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Better Safe Than Sorry
Hallucinations, manic episodes, suicidal tendencies, panic attacks, and night terrors: teens live daily in this devastating reality due to inadequate prescription of psyche-altering drugs. The negative long term effects of antidepressants on adolescent lives are irreversible and must not be taken lightly when it comes to the process of prescribing these types of medicines. It is difficult to decide whether the risks of antidepressants outweigh the benefits, or the other way around. These detrimental life altering challenges are avoidable. Decreasing potential risks ensures that the benefits of antidepressants outweigh the risks; developing a personalized basis for prescription of antidepressants specific to teens is imperative due to adverse effects on a developing brain, dependence and addiction, and individualized cases.
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A precise prescription process of antidepressants for teens is an absolutely necessity for ensuring the utmost safety of today’s developing brains. The stage of human life, adolescence, comes with constant developing brains that are easily impaired. The risks are not side effects that are temporarily tolerable. A conclusive statement, stemming from a review of research by the Agency for Healthcare Research and Quality, describes how all antidepressant medications work “about as well as each other” to improve symptoms of depression and to prevent those symptoms from reoccurring (Mental Health Medications.). Additionally, some individuals respond better to certain antidepressant medications than others, for reasons not yet well understood. Therefore, it is rare for the first antidepressant medication prescribed to function effectively with tolerable side effects. It is common for teens to be tapered on and off of multiple psyche-altering drugs. Not to mention, these teens are still expected to function properly in their everyday lives. SSRI’s, a class of antidepressants, function is to inhibit the activation of serotonin by blocking its reuptake through presynaptic neuron endings (“Selective serotonin reuptake inhibitors (SSRIs). The unknown effects of SSRI’s are a dangerous potential risk that is being taken when the drug enters a developing body. Serotonin is a chemical that sends signals between individual nerve cells. SSRI’s are the first and most commonly prescribed serotonin reuptake inhibitor indicated for acute maintenance treatment of Major Depressive Disorder. There are immediate effects associated with the class of antidepressants, SSRI’s, such as Serotonin syndrome, which is potentially fatal. Serotonin syndrome is caused due to the build up of too much serotonin in the brain. This serious syndrome leads to symptoms of: high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea (Food and Drug Administration). Serotonin syndrome is life-threatening, and the risk increases with simultaneous use of other drugs that impair metabolism of serotonin including: triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines (Selective serotonin reuptake inhibitors (SSRIs). In April 2005, the European Medicines Agency issued a warning regarding the increased risk of suicidal behaviors in adolescents; the warnings were specific to the antidepressant classes: SSRI’s and SNRIs (Effects of the Committee on Safety of Medicines advice on antidepressant prescription to children and adolescents in the UK. SNRI’s are a class of antidepressant medication similar to SSRI’s. However, SNRI’s affect norepinephrine, as well as serotonin. Often times, if SSRI’s are not effectively treating the patient, the next class of medication prescribed is SNRI’s.
Additionally, an immediate side effect, decreased appetite and weight loss, is a sensitive and serious risk. Teens with eating disorders who are treated with SSRI’s are placed in an extremely risky situation due to these effects that progress into dependence. Treatment of a drug that decreases appetite and causes weight loss forces teens with eating disorders to develop a entirely different attachment to this kind of medicine. Furthermore, the counterpart is that when teens with eating disorders are being treated with an SSRI that causes weight gain, the eating disorder also progresses. Consequently, teen patients must be monitored regularly for weight and growth fluctuations, in addition to eating disorder behaviors.
Drug dependence and addiction are a trap easily fallen into by way of careless treatment of psyche-altering medication in teens, which often leads to suicidal behaviors, a serious side-effect that must be accounted for during the prescription process of antidepressants. All antidepressants do have a black box warning stating the potential risk of suicidal thoughts and behaviors during the medication treatment in children and adolescents. But how often do you read the labels on the back of all your prescriptions? I know I did not. During the treatment process, the pediatric population puts its full trust into their parents and psychiatrists. The highest risk of suicidal thinking and behavior occurs during the first few months of treatment with an antidepressant, and when the dosage is increased or decreased. The Food and Drug Administration’s conclusive statement reads, “The analysis showed a greater risk of suicidality during the first few months of treatment in those receiving antidepressants” (Food and Drug Administration). The recommendation by the Food and Drug Administration is based on a review of twenty-four placebo-controlled trials ranging from 4 to 16 weeks and involving nine antidepressant drugs. In total, 4,100 subjects were included in the pediatric trials of SSRI’s (Asarnow). Alcohol and drug use is overwhelmingly present in the society of teens today. I know I failed to check the warning labels before extensive substance abuse. Consequently, drug dependence and addiction are two detrimental lifelong effects of antidepressants on teen lives. Not to mention the greater likelihood of overdose, a deadly situation caused by a toxic amount of a substance in a teen’s system. Drugs and alcohol are not only a social norm, but a main coping mechanism of many of today’s teens. Walking in blind to a lifelong dependence on psyche-altering drug are a common situation that many teens are unknowingly in. Contrary to the advertisements of pharmaceutical companies, the treatment of antidepressant medications is not temporary. The physical and emotional dependence developed to this type of medicine is lifelong. Tapering off of an antidepressant is not only dangerous, but a circumstance that many teens within treatment are not capable of going through. Drug addiction is serious, despite it stemming from a psychiatry prescription or drug dealer.
