Question About Medicating Depression

thebloodfiend

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I've searched some threads for symptoms of depression, but I didn't really get to much on if medication actually works.

For a teenager, does medication work or is counseling better? Or is it more of a person to person thing?

Also, is it a bad thing to show a character getting better with help from medication?
 

PinkAmy

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I've searched some threads for symptoms of depression, but I didn't really get to much on if medication actually works.
There are three chemicals in the brain that regulate depression, serotonin, dopamine and norepinephrine, although other body processes like hormones and medical problems can effect depression

For a teenager, does medication work or is counseling better? Or is it more of a person to person thing?
Usually for both children and adults, a combination of medication and therapy is the best approach IF the depression is not situational. Children should never be medicated without therapy, in my opinion, because therapy will teach them the skills strategies to stave off future depressive episodes. Also, medication effects children and adults differently and kids need to be monitored.
Also, is it a bad thing to show a character getting better with help from medication? Nothing is bad if you do it well ;)

Situational depression is depression that arises from something outside the individual, like if a loved one dies or if the person had her heart set on making a team and she doesn't. It's usually less severe than major depressive disorder and medication doesn't usually help the condition unless it lasts for a length of time. Long term situational depression can change brain chemistry.

Major depressive disorder is the most serious form of depression. There is often no root outside the person, but lies in the biology. If there is a root, the biochemical make up of the person prevents her from recovering after the situation is rectified.

Dysthymia is a chronic, low grade depression that is so pervasive individuals might not realize they have it. They can think it's part of their personality. These folks might appear as negative, pessimistic, always frustrated or in a bad mood. Medication can help these folks live life at a higher level.

There is also the depression that occurs with bipolar disorder and that needs to be medicated differently than major depression.
 
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mgnme

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antidepressants are generally given in conjunction with a strong recommendation to get counseling. in my experience, they don't just say, "here, have some happy pills!" no doctor will prescribe antidepressants without suggesting counseling as well. and since you're talking about a teenager, the parents will be involved - you can decide what your character's parents would do with that recommendation.
 

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Situational depression is depression that arises from something outside the individual, like if a loved one dies or if the person had her heart set on making a team and she doesn't. It's usually less severe than major depressive disorder and medication doesn't usually help the condition unless it lasts for a length of time. Long term situational depression can change brain chemistry.

Major depressive disorder is the most serious form of depression. There is often no root outside the person, but lies in the biology. If there is a root, the biochemical make up of the person prevents her from recovering after the situation is rectified.

Dysthymia is a chronic, low grade depression that is so pervasive individuals might not realize they have it. They can think it's part of their personality. These folks might appear as negative, pessimistic, always frustrated or in a bad mood. Medication can help these folks live life at a higher level.

There is also the depression that occurs with bipolar disorder and that needs to be medicated differently than major depression.

YES. this. perfect explanation. so basically, it's up to you to decide which kind your character has. that will determine what's helpful.
 

PinkAmy

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. and since you're talking about a teenager, the parents will be involved -

One can only hope the parents will be involved, but lots of parents drop their kid off at the therapist's office saying, "Fix my kid." Those parents don't recognize the need to participate in the treatment or they recognize and don't care or have the time or have the emotional make-up or are too drugged up or too something to be able to participate.
I'd say with the kids I've worked with it was about 30/70 with fewer being involved in a helpful way. In my personal experience younger kids in therapy had more involved parents. The older the child, the less involvement.
 

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Medicating adolescents is NOT like medicating children or adults, especially when you're talking psychotropics. There's all kinds of chemical activity going on in their brain thanks to developing hormones and such that it's not generally recommended unless there's a serious mental diagnosis.

When I worked in the Adol Med department of a local hospital, the doctors would refer patients to a psychologist (cannot prescribe drugs) before a psychiatrist (can prescribe drugs)--or bring him into the session if he was in clinic. They would discuss the case with the psychologist before prescribing any psychotropics. Every doc I worked with was very careful before taking that step. From what I read in the articles, etc, that they discussed in their conferences, it was generally a last-step and then only with recommendation from a psychiatric trained practitioner.

As for whether or not it's good to portray someone being helped by medication--I'd say it was, as long as you dramatized that they had a medically treatable problem and you got the facts about what they're taking, etc, right.

Also, people generally don't get meds for depression without also receiving counseling for how to cope or getting down to the root of the depression at the same time. It's a hand-in-hand process.
 

