No Easy Answers for Depression

Suicide is the third leading cause of death for young people ages 15 to 24, according to the U.S. Center for Disease Control and Prevention.

Depression is a scary thing. Many parents of depressed teens fear their child will commit suicide. Turns out this is a legitimate fear.

In Tennessee this month, there is news that the teen suicide rate there is slowly rising. In Manitoba, Canada, on the Cross Lake First Nation Indian Reserve, more than 100 students are on a watch list after the suicide deaths of at least four classmates. Events are being held in nearly every state across the nation this spring to raise awareness of who is most at risk and how to recognize the warning signs — so that families have an outlet to share their stories in the hope others won’t suffer the same agonizing loss.

Anti-depressives can help prevent suicide, but additional questions are still being asked. Will those medications ultimately hurt your child?

The jury is still out.

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Anti-depressives were given as needed to teens until 2006, when the FDA warned of the increased risk of suicide for those using these medications.

In 2011, Rif S. El-Mallakh, a doctor at the University of Louisville, proposed that certain patients initially had a positive response to treatment but became resistant and were on the meds for a long period of time, which actually made things worse in the long run. A study he did speculated that prolonged use of anti-depressives changed nerve tissue and permanently altered the adolescent brain.

Theodore Henderson, a physician and psychiatrist in Denver, Colorado, said the condition was labeled tardive dysphoria (tardive means delayed; dysphoria means unhappy). However, those ideas have not been proven and are strictly hypothetical.

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Anti-depressives are still used for adolescent depression, though not as liberally.

A group of drugs identified as selective serotonin reuptake inhibitors (SSRIs), including Prozac, Celexa, Zoloft and Paxil, are recommended for treating depression in adolescents by the FDA, said Henderson. Of those, Prozac is the go-to treatment for adolescents because it produces the least amount of suicide ideation, Henderson said.

As a group, teens tend to be a pretty bummed-out bunch. Some 11.4 percent of adolescents between the ages of 12 and 17 suffer from depression, according to the National Institute of Mental Health. That is about 2.8 million teens.

It’s a conundrum, Henderson said. Taking anti-depressives can help prevent suicide, yet one of the side effects of the drugs is suicide ideation. Since the 2006 warning, the number of teens on antidepressants has dropped; yet the suicide rate has gone up, he added.

So are anti-depressives ultimately harmful? The long-term effects of taking anti-depressives is inconclusive.

One thing researchers HAVE found is that depression itself injures the brain.

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Depression affects the emotional centers and frontal cortex of the brain and actually “decreases the number of neurons and synapses in the frontal cortex,” Henderson said. He is also guest editor of PLOS One, Journal of the American Medical Association, Journal of Nuclear Medicine and the Journal of Neuropsychiatry and Clinical Neurosciences.

An MRI of the brain of a depressed person shows a smaller frontal cortex. Moreover, there is no evidence showing anti-depressants reverses those changes, Henderson said.

Conversely, psychotherapy can help heal the brain. “Evidence shows that it is reparative,” he said.

There is still a place for anti-depressives, experts say. Therapy combined with medication can be effective for depression, and when patients receive both medication and therapy they are more likely to improve, rather than using either treatment by itself, said Jared Heathman, M.D., of Houston, Texas.

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There is also hope that the anesthetic drug ketamine will be a new tool in the treatment of depression. Ketamine causes the brain to form new circuits and neurons. It rebuilds the brain and reduces or repairs the damage caused by depression; it will ultimately transform treatment, Henderson said.

“There will be a revolution of treatment in the next 10 years. With medication based on ketamines and other new drugs, we will help repair the damage depression causes in the brain,” he added.