(Sue Scheff) Teen Depression: Try Therapy, Switch Medication

Two-Pronged Approach Helps Adolescents Who Don’t Respond to Initial Antidepressant Alone

By Kathleen Doheny
WebMD Medical News
Reviewed by Louise Chang, MD

Feb. 26, 2008 -- Depressed teens who don't respond well to the first antidepressantmedication they are prescribed do improve if they are switched to a different antidepressant medication and also offered "talk" therapy, according to a new study.

The combination -- switching medications and offering talk therapy -- works better than simply changing medications, the researchers found, although switching medications alone also offers improvement.

"This validates our clinical hunch about what to do with these kids," says study researcher David Brent, MD, professor of psychiatry at the University of Pittsburgh. "Which is, if the medicine isn't working, switch it, and if they aren't getting cognitive behavioral therapy (talk therapy), you should add it."

About 40% of teens with clinical depression don't respond well when treated initially with commonly prescribed antidepressants known as SSRIs (selective serotonin reuptake inhibitors), experts say. How to help these adolescents has been an ongoing challenge. Results of the new study, published in The Journal of the American Medical Association, are expected to offer important guidance.

Depressed Teens Study: Four Options
From 2000 to 2006, researchers from the University of Pittsburgh and five other universities and clinics nationwide evaluated 334 clinically depressed teens, aged 12 to 18, who had not responded to a two-month initial treatment with an SSRI antidepressant. They assigned the teens to one of four groups for 12 weeks.

One group was switched to another SSRI antidepressant, such as Paxil, Celexa, or Prozac. Another group was switched to a different SSRI antidepressant than they took initially, plus given talk therapy. A third group was switched to the antidepressant Effexor, which is known as an SNRI (serotonin and norepinephrine reuptake inhibitor). The fourth group got Effexor plus talk therapy.

Effexor was selected, Brent says, because "at the time we designed the study there were studies in adults that found Effexor was more effective for difficult-to-treat depression." The teens studied had been clinically depressed for two years, Brent says.

Up to 12 sessions of talk therapy were offered during the study, and some sessions included family members.

The researchers evaluated improvements in depression with commonly used scales and interview questions.

Study Results
Teens switched to another medication -- either an SSRI or Effexor -- plus talk therapy improved more than those just switched to another medication. Nearly 55% of those given talk therapy and a new medication showed improvement in their depression, but improvement was seen in just 40.5% of those whose medication was switched but who did not get talk therapy.

No substantial differences were found between the two types of antidepressants. Overall, 47% of those on an SSRI improved while 48.2% of those on Effexor did.

Teens who were also on sleep medications, either prescription or over-the-counter, did not do as well as those not taking such medications, Brent says, but the reason is not clear.

The study was funded by the National Institute of Mental Health.

Message for Depressed Teens
For parents and teens, the advice is clear about what to do if the initial medication doesn't work, says Joan Rosenbaum Asarnow, PhD, professor of psychiatry at the University of California Los Angeles and a study researcher. "They should not only consider switching therapy but consider getting their child into cognitive behavioral therapy," she says. "The real finding here is that combining medication with cognitive behavioral therapy is what makes the difference in outcome."

"The most important advice is don't give up," adds Brent. "Even in the kids who only got a medication switch, 40% of them responded."

'Encouraging' Findings
Other experts not involved in the study say the findings are encouraging for tough cases. The good news is that over time the majority of adolescents can and do respond to a combination of interventions, says David Fassler, MD, a clinical professor of psychiatry at the University of Vermont, Burlington. "The study underscores the importance of altering or modifying treatment based on an ongoing assessment of clinical response."

"This study confirms some things we already know," says Nada Stotland, MD, president-elect of the American Psychiatric Association and professor of psychiatry at Rush Medical College in Chicago. "And that is that many people need to try more than one antidepressant before they find the one that works, and that as a whole, no antidepressant is better than another for a whole population, but for individual persons, one is clearly better than another." The study also confirms the value of talk therapy, she says, which may be enough for mild cases of depression.

Early Dating/Early Sexualy Activity (Can this add to Teen Depression?)

First Comes Love

Will you be ready when your son has his first girlfriend? When your daughter has her first boyfriend? Will you be able to help them with the peer pressure to have sex? Will you be ready to address the warning signs of dating violence?