The harshness of these effects are detrimental to the individual lives of today’s teens, including myself. In 2003 a safety commission in the United Kingdom reviewed results from antidepressant drug trials and concluded that Venlafaxine (Effexor) should not be used for depression treatment in children ages 6 to 17 due to the lack of demonstrated efficacy in treating depressive illness and a risk of harmful outcomes, such as hostility and suicidal ideation (Vitiello & Swedo 2004). This happens to be the same drug that I take everyday at the age of 16 to treat my Major Depressive disorder. In 2004 the U.K. warning was broadened to include other SSRIs. (Effects of the Committee on Safety of Medicines advice on antidepressant prescribing to children and adolescents in the UK) Similarly, at this time in October of 2004, the United States Food and Drug Administration issued a black box warning for inclusion in all antidepressants, stating that the drugs increase the risk of suicidal thinking and behaviors in studies of children with major depressive and other psychiatric disorders.
Selective serotonin reuptake inhibitors (SSRIs) remain a staple treatment of depression s in adolescents. The full extent of impacts induced by the use of SSRIs on the developing adolescent brain, however, remains unestablished. An individual drug within this class of medicine is Paroxetine; more commonly known as Paxil. The U.S. Food and Drug Administration (FDA) is an advocate source against the prescription of Paroxetine (Paxil) to the teen population due to effectiveness and safety concerns. The Department of Psychiatry and Human Behavior at Brown University School of Medicine, reported from placebo-controlled clinical trials conducted with pediatric patients, ample adverse effects in at least 2% of teen patients treated. (A Leader in Mental and Behavioral Health Research) The specific negative data collected with this clinical trial consisted of emotional lability, self- harm, suicidal thoughts, attempted suicide, crying, mood fluctuation, hostility, decreased appetite, tremor, sweating, hyperkinesia, and agitation (A Leader in Mental and Behavioral Health Research)Animal studies have predominantly been used to investigate the effects of fluoxetine on the adolescent brain. One study indicated that the administration of fluoxetine stimulated cell proliferation in the hippocampus of adult rats, but not in adolescents (the Department of Psychiatry and Human Behavior at Brown University School of Medicine). Another study of rats that were treated with fluoxetine throughout adolescence found that the treatment group had long-term deficits in object recognition and spatial memory (the Department of Psychiatry and Human Behavior at Brown University School of Medicine). Although these animal studies suggest that the SSRI fluoxetine (Prozac) could be ineffective or, at worst, detrimental to adolescent brain development, the review authors of the the Department of Psychiatry and Human Behavior at Brown University School of Medicine advise exercising caution to such assertion. (A Leader in Mental and Behavioral Health Research)
Dr. Sara Markowitz of Rutgers University explains how anyone considering the use of Paxil in a teen must balance the potential risks with the clinical need (Antidepressants and Youth: Healing or Harmful?). Another example of a specified antidepressant of its own class, Cymbalta, has many lethal adverse effects as well. This drug has been warned against being prescribed to patients with substantial alcohol use or evidence of chronic liver disease (Food and Drug Administration). The severity of these risks should not be taken lightly. Liver dysfunction is another serious risk with extensive severity. Hepatic failure which can also be fatal, has been reported in patients treated with Cymbalta (Food and Drug Administration). Additionally, patients have been reported to develop jaundice and clinically significant liver dysfunction. For teens, this means an extensively severe lifelong lifelong challenges as well. Drug interactions during treatment are also a very serious concern, if not carefully prescribed. Interactions between drugs, for example paroxetine and tryptophan, have been known to occur when coadministered( fda.gov). Adverse issues such as: primarily of headaches, nausea, sweating, and dizziness, have been commonly reported due to tryptophan being administered to patients already being treated with Paroxetine (Paxil) (Food and Drug Administration ). The Committee on Safety of Medicines in the United Kingdom analyzed SSRI’s, and then considered the risk/benefit ratio of the antidepressant: Fluoxetine (Prozac) (Effects of the Committee on Safety of Medicines advice on antidepressant prescribing to children and adolescents in the UK). This individual drug was the only SSRI approved by the FDA for the treatment of depression in children eight to 17 years of age (fda.gov). The Food and Drug administration has since approved Fluoxetine (Prozac) escitalopram for children ages eight plus, and Escitalopram (Lexapro) for children twelve plus. Therefore, these three drugs may be considered for the treatment of moderate to severe depression in the pediatric population (fda.gov).
