Are antidepressants safe for youth?

Antidepressants are used both as first line and adjunct treatment for depression. The most commonly used type is selective serotonin reuptake inhibitors, or SSRIs. A simplified explanation of how SSRIs work can be found here. These drugs are also used to treat other mental health conditions, mostly anxiety disorders. It does takes several weeks for the positive effects of the medication to manifest, at least with depression.

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All medications come with certain risks and side-effects. SSRIs, however, can be extra hard on children, teens and young adults. The FDA has issued a black box warning on all SSRIs, which is its strongest warning. It states that taking these medications can cause an increase in suicidality in those up to age 25. 

This warning is issued because 4 percent of children treated with SSRI medication experience suicidal thinking and behavior (including attempts). This is twice the rate of those who took a placebo (sugar pill). So while the odds of having this reaction to an anti-depressant are low, it is important to watch for, especially in the first month or two and around dosage changes. 

It is believed that the benefits of taking an SSRI outweighs the risks. And it is true that it is a fairly rare reaction. But without discouraging antidepressant use, I want to stress how real that suicidality can be. I was 20 the first time I took an SSRI and there was a marked difference in my level of suicidality. I went from thinking about dying to planning on it. As soon as I realized this, I contacted my psychiatrist and he reduced the dosage. I had to be watched for a few days, but it got better.

What I learned from that is to not go through medication changes alone. Let important people in your life know about the change. These include family, significant others, therapists and other healthcare providers. When symptoms become worse, it can be hard to reach out for help. If others are looking out for you, it is much safer to go through medication changes. They can notice if you change and help make sure you talk to your healthcare provider.

Suicidality isn’t the only side effect of medications. Even in adults, SSRIs can make you more depressed before you get better. I’m now 26, but I let my mom, boyfriend and therapist know every time I go through a medication change, even if it’s just changing the dosage of something I’m already on. No matter what you are taking – whether it’s for a physical condition or a mental one – I think it’s good to tell those who will be around you the most. 

So are SSRIs safe for those under 25? For the most part. Just monitor any adjustments very closely. If you are thinking of taking or having your child take antidepressants, mention any concerns you have to your prescribing physician. She can help you make a plan for how to handle any side-effects that might come up.

Have you taken antidepressants while under the age of 25? What was your experience? Let us know in the comments.

"Mom, Dad, can I have a therapist?"

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With the prevalence of mental health issues in children and adolescents, it’s important to seek help. Since research shows that half of all lifetime mental illnesses start before the age of 14, ignoring potential problems at a young age can lead to a lifetime of difficulties. It’s easier to treat symptoms when they are first appearing rather than waiting for a full-blown disorder to develop. 

Kids/teens: Asking for help is hard. Really hard. I know it is because I've had to do it. The systems that are in place to help you won't always work. Frankly, I'm surprised that some of the assignments I did in high school didn't lead to an after-class talk or referral to a counselor. Unfortunately, not being taken seriously can lead to an escalation in symptoms as you try to get someone to understand that you are
                                                                                                                experiencing internal distress.

If mental health issues are not prevalent in your family (or simply ignored and under-recognized), it can be a challenge to get taken seriously. A sixteen-year-old with mood swings? Nothing new. But when those "mood swings" involve not sleeping for a week followed by two months where all you want is to stay in bed, you probably need some help from someone. If your parents won’t listen, try talking to a trusted teacher or a school counselor. Seek help from the adults in your life that you feel comfortable with. And don’t give up. If you know something is wrong, it’s worth pushing until someone will listen because it will save you so much trouble in the long run.

Parents: Listen to your kids. Going in for an evaluation or talking to the school counselor won't kill you. A "better safe than sorry" approach (within reasonable limits) can save your child years of suffering. Since they are not finished developing both physically and mentally, where they're at is critical. Make sure they are at the best place possible. 

If you think your child might be struggling with symptoms of mental illness, try to find out as much as you can. Look for both patterns of behavior and out-of-character actions. Talk to teachers or others who spend significant time with your child. Ask what they have observed. Keep track of everything you notice and find out. Then talk to your doctor or health care provider. Depending on what she sees, she can make referrals to specialists or local resources.

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Look for ways to make it easier for your child. When you know what is going on, talk to his school to find out what they can do to accommodate him. Create a supportive and safe home environment. If there are extracurriculars or other activities that are causing problems, consider withdrawing your child. Show her that her mental health matters and that it’s healthy and good to take care of yourself. 