These are difficult topics for parents and kids to talk about together... First Comes Love helps you start the conversation. The program features real kids sharing their true dating stories – and suddenly the pressure is off of your children as you talk about the kids in the program. That, says experts, opens the door for communication and learning. The program also features advice from health experts and child specialists about the best way to protect children from the “dark side of teenage love.”

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Connect with Kids is a wealth of information for parents. I refer parents to them daily and I am always impressed with their valuable new weekly parenting articles and DVD’s. In today’s world of teenagers - parents need to be a step ahead!

Do you have a struggling teen? At risk teens? Defiant Teen? Teen Depression? Problem Teen? Difficult Teen? Teen Rage? Teen Anger? Teen Drug Use? Teen Gangs? Teen Runaways? Bipolar? ADD/ADHD? Disrespectful Teen? Out of Control Teen? Peer Pressure?

Find about more about Boarding Schools, Military Schools, Christian Boarding Schools, Residential Treatment Centers, and Therapeutic Boarding Schools.

Sue Scheff: Teaching Empathy in School by Connect with Kids

“Students come out the other side not only with a better education in the subject areas, but they are better citizens.”

– Paul Weimer, director, Character Education Partnership

The No Child Left Behind federal act has many students spending the majority of their day reading, writing and practicing math. However, a new study finds that character education, anti-bullying efforts and lessons in respecting and empathizing with others can actually raise children’s test scores.

“Most of my lessons of character and respect … I learned at home from my mom and my dad,” says Maceo, 13.

But now some schools are teaching lessons about empathy, cooperation and caring about others.

“Okay, what is kindness?” asks a teacher to her student.

Researchers at the University of Illinois analyzed the findings of more than 200 studies. They found that when schools help kids learn to manage their emotions and practice empathy and caring, both their behavior and their grades improve.

“Students come out the other side not only with a better education in the subject areas, but they are better citizens,” says Paul Weimer, director, Character Education Partnership.

But some students say you don’t learn emotional skills with a lecture.

“If they just force us to sit here and understand, it’s going to be sort of hard,” says Susan, 13.

Instead, experts say character skills and emotional growth come with practice.

In one outreach program, high school students spend time with younger kids who need a little help.

“It’s a chance for kids to show that there is character there, ” says Mik, 17.

“What we’re hoping is by making this prevalent in our curriculum, by infusing it into the curriculum and mentioning these words again and again, that our students will hear this, internalize it and they will in turn do these things automatically,” says Nancy Zarovsky, teacher.

Experts say that while character education at school is always helpful, it is considerably less effective if the child’s family and community don’t teach or support those same values.

Tips for Parents

To teach these lessons, we must make the issues of care, connection and civic action part of the core curriculum and school culture. We must look thoughtfully at the ways young people see society operating and help them develop a larger sense of meaning for their lives. (AASA)

Whether we’re feeling empathy when a loved one endures pain, or feeling relief from pain due to a placebo, pain-sensitive regions of our brains are at work — either creating or diminishing the experience of human pain. (MSNBC)

“The ability to “tune in” and empathize with others is a prerequisite for understanding, attachment, bonding and love — all of which are important for our survival,” says Tania Singer, Department of Imaging Neuroscience at University College, London.

Social understanding and social responsibility build on children's desire to understand and feel effective in the social world, to maintain connection with others and to reach out to those in distress. (American Association of School Administrators, AASA)

References

MSNBC
Tania Singer, Department of Imaging Neuroscience at University College, London
American Association of School Administrators (AASA)

Sue Scheff: Troubled Teenagers? See How the Teenage Mind Works

The Teenage Brain

Are you dealing with the emotional rollercoaster of raising a teenager? Teens are impulsive, stubborn and moody. A troubled teenager will yell at you one minute and hug you the next. What’s a parent to do?

Get The Teenage Brain and see the latest research to help you understand defiant teenagers and how their mind actually works. You’ll improve your parenting skills and learn how to influence troubled teenagers and how to better communicate with them.
Find out what makes defiant teenagers tick.

New research shows that there are clear-cut, physical differences between an adult’s brain and a teenager’s brain – differences that explain typical “teen behavior.” The Teenage Brain is a compelling video program that gives families with troubled teenagers hope while providing the latest facts, tips from experts, advice from health practitioners, stories from teens themselves and much more.

When it comes to teenagers, you can never have enough parenting skills.

If you have teens, part of your job is to develop their mind. New research shows that you can actually shape the structure of your child’s brain – so shouldn’t you understand how troubled teenagers' or defiant teenagers' brains work? Now you can.

