Medication
As you will recall from Chapters 1 and 2, the brain is a magnificent organ. While its chemistry is designed to run smoothly, often there are glitches in the neurotransmitter system. When this happens, an individual can experience all sorts of problems.
The neurotransmitters discovered thus far that regulate emotions and mood are called serotonin, norepinephrine, and dopamine. A decrease in one or all of these can result in depression. Medication serves to jump-start the manufacture of one or more of the neurotransmitters. It goes into the brain and helps to increase the natural production of neurotransmitters back to a level where they belong. Once this is happening properly, depressive symptoms are alleviated and your child's mood should return to normal.
There are three general categories of medications used to treat depression: tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs). You need not understand the chemistry behind them, but you do need to know the jargon so that you'll recognize it when you hear it. Your child's doctor can explain how they work.
Alert!
Warning: Tricyclic antidepressants should not be prescribed to children who have certain heart ailments, seizure disorders, or, at times, if there is a family history of cardiac disease or seizures. This is another good reason to give the physician that is treating your child a complete medical history.
Tricyclic Antidepressants
Tricyclic antidepressants are not used as often as they used to be because of their possible side effects, which will be explored later. These drugs are slow acting, which means that a child will have to take them at least two weeks or more before any lessening of symptoms will be observed or reported. A child will start out with a small dose of the medication to see if he can tolerate it, and over a period of four to six weeks that dosage will be increased and tweaked until the right level for your child is achieved.
Waiting for a tricyclic antidepressant to work can be frustrating for the parent who is anxious for a quick fix. Older children and adolescents will also get impatient, and if they don't immediately begin to feel better will often refuse to take their medicine. Thus it is essential that your doctor explain this to your child and to you so that you will be prepared for a longer wait time.
Tricyclic antidepressants include Elavil (amitriptyline), Norpra-min (desipramine), Pamelor (nortriptyline), Tofranil (imipramine), Sinequan (doxepin), and Anafranil (clomipramine).
The names sound complicated, but you need to know both the brand names and the generic names (the ones in parentheses above) so you can recognize them if the doctor mentions them.
Fact
Sometimes children who are depressed begin wetting the bed after they have already been potty trained. Not only is it frustrating for you, it is embarrassing and shaming for your child. If your child has been having uncharacteristic bedwetting accidents, some of the tricyclic antidepressants, such as desipramine or amitriptyline, can help.
Monoamine Oxidase Inhibitors
Here's another fancy name. Actually, you will hear “MAOIs” more often and it sure is easier to pronounce! While they work faster and work on symptoms that don't respond as well to other medication, this is not usually a physician's first choice of medication for your child's depression for two reasons.
First the side effects, if they occur, are severe. Second, your child has to follow a diet that avoids eating any food that contains tyramine. This is an amino acid found in aged cheeses, bananas, meats, products that have yeast, alcohol, and some over-the-counter medications. Eating these foods while taking MAOIs can cause a heart attack, hypertension, and other serious complications.
MAOIs include Nardil (phenelzine), Parnate (tranylcypromine), Eldepryl (selegiline), and Marplan (isocarboxazid).
Selective Serotonin Reuptake Inhibitors
These are also called SSRIs. Doctors like to prescribe them because of their low risk of side effects. They are also very effective in their treatment of depressive symptoms. This is why they are probably the most widely prescribed antidepressants and the most popular. Parents and their children are more likely to cooperate with an antidepressant that has such a good success rate.
SSRIs include Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertaline), Lexapro (escitalopram oxalate), Celexa (citalopram), and Luvox (fluvoxamine).
Alert!
Do not rely only on the advice of a pharmacist about taking or stopping antidepressants. Check with your physician before starting or discontinuing your child's antidepressant medication. Some medicines require that you taper off of them, while some, if taken in conjunction with certain other antidepressants, can cause life-threatening side effects.
Atypical Medications
These are drugs that work well when other antidepressants don't work or can be used alongside SSRIs. Besides its use in treating bipolar disorder, lithium (lithium carbonate) is used in children, especially those whose parents have taken lithium and had good results. Sometimes it is used with SSRIs when there are symptoms not being alleviated fully by the SSRIs alone.
Other atypical antidepressant medications include Remeron (mirtazapine) and Wellbutrin (bupropion). Cymbalta (duloxetine hydrochloride) and Effexor (venlafaxine) increase the production of serotonin and norepinephrine.
Deciding to allow your child to be treated with medication is a huge decision. The antidepressant medications are not addictive but may cause side effects. If a medication is working, a child will typically stay on it for nine to twelve months. Stopping the medication prematurely increases the risk of relapse. After this time has passed, you can work with the doctor to wean your child off of his medicine to see how he does without it.
