are used not only to relieve symptoms of depression, but they have been prescribed to treat other conditions such as anxiety, panic disorder, and chronic pain. The following SNRI’s are approved by the FDA:
– Desvenlafaxine (Pristiq)
– Duloxetine (Cymbalta)
– Levomilnacipran (Fetzima)
– Venlafaxine (Effexor XR)
Antidepressants are used to treat not only moderate to severe depression, but also other conditions such as anxiety disorders, such as Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), and Post Traumatic Stress Disorder (PTSD). Antidepressants can also address the painful mood states that some people with personality disorders experience.
Concerns about SSRI’s
In the past decade, there has been some concern that the use of antidepressant (specifically SSRI’s) may induce suicidal behavior in teens and young adults. As a result, the U.S. Food and Drug Administration (FDA) reviewed all of the available published and unpublished material on antidepressants to determine the danger of the drug on children and teens. Finally, in October of 2004, the FDA issued a public warning about the increased risk of suicidal thoughts or behavior (suicide attempts) 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.
Conclusion: Benefits Outweigh the Risks
More recently, a comprehensive review of clinical trials from 1998 through 2006 led to the following conclusion: the benefits for teens who take antidepressant medication outweigh the risks of suicidal thinking and behavior. The study, partially funded by the National Institute of Mental Health (NIMH), was published in the April 18, 2007, issue of the Journal of the American Medical Association. For this reason, the field of psychology continues to approve the use of SSRI’s for children and adolescents. Common forms of SSRI medication prescribed to teens include:
- fluoxetine (Prozac)
- sertraline (Zoloft)
- paroxetine (Paxil)
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluvoxamine (Luvox)
- venlafaxine (Effexor) – this is not an SSRI but is closely related
The Risks Still Exist
It’s important to remember that although the FDA has approved the use of antidepressants, the risks do exist for a small portion of adolescents. There is a fraction of teens and young adults who experience increases in suicidal thoughts or behaviors due to the use of antidepressants. One study revealed that this increase occurred in 1 in 1,000 when it came to suicide attempts and 1 in 3,000 for suicide. In the FDA review described above, there were no actual suicides committed. However, there was some evidence that SSRI medications increased suicidal thinking. The researchers found that about 4 percent of those taking SSRI medications experienced suicidal thinking and with some there were actual suicide attempts, twice the rate of those taking placebo, or sugar pills. For this reason, the FDA has issued a black box warning, which is the most severe warning in the labeling of prescription medication.
What Parents Should Do
It’s important that teens and their parents stay in close communication with a psychiatrist. Furthermore, parents should remember to closely monitor their children while he or she is using this type of antidepressant medication. Although there are risks, this type of psychotropic medication has also been incredibly successful in treating depression and other types of teen mental illness. For this reason, it might be the best treatment choice for your teen. However, keep the risks in mind when you are communicating with your teen’s psychiatrist.
Another Risk to Consider
If your teen has been diagnosed with depression or another mental illness, they may have been prescribed psychotropic medication, such as antidepressants. However, another downside to taking medication is that it continues to carry a stigma. Although it is a growing choice for treating psychological illness, medications may not be the answer for all teens. Sadly, those who take medication for their mental health are sometimes judged or looked down upon.
The Ideal Drug
Assuming that a teen or young adult is willing to take medication and there has been a discussion regarding the risks with the prescribing psychiatrist, parents should know what to look for in medication. The following are characteristics of an ideal drug:
- Do a good job of reducing or eliminating symptoms
- Be safe in that the side effects are not harming or dangerous
- Create little to no risk
- Not interact with other drugs, making them ineffective or produce additional side effects
- Be convenient to use, such as a pill a day or with meals
- Be inexpensive
It’s important that parents and caregivers keep these in mind when discussing treatment options for their teen. In fact, parents should expect to have a thorough discussion with a prescribing psychiatrist about the risks, side effects, cost, and effectiveness before having a teen take antidepressants or any other form of psychotropic medication.
Do you have experience using antidepressants to treat depression? Share you story with us in the comments below.