Depressed Youths Benefit From Therapy, Medication

A Story Of Depression

  

Johns Hopkins senior Juliana Kerrest has struggled with mental illness since her early teens. In college, she went so far as to plan her suicide. But she was stopped by the thought that her work with the support group Active Minds could help others suffering from mental illness.

  

Read About Juliana

Suicide is a very real risk for young people who suffer from clinical depression. In fact, during the past two years, suicide has increased among youths between the ages of 10 and 19. But there are treatments that can help.

Research shows that the most effective treatment is a combination of antidepressants and talk therapy. Antidepressants work by increasing amounts of the chemical serotonin, which facilitates communication between neurons in the brain. Antidepressants are an effective treatment for most adults, but when it comes to teenagers, it's not enough, said Dr. Richard Shelton, a psychiatrist with Vanderbilt University Medical Center.

"The teenage years are full of turmoil, emotions and hormonal changes, and there are family conflicts and conflicts with relationships that can contribute to distress in adolescents," Shelton said. "And antidepressant medications may not be able to deal with all of those problems."

Psychotherapy — specifically, cognitive behavior therapy — needs to be a part of the treatment, Shelton said. In a recent major study, when this therapy was used along with antidepressants, 75 percent of kids reported feeling better and less suicidal after just three months — "probably because the cognitive behavior therapy targets thinking and feeling in a very particular way that medicines may not — and in particular suicidal thinking," said Dr. Richard Friedman, a psychiatrist with Cornell University Medical College.

"Most people think when they're depressed, it just means you feel sad," Friedman said. "In fact, the so-called cognitive symptoms of depression are probably the most painful for a lot of people, which are the feelings that you're useless, worthless, unlovable, no good, a loser. Those are the cognitive symptoms. And the most extreme cognitive symptom, of course, is suicidal feeling, where you feel so hopeless that you don't believe anything will get better and you're better off dead."

Cognitive therapy challenges that kind of thinking. For example, say you're a depressed teen and someone at school says something critical. Typically, that might spin into feelings of being a complete loser. Friedman said cognitive therapy helps patients see all the times they've been successful, both at school and with friends.

"It's completely the opposite of how you feel. So you challenge them with reality, and then you correct their dysfunctional beliefs, and that will actually change the way they feel," Friedman said.

It's a sort of personal reality check that puts negative experience in context. Once the combination of medication and therapy works, patients may decide to stop taking antidepressants. But Shelton said they should do so with caution because they may experience side effects: "They can get rebound kinds of symptoms. It can include things like feeling anxious or having insomnia, very dizzy and have nausea."

Shelton said doctors can taper medication over weeks or months, giving the brain the time it needs to adjust to lower levels of serotonin.

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