The Centers for Disease Control and Prevention reported drastic increase in the suicide rates of ten to twenty-nine year-olds (Suicide Rates for Teens Aged 15–19 Years). Reasonably so, a significant drop in antidepressant prescriptions for teens followed the recent statement releases. However seemingly unnecessary per situation, extreme precautions need to be taken invariably. In Restoring Study 329, researchers re-analyzed this data, Upon this second look, researchers found that Paroxetine (Paxil) lead to clinically significant increases in suicidal thoughts or behavior in the pediatric population.
A 2015 Swedish study of their entire population ages fifteen plus, reported that 11,225 out of 856,493 (1.3%) teens and adults taking SSRIs were convicted of a violent crime. 40,384 out of 7.1 million individuals (0.6%) of the same age not taking SSRIs were convicted of a violent crime. The risk of being convicted of a violent crime was the highest among the youngest age group: 3.3% of SSRI patients between the ages of 15 and 24 years old were convicted of a violent crime. (PLOS). As antidepressants became more commonly prescribed for acute Major Depressive Disorder, the reports of patients’ experiencing severe suicidal thoughts and actions have become extremely concerning to all individuals involved in antidepressant medication treatment. This raises the question of the safety of these medications. Researchers found evidence that individuals taking antidepressant medication may be at even higher risk of suicide than individuals whose depression is easing for therapeutic treatment. Studies showed that children and adolescents taking antidepressants were almost twice as likely to have suicidal thoughts or to attempt suicide. When initiating an antidepressant in a child or adolescent, clinicians should have an open discussion with patients and their caregivers, remaining transparent about the potential risks of treatment, including; specific target symptoms, and potential harms including emotional and behavioral adverse effects. Given that the expected effectiveness of antidepressants are not immindiate, physiatrists rarely need to prescribe an antidepressant on the first appointment. Careful follow-up is necessary, and if medication is prescribed, telephone contact regarding any potential concerns must be offered. The seriousness behind the issue of safety and effectiveness in the pediatric population of antidepressant is that a standard prescription process has not yet been thoroughly established. Major Depressive disorder is a significant problem worldwide. Furthermore, the highest incident risk time period is during adolescence (Antidepressants and Youth: Healing or Harmful?). A depressive illness during teen years is associated with negative long-term consequences that include:suicide, additional psychiatric comorbidity, interpersonal relationship problems, poor educational performance and poor employment attainment well into adult life (Antidepressants and Youth: Healing or Harmful?).
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Coming off of an antidepressant is just as dangerous as beginning administration of the drug. Due to the metabolism of these antidepressants over time, dosage is often increased regularly to achieve maximum effectiveness. Antidepressants must not be abruptly stopped. During treatment, the brain’s current dependence on the antidepressant medication is serious. Withdrawals and return of intense depressive symptoms. Whatever struggles the pediatric patient was previously enduring, they will not only return, but will be magnified if an antidepressant is abruptly stopped or changed.