As part of your child’s treatment, consider looking at the whole family. Going to family therapy may be helpful because your child’s condition is not happening in isolation. In addition, all family members are impacted by the struggles of one. A good counselor will not merely single out the child with the problem, but will look at how the family as a whole can be healthier. 

The most important thing you can do is to take your child’s mental health seriously. Seek appropriate treatment from licensed professionals. Well-intentioned religious leaders or other significant adult figures can be helpful, but are not substitutes for professional help. Listen to specialists regarding treatment recommendations. By showing that you are taking your child seriously, you are helping him see that he and his health matter, which is a lesson that is valuable across the lifetime.

What have you found helpful in getting children and adolescents mental health help? Answer in the comments.

Mental health myths: children and mental illness

I am taking some time to discuss issues related to childhood and adolescent mental health. Let’s start with a very basic mental health myth.

Myth: Children cannot develop mental illnesses.

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Fact: A significant number of children and teens struggle with mental health issues. 

Sadly, being a minor does not eliminate the possibility of having mental health issues. According to the National Institute of Mental Health, 13 percent of kids and teens between the ages of 8 and 15 struggle with a severe mental health condition. For teens between 13 and 18, that number increases to 20 percent. And those are just severe conditions – there are even more that are struggling with mild and moderate mental health issues.

There are dozens of diagnoses that are considered childhood disorders. These include learning disorders, but also conditions related to development, attachment, behavior, and more. In addition, mental illnesses that adults get can have separate diagnostic criteria for childhood versions of the same condition.

By some estimates, there are more children suffering from mental illnesses than physical ones in North America. These conditions can be devastating not only to children, but to entire families. When one family member struggles with mental illness, it affects the whole family. The family dynamic is disrupted and other family members can experience stress, anger, guilt, shame or denial. It is therefore important for everyone’s needs to be considered, not just those of the one struggling with mental health issues.

By being young, kids and teens won't always have the perspective of knowing what is and isn't normal in terms of their psychological health. We assume that others are like us, so until someone points out that, no, most people don't have to wash their hands repetitively, they might think it's the standard. Some children have never really had a chance to not struggle with mental health, so they don’t know that there is something wrong. That’s why it’s so important for adults to look for signs of mental illness in children.

Some symptoms to watch out for in children and teens include:

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• Being unable to cope with everyday problems.

• Not doing well at school (especially if the child is really trying).

• Difficulty concentrating.

• Loss of interest in activities and friends.

• Persistent negative moods.

• Sleep problems, including disrupted sleep, nightmares and sleepwalking.

• Frequent physical symptoms, such as headaches and stomachaches.

• Changes in eating habits.

• Unwarranted amounts of worry and anxiety.

• Regressing to behaviors of a younger age, such as becoming clingy or bedwetting.

• Risk-taking behavior.

• Repeated anger outbursts.

• Frequent disobedience and aggressive behavior.

• Self-injury.
• Substance abuse.

• Unusual amounts of time spent alone.

• Disproportionately intense feelings.

• Seeing or hearing things that aren’t there.

Take these symptoms seriously. On Saturday, there will be a post detailing how to get help when children and teens experience mental health concerns.

Do you have an experience with childhood or adolescent mental illness that you’d like to share? Please post in the comments.

Challenging Orthodoxy in Mental Health

Every profession has its orthodoxies, opinions or philosophies which have been accepted as truth, either implicitly or explicitly.  The field of mental health is no different.  At times these are presented with an air of sanctimony and imperialism which are serious obstacles to further inquiry or maturation of the field.  Given that many of us are involved in improving human welfare, this ought to be viewed with suspicion, if not derision.  When it comes to the study and advancement of human beings, everything is open for further questioning.

Here I list a few of the orthodox assumptions in our field, along with comments from my point of view.