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Medicating adolescents is NOT like medicating children or adults, especially when you're talking psychotropics. There's all kinds of chemical activity going on in their brain thanks to developing hormones and such that it's not generally recommended unless there's a serious mental diagnosis. yes, but in practice lots of teens are medicated, often by GPs/pediatricians and not psychiatrists. It's not a good thing, but it is not uncommon

When I worked in the Adol Med department of a local hospital, the doctors would refer patients to a psychologist (cannot prescribe drugs) before a psychiatrist (can prescribe drugs)--or bring him into the session if he was in clinic. They would discuss the case with the psychologist before prescribing any psychotropics. Every doc I worked with was very careful before taking that step. From what I read in the articles, etc, that they discussed in their conferences, it was generally a last-step and then only with recommendation from a psychiatric trained practitioner. often times therapists are the ones who make the psychiatric referrals after working with teens. What they told you at a conference is often different than what happens in practicality. What you describe is the ideal, but not common practice in the different situations I've worked inpatient and out patient as a psychologist.

As for whether or not it's good to portray someone being helped by medication--I'd say it was, as long as you dramatized that they had a medically treatable problem and you got the facts about what they're taking, etc, right.

Also, people generally don't get meds for depression without also receiving counseling for how to cope or getting down to the root of the depression at the same time. It's a hand-in-hand process. Ideally, but that is not true when dealing with GPs and pediatricians who prescribe. The ideal is most helpful to the patient, but unless the patient has a serious mental illness or a recent hospitalization, reality doesn't measure up. What your saying is the way it should be, but HMOs insist doctors see more patients for less time and less money and therapists, while generally less busy can't spend all day playing phone tag. It can take a long time to hook up with a physician, because we don't take calls during sessions and drs don't take calls when they are with patients.
You must be a student. Everything you're saying is right on the money about what should happen for best standards and practice. I wish things were the ideal rather than what happens in practicality.
 

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I didn't even know that Dysthymia existed.
Most people don't. I believe dysthymia is one of the most frequent undiagnosed mental illnesses, because when someone is so depressed she wants to slit her wrists, that stands out as serious and needing of intervention. But chronic low grade depression can go a lifetime w/o diagnosis, which is such a shame to people who could be living more engaging lives.
 

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You must be a student. Everything you're saying is right on the money about what should happen for best standards and practice. I wish things were the ideal rather than what happens in practicality.

Yes, who the kid sees (psych versus GP/pediatrician) could change the way your story goes (ie, give you some other alternatives). Many parents won't take their kids to other than the family doctor or pediatrician - that way their kid isn't really 'crazy'. And unfortunately, many (most?) GPs/Peds know little or nothing about the full effective treatment of any MI. The good ones will strongly recommend a 'specialist'.
 

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I've searched some threads for symptoms of depression, but I didn't really get to much on if medication actually works.

It depends on the situation, type of depression and the person and how they take to the meds. Some people respond better to certain medication better than others. It should be noted that sometimes antidepressants can react badly with an individual and can actually make the symptoms worse, Citalopram is one example that has recieved a lot of press recently about this.

For a teenager, does medication work or is counseling better? Or is it more of a person to person thing?

It's quite difficult to mediate a teenager, as others upthread have said. However, many GP's still do it and, as with anything of this nature, there are varying results.

Also, is it a bad thing to show a character getting better with help from medication?

No. Not at all. Many people are too embarrassed or ashamed to get help, and some people see taking pills as a way of glossing over the problem, but in reality, if they help then they help.


and since you're talking about a teenager, the parents will be involved - you can decide what your character's parents would do with that recommendation.

Not necessarily. I don't know what it's like in the US, but over here doctor/patient confidentiality means that if a teenager goes to see a doctor then that doctor isn't allowed to tell the parents anything without the child agreeing to it. That has caused some issue in the past with 15 year old girls having abortions without their parents knowing etc.

Also, as other have said, you're assuming that the parents give a shit. Sadly many don't.
 

thebloodfiend

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Yeah, in both cases, the parents don't give a shit.

Could a school counselor recommend that someone see a professional if parents aren't involved?
 

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Keep in mind, too, that most medications for depression are not fast-acting. The person doesn't swallow the pill, and within a half hour start feeling their depression lifting. Most anti-depressants take weeks of regular use before you start seeing a change in mood. If you skip one, you're not going to instantly downswing, and if you take an extra pill, you're not going to feel better immediately.