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Connect with Kids is a wealth of information for parents. I refer parents to them daily and I am always impressed with their valuable new weekly parenting articles and DVD’s. In today’s world of teenagers - parents need to be a step ahead!

Do you have a struggling teen? At risk teens? Defiant Teen? Teen Depression? Problem Teen? Difficult Teen? Teen Rage? Teen Anger? Teen Drug Use? Teen Gangs? Teen Runaways? Bipolar? ADD/ADHD? Disrespectful Teen? Out of Control Teen? Peer Pressure?

Find about more about Boarding Schools, Military Schools, Christian Boarding Schools, Residential Treatment Centers, and Therapeutic Boarding Schools.

Parents Universal Resource Experts: Anxious Teens and Depressed Teens by Connect with Kids

Leave Me Alone!

We all know teenagers can be moody, impulsive and irritable – but how can parents tell if the tears will go away or if they’re a sign of something more? When your teen slams the door and shouts “Leave me alone!” – should you? Will your child be safe? Or are there signs of depression, anxiety, even suicidal thoughts?

Every parent needs to know the warning signs – when life feels too heavy or too scary for your son or daughter to handle alone. Every parent needs to know what treatments are available and what works with kids.

Every parent needs to watch Leave Me Alone!

You’ll hear actual teenagers talk about their struggles, giving you insight into what your own child may be feeling.

You’ll learn practical parenting advice from child experts about what you can do to help your teen face the fears and alleviate the pain.

And you’ll hear the inspiration and hope of families whose children are living happier, healthier lives.

Do you have a struggling teen? At risk teens? Defiant Teen? Teen Depression? Problem Teen? Difficult Teen? Teen Rage? Teen Anger? Teen Drug Use? Teen Gangs? Teen Runaways? Bipolar? ADD/ADHD? Disrespectful Teen? Out of Control Teen? Peer Pressure?

Find about more about Boarding Schools, Military Schools, Christian Boarding Schools, Residential Treatment Centers, and Therapeutic Boarding Schools.

Sue Scheff: Teenagers Cutting Themselves by Connect with Kids

The Enemy Inside

It's hard to understand teenagers cutting themselves, but kids do deliberately burn, scratch and cut themselves until they bleed. Even the kids involved with teenage cutting can’t tell you why it makes them feel better... at least for the moment. They can tell you that it’s addictive and scary.

“Cutting” is the most popular form of self-injury today, and it is on the rise among adolescents. Teenagers cutting themselves is a sign of emotional pain but it can also lead to major physical injury... and even death in some cases. The addictive nature of this condition allows it to spin quickly out of control.

How can you help prevent teenage cutting?

The first step is communication, but talking about teenage cutting isn’t easy.

The Enemy Inside can help. Compelling true stories from kids who struggle with self-injury will help explain why kids do it, why they want to stop – and so often why they can’t. You’ll also hear expert advice for parents, teachers and counselors, on how to help prevent this kind of self-harm cutting and how to suggest healthier alternatives.

Order your copy of The Enemy Inside to learn what you need to know about teenagers cutting themselves and to see why Connect with Kids programs have been shown to improve youth behavior and increase communication between parents and children.

Do you have a struggling teen? At risk teens? Defiant Teen? Teen Depression? Problem Teen? Difficult Teen? Teen Rage? Teen Anger? Teen Drug Use? Teen Gangs? Teen Runaways? Bipolar? ADD/ADHD? Disrespectful Teen? Out of Control Teen? Peer Pressure?

Find about more about Boarding Schools, Military Schools, Christian Boarding Schools, Residential Treatment Centers, and Therapeutic Boarding Schools.

Loving your kids is easy; Parenting teenagers is hard.

Parents today face very real and sometimes frightening concerns about their children’s lives. As they get older, your kids have their own interests, problems, even their own language. So what's the key to parenting?

You could buy a book…but your child probably won’t read it. You could search the Internet for advice, and ask other parents. Those are good options, but there's one that's even better for parenting teenagers: reality-based DVDs for kids and parents to watch and learn together. Parents don’t typically think of buying a DVD to help them with the issues their children or a problem teenager faces, but this is powerful positive television programming produced by the Emmy® award-winning Connect With Kids team.

Build Your Own Library

We have a complete library of half-hour programs devoted to parenting teenagers and kids, all related to social, emotional and physical health. These aren’t lectures or scare tactics strictly about how to deal with a problem teenager; they’re true stories of real kids facing issues like drugs, drinking, STDs, obesity, racism, peer pressure, body image, bullying, and more.

