Antidepressant Rx: Careful Monitoring Needed
Patients need close follow-up for treatment of clinical depression.
For most children, antidepressants are prescribed for short-term treatment, although some will need to continue much longer, says Fassler. "Some kids, particularly those with recurrent episodes of depression, may take medications for many years and into adulthood."
3) Discuss the merits of therapy.
Research has shown that a combination treatment -- both medications and therapy -- can prevent recurrences of depression for many years after drug treatment ends. When people take antidepressants alone, they are more vulnerable to depression once they stop the drug.
Therapy helps people understand the roots of their depression, change negative thought patterns, and learn better coping skills, Fassler explains.
Therapy can also help fix emotional problems caused by the depression itself, he says. "By the time patients get help, there are lots of secondary emotional ramifications -- self-esteem problems, guilt about their depression, they feel different, have trouble at school, home, friends. Medication isn't going to fix those problems."
If kids are reluctant to take antidepressants, therapy can provide the encouragement they need, Fassler tells WebMD. "It's a struggle. But if kids really understand what the illness is about, and see how medicine helps them live more normal and healthy lives, they are more likely to take it."
4) Make sure doctors communicate with each other.
If multiple doctors are treating you or your child, make sure they share treatment information, says Fassler.
"Across the country, we're seeing more and more prescriptions for antidepressant medications written by pediatricians and primary care physicians," says Fassler, who is also a spokesman for the American Academy of Child and Adolescent Psychiatry.
"Make sure the various doctors are talking to each other -- so they can see how the child is doing" he tells WebMD. He also says to make sure that the signs of side effects are dealt with right away.
5) Know symptoms of worsening depression.
Doctors will usually see patients at least monthly when they are starting or changing doses of antidepressants, says Thase. "But with the new FDA cautionary statement, follow-up should be more frequent." Telephone check-ins could be set up and may be sufficient.
However, "it's important for patients to know that if they take a turn for the worse, they can see the doctor quickly," he tells WebMD. "If patients notice they're not sleeping well, getting restless, having more negative thoughts, let the doctor know that, so the dosage can be changed. They should not suffer in silence."
Children should get careful monitoring, says Fassler. "Every child's depression is different, and parents have to work with the doctor to figure out what symptoms should be monitored -- whether the child's energy is improving, if they're less irritable, sleeping better, appetite better, doing more things with friends. If any child is expressing thoughts about hurting themselves or anyone else, obviously they need to be seen and re-evaluated."