Medical judgement is used by psychiatrists during the prescription process of anti-
depressants for teens, but how much trust is being put into the hands of these specialized doctors? Based on personal experience and observation, a teen patient is not in the psychiatrist’s office for more than 10 minutes before being prescribed a potentially dangerous drug. A devastating personal story by an anonymous writer shared how a psychiatrist “Endangered Their Life and Were Afraid to Speak out”. This eighteen year old had been recommended by their therapist to begin seeking medicative treatment. The unempathetic medical professional asked all of the wrong questions: “Why are you depressed?” and “Why would you see a psychiatrist if you are getting good grades?”(A Psychiatrist Endangered My Life and I Was Afraid to Speak Out). The shame that this teen endured for being accused of “overreacting” is incomprehensible. The rude and neglective psychiatrist asked no questions about the teen patients past before asking, “What kind of pills do you want?” The teen had only heard of the antidepressant medication, Fluoxetine (Prozac), and the trusted medical professional wrote the teen a prescription for Fluoxetine (Prozac) without any information about the patient or their past, then told them to leave. These are people who receive immense trust of developing brains, and this professional failed their teen patient. Due to this inadequate prescription, the teen patient immediately began experiencing side effects such as: “ rapid cycling, volatile mood swings, vivid suicidal ideation, mania like [they had ever] seen before, complete breaks from reality, and [They] scared everyone around [them]” (A Psychiatrist Endangered My Life and I Was Afraid to Speak Out). In urgency to relieve these horrible side effects, the teen patient called the psychiatrist multiple times and left voicemails. The medical professional never returned the patient’s calls. Helpless, in a dangerous situation the teen was left vulnerable and distraught. The heartbreaking story of this eighteen year old, is sadly only one of many. These psychiatry horror stories are not rare and must not be tolerated.
Waking up drenched in sweat from night terrors, constant paranoia, progressive eating disorder behaviors, intense suicidal tendencies, and substance abuse were only a few of the challenges in my everyday routine. Going through 5 alterations of medications treating my Major Depressive Disorder in a span of 4 months took a massive toll on my body and mind. These deteriorating effects of antidepressants are an intolerable norm in current or future teens’ lives. Fragile developing brains must not be carelessly chemically altered by trusted psychiatrists. I will never forget laying on a hospital bed, admitted for suicide watch, while an insensitive nurse told me, “You’re too pretty to be depressed.” I did not have it in me to respond to that invalidating comment at the time. I sat quietly and shrugged; it was not a compliment. She left the room, clueless to the impact she made on me that night. Adults are often unaware of the influence they have on teens in a medicative treatment process. Consequently, a larger responsibility falls onto the parents of the treated youth. Extensive research and understanding needs to be done about these serious medications; before allowing psyche-altering medications to be administered to their child, parents must do their homework. If all adults involved were enlightened to the dangers of antidepressant medications, their devastating effects upon adolescents could be avoided. Evidently, responsibility is intended for all parties involved in medicative treatment of teens. In addition, detrimental effects of antidepressant medication treatment must be avoided by improving the physical process of prescription. Something as simple as devoted time and genuine care by a psychiatrist will prevent severe long term effects. Fragile developing brains must not be altered without proper understanding of each individual teen patient’s past and vulnerabilities to potential risks. It is not inherent to endure a challenging life that includes constant side effects such as: hallucinations, manic episodes, suicidal tendencies, panic attacks, and night terrors. These easily avoidable effects cause immense pain in teen lives everyday when affected by the careless prescription of psyche-altering drugs.
“A Leader in Mental and Behavioral Health Research.” Duke Clinical Research Institute, Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA, psychiatry.duke.edu/research.
- Asarnow, Joan Rosenbaum, “Effectiveness of a Quality Improvement Intervention for Adolescent Depression in Primary Care Clinic, sA Randomized Controlled Trial” Jama, PhD, UCLA Neuropsychiatric Institute, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024-17592005;293(3):311-319, doi:10.1001/jama.293.3.311, January 19, 2005, https://jamanetwork.com/journals/jama/fullarticle/200194.
- Birmaher B et. al. “Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders.” US National Library of MedicineNational Institutes of Health, Journal of the American cademy of Child and Adolescent Psychiatry. 1998;37:1234-8, https://www.ncbi.nlm.nih.gov/pubmed/10075518.
- Curtin, Sally C “Suicide Rates for Teens Aged 15–19 Years, by Sex — United States, 1975–2015.” Centers for Disease Control and Prevention, MA, 301-458-4142, August 3, 2017, https://www.cdc.gov/mmwr/volumes/66/wr/mm6630a6.htm?s_cid=mm6630a6_w&c_cid=journal_search_promotion_2018.
- Elbogen, Eric B. “The Intricate Link Between Violence and Mental Disorders.” Arch Gen Psychiatry, Forensic Psychiatry Program and Clinic,, CB 7160, Chapel Hill, NC 27599, Johnson JG et. al 2002;59:741-9. 2003;42:386-405, April 4, 2008; final revision received June 21, 2008; accepted July 21,2008, jamanetwork.com/journals/jamapsychiatry/fullarticle/210191.
- Finch, Sam Dylan “A Psychiatrist Endangered My Life and I Was Afraid to Speak Out” May 31, 2015, https://letsqueerthingsup.com/2015/05/31/a-psychiatrist-endangered-my-life-and-i-was-afrai
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