These powerful stories are unscripted, unrehearsed and told in kids’ own words, so your children will easily relate to them without feeling defensive, embarrassed, pressured or talked down to. The kids' stories are supported with interviews and advice from leading child specialists, health experts, educators and counselors.

Watching together is a great way to start talking with your kids. Each 30-minute video is only $19.95, and comes with a Viewing Guide with facts, suggested conversation starters and professional advice. To order, visit our products page.

As a Parent Advocate, Connect with Kids offers a great number of informational articles, DVD's, video's and more to help parents understand today's kids.

Do you have a struggling teen? At risk teens? Defiant Teen? Teen Depression? Problem Teen? Difficult Teen? Teen Rage? Teen Anger? Teen Drug Use? Teen Gangs? Teen Runaways? Bipolar? ADD/ADHD? Disrespectful Teen? Out of Control Teen? Peer Pressure?

Find about more about Boarding Schools, Military Schools, Christian Boarding Schools, Residential Treatment Centers, and Therapeutic Boarding Schools.

Sue Scheff: Teen Stress by Connect with Kids

“Depression and anxiety are closely related. And so you can have kids that stop wanting to be involved in things and they spend more and more time in their room and less and less time out playing, cultivating friends -- those are all warning signs.”

– Dr. Nancy McGarrah, Ph.D., psychologist

Who is more stressed out: a parent who has to work hard to pay the bills and raise a family, or a teenager who has to go to school and learn? You may have correctly guessed the answer; still, to some it may come as a surprise.

Recent polls report that 75 percent of adults are stressed or worried about money, family troubles and problems with their boss. But there is a group even more stressed out: kids.

“You know everyone talks about stress and there is a lot of stress,” says Marcus, 16.

“Something you’re always going to have to deal with; it’s never going to go away,” says Andrew, 17.

According to a new Associated Press/MTV poll, 85 percent of teens say they feel stressed. Almost half the boys and a third of the girls say the pressure is there almost every day. Their biggest worry is school.

“Sometimes it’s going to be really stressful because you’re going to get down to the end one night and you’ve got a test the next day and a paper due but you know you have to do it,” says C.T., 17.

Experts say a little stress can energize and motivate a child, but too much has another name: anxiety. And that can be de-motivating.

“Depression and anxiety are closely related. And so you can have kids that stop wanting to be involved in things and they spend more and more time in their room and less and less time out playing, cultivating friends -- those are all warning signs,” says Dr. Nancy McGarrah, Ph.D., psychologist.

Experts say parents can help by offering a careful balance of expectations.

“The most important thing is that you don’t underestimate nor do you overestimate your expectations of your child’s performance,” says Dr. Sherwood Smith, Ph.D., psychologist.

Which is no easy task for parents, he says. Still, his next advice may be a little easier.

“Let your child know that regardless of their level of success, you love and you value that child,” says Smith.

According to the poll, school and studies was ranked the number one stressor by a third of all teens. Fourteen percent said their job was number one; 11 percent said family caused the most amount of stress in their life.

Tips for Parents

Pressure that is too intense or lasts too long, or troubles that are shouldered alone, can cause people to feel stress overload. Here are some of the things that can overwhelm the body's ability to cope if they continue for a long time: (Nemours Foundation)

Being bullied or exposed to violence or injury

Relationship stress, family conflicts, or the heavy emotions that can accompany a broken heart or the death of a loved one

Ongoing problems with schoolwork related to a learning disability or other problems, such as ADHD (usually once the problem is recognized and the person is given the right learning support the stress disappears)

Crammed schedules, not having enough time to rest and relax, and always being on the go

The most helpful method of dealing with stress is learning how to manage the stress that comes with any new challenge, good or bad. Stress-management skills work best when they're used regularly, not just when the pressure's on. (Nemours Foundation)
Knowing how to "de-stress" and doing it when things are relatively calm can help you get through challenging circumstances that may arise. Here are some things that can help keep stress under control: (Nemours Foundation)

Take a stand against over-scheduling. If you're feeling stretched, consider cutting out an activity or two, opting for just the ones that are most important to you.
Be realistic. Don't try to be perfect -- no one is. Expecting others to be perfect can add to your stress level, too (not to mention put a lot of pressure on them!) If you need help with something, such as schoolwork, ask for it.

