Lesson #7: How do you know if your teenager needs antidepressants for their depression

There’s a lot of debate about antidepressants for teenagers. So how do you know, as a parent, if your teenager needs antidepressants for their depression.

One on the one hand, doctors will tell you that antidepressants, combined with psychotherapy, is a very effective treatment for clinical depression. On the other, studies show that antidepressants may not work on teenagers. That they could do more harm than good.

I believe antidepressants saved my daughter’s life. But the decision to give her medication that carries a “black box” warning, the most serious type of warning issued by the Food and Drug Administration (FDA), wasn’t an easy one.

If you’re wondering whether your teenager should take antidepressants for their depression, here are three things I’d urge you to consider.

Does your teenager want antidepressants?

Soon after my daughter asked me for help with her depression, she said she felt she needed antidepressants. I disagreed.

It wasn’t stigma that held me back. It was ignorance.

I had it in my head that antidepressants were a last resort. Something we’d try only after exhausting the other options. She had just started talk therapy. I thought she needed to give it some time.

If I’m honest, it was also because I thought she wanted an easy fix to her problems. A magic pill to make everything better rather than going through the hard work of unburdening herself in a therapist’s office.

I now know that nothing about my daughter’s depression was easy, including trying medication to relieve her suffering.

And contrary to my self-centered view of things, she hadn’t just pulled onto the “road to recovery.” She had been trying to manage her illness on her own, without success, long before I got involved.

If you read my earlier post, you’ll know that I missed signs of depression in my daughter for months. While there was some grade-eight girl drama, she had good friends, was doing well in school, and managing a regular babysitting job. On the outside, she looked fine.

It was, in fact, this very ability to function that made me question the need for medication even more. It made me think her illness wasn’t severe enough to warrant medication. After all, how could depression and ambition co-exist in her brain? It didn’t make sense to me.

It my husband who reminded me, thankfully, this wasn’t about me. What I thought she was feeling, what I thought she needed, and what I thought depression looked like was irrelevant.

I needed to put my own feelings and beliefs aside and focus on hers.

Do doctors say your teenager needs antidepressants?

I am all for mama-bear instincts when it comes to my protecting my kids, but when it comes to treating my teenager’s  depression, I have learned to defer to trained medical doctors. It wasn’t easy.

The first therapist we saw recommended my daughter might benefit from antidepressants after a single appointment. The second therapist lasted only a few sessions and came to the same conclusion. She couldn’t prescribe them, but suggested we find a psychiatrist who could.

I was furious. Literally angry at them. I felt they were encouraging my daughter down a path I hadn’t sanctioned.

But what did I know? What do you know? If you haven’t asked yourself this question, I’d encourage you to do so.

Looking back, with the advantage of hindsight, here’s what I knew to be true at that time.

We were in a holding pattern, sitting uncomfortably in one of the gaps of Canada’s mental health care system, a state of purgatory between therapy and psychiatry. I knew my daughter wanted and likely, according to trained therapists, needed medication for her depression, but she wasn’t yet in acute crisis.

I also knew my daughter’s mental health was declining. While we waited for a psychiatrist, she started cutting. Tiny scars raking the insides of her forearms. When she first showed me, I didn’t even know cutting existed. She assured me she wasn’t suicidal. The cutting helped her feel better, she said.

I also knew her resistance to her depression was weakening. She was coming to me more often, late at night, in tears, asking how much longer. On those nights, we’d debate whether or not to go to the hospital, neither one of us really knowing what that entailed, or hold on another day.

I knew her therapist didn’t think she was suicidal. She was asking for help. She wanted help. She was reaching out when she felt vulnerable.

That’s what I knew. I didn’t know why she felt the way she did. I didn’t know what she said to the therapists or later to the psychiatrist who prescribed medication on her first visit.

I was untrained, uninformed, and entirely green when it came to dealing with depression. So, why did I ever think I knew more than the doctors?

Do you have other treatment options at this time?

I think most parents are reluctant to have their teenagers take antidepressants. It’s a natural reaction.

We’ve worked their whole lives to keep medication out of reach. As kids become teenagers, we warn them about the risks of drugs and alcohol. I think we’re programmed to resist.

I also think most parents who “decide” to give their teenagers antidepressants, do it because they’ve run out of options. The risks of not trying antidepressants starts to outweigh the risks of the medication. At least this was how it was for me.