I mention this because I recently read an otherwise really engaging book about a teenage girl who suffered from depression, but the author had her instantly feeling better every time she popped a pill. It just doesn't work that way, unless it's psychosomatic.
 

shadowwalker

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Keep in mind, too, that most medications for depression are not fast-acting. The person doesn't swallow the pill, and within a half hour start feeling their depression lifting. Most anti-depressants take weeks of regular use before you start seeing a change in mood. If you skip one, you're not going to instantly downswing, and if you take an extra pill, you're not going to feel better immediately.

I mention this because I recently read an otherwise really engaging book about a teenage girl who suffered from depression, but the author had her instantly feeling better every time she popped a pill. It just doesn't work that way, unless it's psychosomatic.

Good point. Someone else touched on the "happy pill" - they definitely are not fast-acting and they are not 'uppers'.
 
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and since you're talking about a teenager, the parents will be involved - you can decide what your character's parents would do with that recommendation.
One can only hope the parents will be involved, but lots of parents drop their kid off at the therapist's office saying, "Fix my kid." Those parents don't recognize the need to participate in the treatment or they recognize and don't care or have the time or have the emotional make-up or are too drugged up or too something to be able to participate.
I'd say with the kids I've worked with it was about 30/70 with fewer being involved in a helpful way. In my personal experience younger kids in therapy had more involved parents. The older the child, the less involvement.
Fuck this is so wrong. No, there is not always a need for parents to participate.

I had medication and therapy as a teen and my parents were definitely not involved. I wouldn't have wanted them to be, particularly as my mother was part of the damn problem.

As a kid, I was referred to a child psychologist who came round to the house when I was home from school at lunchtime. I loitered, expecting him to want to speak to me, but was told to go back to school. As I left, I heard him ask questions like, "Does she have a lot of friends at school?" and my mother said, "Oh yes, she has plenty of friends," which showed how little she knew about me, and how much she was capable of spouting bullshit about things she knew nothing about.

I never heard anything about the psychologist again, so he evidently fell for said bullshit.

Years later I sought help myself and my parents weren't involved in any of it, which is probably why the treatment worked somewhat. Or at least set me on the road o recovery.
 

PinkAmy

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Yeah, in both cases, the parents don't give a shit.

Could a school counselor recommend that someone see a professional if parents aren't involved?

Legally the parents have to be involved for children under 18, plus, they need the parents' insurance to pay for the treatment.
 

PinkAmy

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Yes, who the kid sees (psych versus GP/pediatrician) could change the way your story goes (ie, give you some other alternatives). Many parents won't take their kids to other than the family doctor or pediatrician - that way their kid isn't really 'crazy'. And unfortunately, many (most?) GPs/Peds know little or nothing about the full effective treatment of any MI. The good ones will strongly recommend a 'specialist'.
Maybe you're not familiar with how difficult getting an appointment with a child psychiatrist is in some areas of the country. Psychiatrists who aren't familiar with working with children often have less experience prescribing for kids than pediatricians. Ideally I'd love my clients to have child psychiatrists, but a good pediatrician who is familiar with psychotropics can be just as good, even if not ideal. I have seen cases where parents medication shop for their kids based on things other parents have used or based on what they've read about and unfortunately I have seen psychiatrists and GPs who will prescribe.
I worked with a kid who's mother had been trying for two years to get an appointment with one of the few child psychiatrists that saw medicaid patients. She was on waiting lists. Low income folks often have to settle for less than ideal circumstances in some areas of the country.
 

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Fuck this is so wrong. No, there is not always a need for parents to participate.

I had medication and therapy as a teen and my parents were definitely not involved. I wouldn't have wanted them to be, particularly as my mother was part of the damn problem.

As a kid, I was referred to a child psychologist who came round to the house when I was home from school at lunchtime. I loitered, expecting him to want to speak to me, but was told to go back to school. As I left, I heard him ask questions like, "Does she have a lot of friends at school?" and my mother said, "Oh yes, she has plenty of friends," which showed how little she knew about me, and how much she was capable of spouting bullshit about things she knew nothing about.

I never heard anything about the psychologist again, so he evidently fell for said bullshit.