Get a good night's sleep. Getting enough sleep helps keep your body and mind in top shape, making you better equipped to deal with any negative stressors. Because the biological "sleep clock" shifts during adolescence, many teens prefer staying up a little later at night and sleeping a little later in the morning. But if you stay up late and still need to get up early for school, you may not get all the hours of sleep you need.

Learn to relax. The body's natural antidote to stress is called the relaxation response. It's your body's opposite of stress, and it creates a sense of well-being and calm. The chemical benefits of the relaxation response can be activated simply by relaxing. You can help trigger the relaxation response by learning simple breathing exercises and then using them when you're caught up in stressful situations.

Treat your body well. Experts agree that getting regular exercise helps people manage stress. (Excessive or compulsive exercise can contribute to stress, though, so as in all things, use moderation.) Eat well to help your body get the right fuel to function at its best. It's easy when you're stressed out to eat on the run or eat junk food or fast food. But under stressful conditions, the body needs its vitamins and minerals more than ever.

References
Nemours Foundation

Sue Scheff: Child Depression and Adolescent Depression

by National Institute of Mental Health
December 6, 2007

Depression in Children and Adolescents

Depression is a very real and serious problem for both children and teens.

Research has shown that childhood depression often persists, recurs and continues into adulthood, especially if it goes untreated. The presence of childhood depression also tends to be a predictor of more severe illnesses in adulthood.

A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to accurately diagnose a young person with depression.

Before puberty, boys and girls are equally likely to develop depressive disorders. By age 15, however, girls are twice as likely as boys to have experienced a major depressive episode.23

Depression in adolescence comes at a time of great personal change–when boys and girls are forming an identity distinct from their parents, grappling with gender issues and emerging sexuality, and making decisions for the first time in their lives. Depression in adolescence frequently co–occurs with other disorders such as anxiety, disruptive behavior, eating disorders or substance abuse. It can also lead to increased risk for suicide.

One research study of 439 adolescents with major depression found that a combination of medication and psychotherapy was the most effective treatment option. Researchers are developing and testing ways to prevent suicide in children and adolescents, including early diagnosis and treatment, and a better understanding of suicidal thinking.

Sue Scheff: Teen Depression Risk Factors by DepressionReport.info

Teen Depression Risk Factors

There are a number of factors that put a teen at a higher risk for developing depression. Many of these risk factor are red flags for parents, friends, and loved ones to watch out for in a teenager. These factors include:



Experiencing problems or difficulty at school.

Going through a traumatic event. Examples include parents who get divorced, abusive parents, the death of a loved one, or a break up with a boyfriend or girlfriend.

Weight loss or weight gain.

Difficulty dealing with anger.

Developing an interest in violence or a becoming increasingly fearful of violence.

Difficulty sleeping.

Developing an interest in drugs or alcohol.


Teenage depression is the leading cause of teenage suicide. Yet, approximately 80% of teenagers thinking of suicide leave clues. Through careful observation and an understanding of the risk factors of teenage depression, many of these suicides can be prevented.


Causes of Teenage Depression

Teenage depression is largely caused by stress. During the adolescent years, a person undergoes a number of emotional, physical, and mental changes. First of all, hormones start raging and bring with them a plethora of confusing emotions. In addition, teenagers often feel a great deal of pressure from their parents and from teachers to do well in school and to participate in athletics. Furthermore, peer pressure and an overwhelming desire to do whatever it takes to fit in with their peers causes teenagers a great deal of stress.

The stress teenagers feel can result in anger, nervousness, and an inability to concentrate. It can also lead to physical symptoms such as nausea and headaches. Ultimately, the stress can cause social withdraw and depression.


Preventing Teenage Depression

Thankfully, there are several steps a parent can take to prevent teenage depression from setting in on their child.

The first is to always utilize positive disciplinary techniques. Desirable behaviors should be reinforced through praise and recognition rather than utilizing punishment and shame techniques. Punishment and shaming only serves to leave the teenager feeling worthless and inadequate.

At the same time, parents must be careful not to overprotect or to overdirect their teenagers. Children and young adults need to make mistakes and learn from those mistakes.

Protecting your teen from experiencing mistakes, or continually telling your child what to do rather than letting him or her make independent decisions, will ultimately make them feel as if you have know faith in his or her ability to make decisions.

It is also important to never push your teen to participate in certain activities because you want him or her to reach your unachieved goals. Your child needs to find his or her own sense of identity and worth.