1. Confidentiality is absolute.  Though it is without doubt the bedrock of good psychotherapy, a healthy degree of which is required for success, confidentiality has never been absolute.  There are exceptions both in law and ethics, such as risk for harm to self or others, which are commonly known.  Lesser known, perhaps, are exceptions which in the judgment of the therapist are necessary for the welfare of the individual.  Sometimes this orthodoxy is taken to extreme and ridiculous levels, such as when therapists block any communications with third parties, nor allow them physically near the facility "in order to protect privacy".  Many times good therapy involves working with a broader system of people, organizations, or policies which offer wider possibilities for the advancement of human causes.
2. There is a superior paradigm for mental health.  Advocates for this orthodoxy, often from medical disciplines, proclaim their model as "best practice", and cite evidence for this position.  But rarely is disconfirming evidence cited even though it is easily found (as it is for any position).  Too often, other evidence is not considered or acknowledged, nor is the existence of other paradigms or models.  These include developmental, contextual, feminist, and culturally-bound models, all of which have profoundly important things to say about the human condition and its improvement.
3. There is a hierarchy in the mental fields, and the topmost is the leader of the "team".  This orthodox view is closely related to number two above.  This is part of an imperialistic attitude which has no place in mental health.  It runs counter to basic concepts of respect and egalitarianism which are central to the therapeutic process.  Regardless of marketplace values, all fields have important things to contribute and their diversity is to be held in high esteem.  Also, the most important unit is the therapist-client dyad, and nothing can alter this fact.
4. Suffering should not be a part of healing.  Even on the most basic level of our physical selves this is a falsehood.  All wounds hurt, and this hurting is a sign the body is doing what it is built to do.  The body and brain are capable of self-correcting if we give them a chance.  Many people, clients and therapists alike, appear to operate from a position that all symptoms, all pain, should eliminated from the start.  This posture, promoted by the pharmaceutical and insurance conglomerate, leads to premature diagnosing, premature intrusive interventions such as medications, and often, the premature conclusion of therapy.  Suffering is a part of life, and it is not always "diagnosable".  As we come out of our unconscious stupors, our avoidance and fetishes, we are bound to feel bad.  And probably for a while.  This is a part of healing and it is to be embraced and understood.  Then real and lasting progress may occur.
5. A toolbox of "interventions" is what makes therapy work.  Though such a toolbox is important to possess, as is knowing when to use its contents, non-specific factors account for the lion's share of progress in therapy.  These include the personalities and styles of the therapist and client, and the quality of their relationship.  In spite of all our technological advances, adequate time, good listening, a deeply trusting and understanding relationship, and the ability to communicate from the client's experience are the most fundamental components of good therapy.  Without these your toolbox is useless.

Orthodox positions usually derive from economic, political, legal, and even religious points of view.  In reality these may have little to do with a heartfelt, caring and professional relationship between two human beings.  To the extent that such points of view are given space in the therapy room, we may impair the healing process which is before us.

5 activities to help between sessions

Sometimes, the time between therapy sessions can be hard. If you have something big going on or a chronic condition, it can be difficult to just let time pass. You can’t pause your problems. Sometimes, you just have to find ways of handling them until you can really work on them in therapy. Here are five things to do between sessions that can tide you over.

     

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Journaling

Putting thoughts on paper can keep them from incessantly taking your attention. Writing also forces you to slow down your thinking process and helps you see things that you otherwise would have missed. When you do go into therapy, you will have new material to work with. If you are comfortable sharing what you wrote with your therapist, that might help, but you really don’t have to.

Creative expression

Some feelings and experiences are beyond words, at least in narrative form. That’s why it can be so cathartic to express these things through creative means. It can take any form you like. I used to write poetry, then I painted and right now I mostly collage. Other options include writing fiction, other visual arts, dance, theater and crafts (knitting, sewing, repurposing objects, etc.). I promise there’s something for everyone! 

Meditation

Meditation has been used for thousands of years to become more in tune with oneself. Whether used as a spiritual practice or as a means of self-improvement, meditation allows us to slow down and let the body and mind enter a state of rest. You don’t have to have an elaborate routine. Simply focusing on your breathing for even one minute can make you feel better. 

Exercise

The health benefits of exercise are numerous for both physical and mental health. In fact, regular exercise has been found to be comparable in benefits to antidepressants. In the short-term, it can also help eliminate negative emotions. Stress, anxiety, anger, frustration, irritation and more can be taken out at the gym or on a run.

Self-care

Take time to do whatever makes you feel good. It’s easy to get caught up in responsibilities and the never-ending list of things we should do and forget to take care of ourselves. Whether it’s a hot bath, a tasty treat or skipping the dishes for one night, doing things for yourself is important to keeping you mentally healthy.

What do you do to manage the time between sessions? Share your tips in the comments.

Who do I call?

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Sometimes, it’s hard to know where to turn to for help. Loved ones may not always be available or you might not be ready to share some of your concerns with them. That’s why hotlines exist. 

Below is a list of hotlines that can be used within the U.S. My blog stats show that my readership is currently almost exclusively here, so that’s who I kept in mind when I made the list. If you are wondering about getting help in another country, feel free to leave a comment and I will see what I can find.

