When your child is feeling a little anxious or sad, you can feel great relief if you take them to a doctor and they prescribe a medication. It's normal to think, "Okay, now my child will feel better." However, there are some medications that we should definitely be aware of, especially when it comes to children's mental health problems. Today we're going to talk about that. This is a bit of a sensitive topic, but as parents, this knowledge is very important for us.
What exactly is this risk?
This story begins with an incident in America in 2004. A 13-year-old boy named Matt commits suicide. His father later said at an FDA (US Food and Drug Administration) hearing, "My son died after being given a drug we had never heard of, for a condition that a doctor didn't even know existed." Matt had been given a drug called `Zoloft`, which is used to treat depression. The doctor had said that the only possible side effects were insomnia and an upset stomach.
With so many incidents like this being reported, the FDA began to investigate the matter in depth. What they found shocked the whole world.
That is, there is a small but significant risk that some medications used to treat depression, especially in children and young people, may worsen their depression and lead to suicidal thoughts, especially when they first start using them.
Because of this, drug regulatory agencies in the United States and Britain have mandated that these medications include a "black box" warning, a warning about a very serious risk, on their packaging.
What are these SSRI medications?
This risk is often discussed with a class of drugs called `SSRIs (Selective Serotonin Reuptake Inhibitors)`. Simply put, our brains contain a chemical messenger called `Serotonin`. This is what controls our happiness, sleep, and appetite. A person with depression may have low levels of this `Serotonin`. What SSRI drugs do is help the brain use the `Serotonin` it has more efficiently.
Some of the most commonly used medicines in Sri Lanka that belong to this category are:
- Fluoxetine (known by the brand name Prozac)
- Sertraline (known by the brand name Zoloft)
- Citalopram (known by the brand name Celexa)
- Escitalopram (known under the brand name Lexapro)
- Paroxetine (known by the brand name Paxil)
Importantly, this risk is not limited to SSRIs. This warning now applies to most antidepressants .
What are the signs you should look out for as a parent?
If your child starts taking this type of medication, it's important to be very careful , especially during the first few weeks and months . This attention is important whenever the doctor changes the dosage.
| Changes to watch out for | Description |
|---|---|
| Talking about suicide | If you say things like "I feel like dying," "This life has no meaning," or if you look for ways to harm yourself. |
| Sudden changes in behavior | Being more restless than before, constantly pacing back and forth, and acting recklessly and dangerously. |
| Intense anger or anxiety | If you get angry more quickly than before, feel constantly afraid, or have panic attacks (sudden onset of fear). |
| Sleep problems | Insomnia or excessive sleeping. |
| Increased depression | If the child's feelings of sadness, anxiety, and loneliness seem to have increased after starting medication. |
| What do you do if you see something like this? | |
| Call your child's doctor immediately. If you have any suspicion that your child is in danger of harming themselves, take them to the nearest hospital's Emergency Department (ETU) . Never leave your child alone. | |
Be careful about bipolar disorder too.
Some children do not have normal depression, but a condition called `Bipolar Disorder` (formerly `Manic Depression`). In this, there is a change in the states of extreme anxiety (depression) and hyperactivity (mania). If someone in the family has this disease, the child is also at higher risk. If a child with `Bipolar Disorder` is only given medication for depression, it can worsen the `mania` state and increase the risk of suicide. Therefore, it is very important to give the doctor a complete description of the family's illnesses.
So is it wrong to give this medicine?
The important thing to understand here is that these medications have saved millions of lives . Many people with severe depression get great relief from them. The problem is that when these medications are given to children and young people, the benefits and risks need to be carefully weighed.
Some studies suggest that the increased suicidal thoughts are not caused by the medication itself, but rather by the severity of the depression. There is also evidence that the risk increases in the early stages of psychotherapy.
However, there are also allegations that pharmaceutical companies have been marketing this drug by hiding unfavorable research results and only releasing positive results. This is why, as parents, we need to be aware of this and ask questions.
Is medication the only solution?
No. The best results are achieved by providing counseling or psychotherapy along with medication.
Cognitive Behavioral Therapy (CBT) is particularly effective. It identifies the child's negative thought patterns, changes them, and teaches them how to deal with problems.
The famous study called TADS (Treatment for Adolescents with Depression) found that the best results were achieved when both Prozac and CBT were given together. However, the same study also showed that Prozac alone was more effective than CBT alone.
The problem is, even in Sri Lanka, it is difficult to find trained professionals who can properly administer `CBT` therapy. However, you can ask your child's doctor about this and ask them to refer you to someone suitable.
Take-Home Message
- Leave the decision on medication to the doctor: The decision on whether or not your child needs medication for depression, and what medication to give, should always be made by a qualified doctor . Discuss any questions or concerns you have with your doctor.
- The first month is very important: Pay close attention to your child's behavior during the first few weeks and months after starting the medication. Report any unusual changes to the doctor immediately.
- Do not stop the medication suddenly: Never stop giving the medication without the doctor's advice. Doing so may worsen the child's condition.
- Risks and benefits: As with all medications, there are risks and benefits. The risks of developing depression without treatment often far outweigh the risks of medication.
- You are not alone: Dealing with a child's mental health issue is difficult. If necessary, seek psychological counseling support. Your mental health is also very important to your child.
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