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BEYOND WARNING LABELS Experts say monitoring is key for youth on antidepressants, other medication Shauna Murphy thinks it's a smart idea to put warning labels on antidepressants. She has good reason. Nine years ago, at age 10, she was put on a particular brand of the medication and, shortly after, tried to kill herself. It's the kind of outcome that has prompted the Food and Drug Administration to begin work on writing “black box” warnings — the strongest caution possible — for young people who take antidepressants. Some parents have already taken their children off the drugs. But even with the troubles they've had, Murphy and her parents are not speaking out against antidepressants. Instead, they are among a number of families, doctors and mental health groups who — worried the warning labels might stop some people from seeking treatment — are taking the opportunity to encourage families to get help for young people with depression and other mental health issues. They are particularly focused on teaching parents to monitor their children and figure out which treatment works for a particular child — whether it be therapy, medication, or both. “It's a real process and a matter of educating yourself as a parent,” says Cheryl Murphy, who is Shauna's mom and leader of the southern Nevada chapter of the Depression and Bipolar Support Alliance. She found that it took two years and more than one doctor to find a treatment that helped her daughter. Eventually, Shauna was diagnosed with bipolar disorder, which causes moods to fluctuate between periods of depression and high-energy mania. She now takes an antipsychotic medication. “The medication I'm on is working quite well,” says Shauna, who's now 19 and living with her parents in Las Vegas. The Depression and Bipolar Support Alliance, a Chicago-based organization with chapters nationwide, provides monitoring tips on its Web site. In response to the warning-label issue, Massachusetts-based Families for Depression Awareness also is working on a “depression monitoring tool” that will provide guidelines to help parents and patients track symptoms and medication side-effects. They expect to have it done in the next few months. Mental health experts who specialize in young people agree that monitoring a child on treatment is key, as is doing a thorough evaluation. “If a child comes in with symptoms A, B and C, the symptoms should, at worst, not get worse — and, at best, they should start to get better. If not, they're on the wrong medication,” says Rich Macur Brousil, director of child and adolescent behavioral health at Mt. Sinai Hospital in Chicago. If medication is deemed necessary, he says children should be started on the lowest dose to see how they respond. He and other mental health professionals also strongly recommend that any psychiatric medication be used in combination with counseling — and frequent visits for follow-up. Dr. Bela Sood, who heads the division of adolescent psychiatry at Virginia Commonwealth University, says signs that a medication isn't working might include heightened aggressiveness, unusually bold behavior or a feeling that “you're crawling out of your skin.” During an evaluation, she also asks young patients directly if they have thought about suicide. “There's this myth that if you suggest suicide to a kid that you might turn someone into someone who's considering suicide — and that's wrong," says Sood, who's noted that parents often have no idea their children have considered killing themselves. She and other experts say it is especially important to watch a young person during the first few weeks of treatment — in part because an antidepressant, for instance, can give someone who is depressed the energy to act upon suicidal thoughts. It's a lot for parents to think about. And Toni Embrey, a parent who lives on Chicago's West Side, knows how difficult it can be. She is raising three grandchildren and also has adopted three of her niece's children. Four of the six are on medication of one sort or another — from stimulants used to treat hyperactivity to antipsychotics and antidepressants. Several of the children go the counseling once a week. “It can be hard to keep track of it all,” Embrey says as she spreads the children's pill boxes on her coffee table. “But I have to look at what it does for them on a daily basis.” One of her adopted sons, 12-year-old Anthony, says the stimulant he takes has helped keep him calm and out of trouble at school. He also feels like therapy sessions with Macur Brousil at Mt. Sinai have helped him work through his sadness over his biological mother leaving him with Embrey. “If I talk to Dr. Rich, I get all my anger and stuff out,” the seventh-grader says. Meanwhile, Deborah Gongora, a mom in Victorville, Calif., has found that an antipsychotic has worked well for her 12-year-old daughter, who's bipolar. But her 15-year-old son, who suffers from depression, has done best with therapy and no medication. Says Gongora: "It really is a case-by-case basis."
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