Even if you think you’re okay, read through the list of numbers. They are very varied and you might find something helpful you didn’t know was out there. All numbers are listed in alphabetical order and available 24/7 unless otherwise stated.

Boys Town National Hotline (at-risk teens and kids): 800-448-3000

Bulimia and Self-Help Hotline: 314-588-1683

Childhelp National Child Abuse Hotline: 800-422-4453

Crisis Call Center: 800-273-8255 or text ANSWER to 839863

Crisis Text Line (teens): Text SUPPORT to 741741

Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury (military and others affected): 866-966-1020

Depression and Bipolar Support: 800-273-8255
IMAlive chat support: www.imalive.org
Lifeline Crisis Chat: www.crisischat.org

National Alcohol and Substance Abuse Information Center: 800-784-6776

National Association of Anorexia Nervosa and Eating Disorders: 630-577-1330 (10 a.m. to 6 p.m. EST, Monday to Friday)

National Center for Posttraumatic Stress Disorder: 802-296-6300

National Council on Alcoholism and Drug Dependence: 800-622-2255

National Domestic Violence Hotline: 800-799-7233

National Eating Disorders Association: 800-931-2237 (9 a.m. to 5 p.m. EST, Monday to Friday)

National Institute on Alcohol Abuse & Alcoholism: 800-662-4357

National Institute of Mental Health Information Center: 866-615-6464 (8 a.m. to 8 p.m. EST, Monday to Friday)

National Mental Health Association Hotline: 800-273-8255

National Runaway Safeline: 800-786-2929

National Safe Place: Text SAFE and your current location to 69866

National Suicide Hotline: 800-784-2433

National Suicide Prevention Lifeline: 800-442-4673

National Teen Dating Abuse Helpline: 866-331-9474

Postpartum Support International: 800-944-4773

Rape, Abuse, and Incest National Network: 800-656-4673

Safe Horizon’s Crime Victims Hotline: 866-689-4357

Safe Horizon’s Rape Sexual Assault & Incest Hotline: 212-227-3000

Substance Abuse and Mental Health Services Administration: 800-662-4357

Suicide Prevention Services Depression Hotline: 630-482-9696

The Trevor Lifeline (LGBTQ): 866-488-7386

Thursday’s Child National Youth Advocacy Hotline: 800-872-5437

Veteran Combat Call Center: 877-927-8387

Veterans Crisis Line: 800-273-8255

Update: Here is a link to international suicide hotlines.

If you have any corrections or additional hotlines for the list, please leave a comment. I have not personally called each number to verify the information, so I don’t make any guarantees about them. This list is not intended to be comprehensive. 

Substance abuse and mental health

Mental illness has a potentially devastating companion. Substance abuse and dependence are common in people who are struggling with their mental health. According to the National Alliance on Mental Illness, 29 percent of those who are diagnosed as mentally ill abuse either alcohol or drugs. That's almost one-third. Looking at it the other way around, over one-third of all alcohol abusers and more than one-half of all drug abusers struggle with mental illness.

  

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This creates an entire population of mental health patients with very distinctive needs. Treating a mental illness becomes much more difficult when substance abuse and dependence are involved. If you have a predisposition towards a certain illness, but it has yet to manifest, substances can trigger it. When you are already struggling, substances can make your symptoms worse. On the other hand, mental illness can make you want to self-medicate and thus can cause a substance abuse problem. The two feed into each other.

When you are abusing or dependent on a substance, you cannot engage in treatment for your mental illness in the same way you can when sober. Your mind will simply not work the way it needs to in order for you to heal from your mental health issues. In addition, sometimes these substances can interfere some with medications. This is why it is so important
                                                                                                                  to get help for substance abuse problems. 

There are, of course, rehab and treatment centers specifically for detoxing. For some people, this is the best route to go. But it's worth knowing that there are also treatment facilities that cater specifically to people with the dual diagnosis of mental illness and substance abuse. There are entire programs that are designed to help with the specific needs of this population. When evaluating facilities, ask about these types of programs. Some of them will be listed as psychiatric hospitals, so don't rule those out when you are searching for a treatment center.

More in-depth information on substance abuse and mental illness can be found at the Substance Abuse and Mental Health Services Administration's website. You can also call them at 1-800-662-4357. The primary purposes of this helpline is to refer people to treatment options in their area. The National Institute on Drug Abuse offers a helpful guide for evaluating treatment centers on this page.

Have you or someone you love experienced problems with both mental illness and substance abuse? Share your stories and insights in the comments.