Antidepressants at College (page 2)

By — John Wiley & Sons, Inc.
Updated on Aug 25, 2011

Should Your Child Use?

Now, let's get to the key question for you: When you are considering an antidepressant trial with your child, what are the things to weigh and how do you decide whether or not to try the medication? As with most decisions in life, it is important to weigh the risks and potential benefits.

How do you know if someone has a "biologic" depression that will respond to medication? Or if that person would respond better to psychotherapy? There are no simple answers to these questions. There is a lot of current research looking at chemical changes in the body, and I think most of us hope that someday there will be a blood test to tell us whether someone is clinically depressed and which neurotransmitter is abnormal, guiding us to medication choice. But we aren't there yet.

There is also bias on the part of providers toward or against prescribing medication for depression based on training and background. If you're a hammer, everything looks like a nail. Some prescribers have a very biologic orientation and recommend medication as part of most treatments. If your school of choice has limited prescribing ability or the counseling staff has a developmental background and approach, they believe that most things are developmental and psychotherapy is the solution. As usual, the truth lies somewhere in between. Most prescribers ask about "vegetative" signs of depression, and if several symptoms are persistent over at least two to four weeks, depending on severity, medication and psychotherapy combined might be the answer.

Some of these signs include:

  • Changes in sleep patterns: insomnia, waking through the night, early morning waking or lethargy in the morning
  • Changes in appetite: either increases or decreases
  • Concentration problems
  • Decreased energy
  • Loss of interest in usual activities that used to be ­ enjoyable
  • Social withdrawal
  • Loss of self-esteem
  • Feelings of hopelessness or despair
  • Irritability: little day-to-day frustrations getting to you that didn't before
  • Seeing the negative side of everything: "The glass is always half empty"
  • No external reasons (such as losses, disappointments, and so on) for these symptoms
  • Significant family history of depression or alcoholism

There is no hard and fast rule here, and many of us trained in psychotherapy and prescribing feel that a trial of psychotherapy is usually the first course of treatment. But because medications take three to six weeks to work, if students are way behind academically, feeling overwhelmed, and have a significant number of symptoms, sometimes medication and psychotherapy are started simultaneously, especially when speed of response is paramount.

I have seen many students over the years who were resistant in principle to medication and had a number of other issues that we worked on in psychotherapy. They eventually decided to try medication because their symptoms persisted, and it was not unusual that after a month or two, the student would say, "You know this medication has made a huge difference for me, and although I enjoy talking with you about these other issues, I feel like myself again. I'd rather be out with friends and come to see you when needed for refills." I'm not implying that psychotherapy isn't valuable, but biology is sometimes 70 to 80 percent of the problem.

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