Years later I sought help myself and my parents weren't involved in any of it, which is probably why the treatment worked somewhat. Or at least set me on the road o recovery.
I think you misunderstood what I was saying. The parents should be involved so that they can chance their behavior that is causing the child problems. Half the time kids are in therapy because of their parents problems, not because they children have the problems. Kids often act out because of problems in the family, as a way to get help for the family. Don't judge everyone based on that one asshole psychologist. That guy was wrong not to talk to you. When parents don't want therapy for their kids it can be because they don't want "family secrets" revealed. I'm not talking about abuse or anything that bad, though it does apply, but they don't want the input of a professional who might upset the balance and change the way things need to be.
A child therapist has to balance the needs of the child vs. the sometimes fragile egos of the parents, especially because the parents could pull the kids from therapy.
Therapy is confidential, unless kids are a danger to themselves or others. If your mom had come to a session and told me how perfect your life was, that would tell me a lot about her and what you're up against and help me help you with strategies to get your needs met (if she wasn't amenable to seeing what she could do to improve her treatment.)
I'm sorry if I wasn't clear enough.
 
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Any treatment I had (apart from counselling in my early 20s with a particular group) was on the NHS, so you pretty much had to take what you were given, unless you could afford to go private.

I only wish someone had listened to my mother's "Life is perfect," spiel and told her, "Bitch, please. You're not fooling anyone."

Still, she wouldn't have listened, I think. She's one of those "La la la, you will not interfere with my version of reality," people. You know the sort. She'd swear black was white if it suited her (and has done).

Sorry, off-topic. I'll shut up now. :)
 

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I'm so sorry your mom was such a hypocrite. I guess your experience is the downside of universal health care. I would have loved to tell her she wasn't fooling anyone, but calling your clients' parents bitches usually doesn't have positive results for the client ;) or encourage parents to keep their kids in therapy ;) LOL.
 

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Maybe you're not familiar with how difficult getting an appointment with a child psychiatrist is in some areas of the country. Psychiatrists who aren't familiar with working with children often have less experience prescribing for kids than pediatricians. Ideally I'd love my clients to have child psychiatrists, but a good pediatrician who is familiar with psychotropics can be just as good, even if not ideal. I have seen cases where parents medication shop for their kids based on things other parents have used or based on what they've read about and unfortunately I have seen psychiatrists and GPs who will prescribe.
I worked with a kid who's mother had been trying for two years to get an appointment with one of the few child psychiatrists that saw medicaid patients. She was on waiting lists. Low income folks often have to settle for less than ideal circumstances in some areas of the country.

I'm well aware of how difficult it is to get psychiatric help if you're poor. I'm also aware of the difficulties in finding child psychiatrists. That doesn't change the fact that many parents opt for the GP/Ped because they don't want to accept that their kid actually has mental health issues. And GP/Peds do not have the expertise needed (regardless of their knowledge of drugs alone) to really benefit a kid with mental health issues. Just like with oncology, surgery, or any other specialty - they're better than nothing, but not by much.
 

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Why would it be bad to show someone getting help from meds? If anything, I wish more people were open to taking meds. I have ridiculous depression without my antidepressant. I have nearly zero with it. I'm thrilled they make them!

I can't believe all the years I had to wish and dream and scrap to try to figure out what to do about my thoughts. I knew they weren't real, that it was disturbed thinking that was very hard/impossible to turn off. It was so tiring trying to. And the medicine cleared that problem out in weeks. Amazing.

I believe in therapy, definitely. But I can't help but believe the 'physical' component to some psychiatric conditions. Faulty wiring, if you will ;) Meds can really help imbalances. And they won't do a thing if you don't need them, in the sense that they are not 'fun' drugs at all.

I agree that therapy at least as far as diagnosis/treatment is very important, but I'm not even sure that every depressive would need ongoing psychological therapy. It depends on the individual case. (Mine was biochemical, but I needed therapy for reasons other than depression, really. So I had work to do even after the meds did their work).
 

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My husband was actually recently diagnosed with this Dysthmia thing. Nothing changed in his treatment; he just has a different name for his illness. Eh.

In my experience, severe depression has to be treated with medication before you can consider counselling. You have to get the patient to a state where they can engage.
 

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And they won't do a thing if you don't need them, in the sense that they are not 'fun' drugs at all.

Very good point. If you have a fever, aspirin will help. If you're hot because it's a brutal summer day, aspirin isn't going to make you cooler.
In my experience, severe depression has to be treated with medication before you can consider counselling. You have to get the patient to a state where they can engage.
No. This isn't right. While depression might not improve much before medication, severely depressed patients need therapy to monitor for suicidal ideation and the need for hospitalization. Additionally, antidepressants usually take 4-6 weeks before their effects are fully realized and at this time suicide can actually be more likely so therapy is absolutely necessary.
Some people wrongly assume that suicide after beginning medication is because of the medication, but in actuality, sometimes when people start feeling better, they feel "good enough" to act of the suicidal ideation they were previously too depressed to act upon (crazy huh?)