While my daughter was high functioning, she wasn’t able to manage her depression. She agreed to talk therapy, but only as a stop gap while we searched for a psychiatrist who could prescribe medication.

She wasn’t sleeping well at night. She rarely ate dinner with us. I rarely saw her eat at all, though I know she’d do it in private. I didn’t know back then to pull her phone from her clutches.

And though she acknowledged she was in significant pain, she wouldn’t tell me why. As her condition declined, she boarded up even further, shutting out even a sliver of light.

Within four months, therapists and a psychiatrist in the wings, I watched her mental health decline to the point that we wound up in the emergency room.

Today, she says she’s “happy.”It took three years of trial and error with antidepressants and continued therapy, but she’s currently symptom free and I’m cautiously optimistic.

Am I sorry she’s on antidepressants? No way. I’m still concerned about the long term effects, and I wonder constantly when and if we can start to wean her off, but I don’t regret it.

The best depression treatment may be the one they want

If you’re still debating, consider this article on WebMD. It’s about a 2005 study involving 335 patients with depression.

Researchers at the VA Puget Sound Health Care System and the University of Washington in Seattle found that 72% of patients matched with their preferred treatment were significantly less depressed than those not matched. Patients who got their preferred treatment also tended to be less depressed after nine months.

So, what does your child want? What do the doctors recommend? Do you have other options?

These three questions might not solve your internal debate about whether or not your teenager needs antidepressants, but I hope they help you help you take the next step, whatever that is.

In the news: VR Therapy for depression and anxiety

Pixana, a virtual reality (VR) solutions provider, and Limbix, a company that uses VR therapy in healthcare announced they’re teaming up to develop interactive VR therapy to help teens better understand and cope with depression and anxiety. 

Working with Harvard University researchers and Stony Brook University they plan to develop VR scenes to help teenagers work through emotions and stressful situations in a safe place. 

VR Intervention for depression
A behind these scene look at a project built to deliver mind set training to adolescents with depression.

At the root of this idea is Growth Mindset Training, the belief that neither intelligence or personality are fixed mindsets. Just as academic success can change, so too can personality traits like sadness, shyness or likability.

For kids and teenagers, a growth mindset has been shown to have a powerful impact on their psychological recovery from socially stressful situations. 

If schools can intervene early to help students develop growth mindsets, they could improve students abilities to cope with stress and reduce anxiety. 

You can read more about mindsets and mental health, and growth mindset parenting here.

Lesson #6: Learning to parent through fear

Parenting a teenager with major depression is an exercise in learning to parent through fear.

To be fair, I guess all parents feel afraid for their children.

I remember when my husband and I left the hospital with our brand new daughter, less than 24 hours old. We were amazed they let us leave. Didn’t they know we didn’t know how to care for a baby? We could barely get her in her car seat in the hospital parking lot.

In those early days as a new mom, my anxieties crept into my sleep. I dreamed of a flood. As waves of water thundered against the walls of our house, I held my daughter close while screaming that I couldn’t take care of her with this storm raging. It was terrifying.

But not nearly as terrifying as bringing my daughter home from another hospital, thirteen years later, knowing I really couldn’t keep her safe. I couldn’t swaddle her like I did when she was a baby or bring her into my bed to keep watch over her in the darkness.

She was no longer dependent on me to keep her free of harm. Instead, I was dependent on her and on her willingness to live.

Continue reading “Lesson #6: Learning to parent through fear”

In the news: Apple introduces tools to limit screen time

In July 2018, Apple introduced tools to monitor and limit screen time as part of the iOS 12 update.

(To be fair, so, too, did Google on their Android P system, but we’re a family of Apple users.)

If you read my  post on smartphones, you’ll know I struggle with restricting my kids’ screen time. And you’ll know that I believe unchecked smartphone use, and in particular Snapchat, played a role in my daughter’s depression.

Which is why, when a tech company does something that might help us be more mindful of our digital habits, I rejoice. Even if Screen Time is providing Apple with incredible amounts of data about how I, and my kids, spend literally every minute of our days.

If you haven’t heard of Screen Time, or like me are slow to update your phone’s software, here’s the quick and dirty. For a full step by step guide on how to set it all up, check out this article from Tom’s Guide.

Continue reading “In the news: Apple introduces tools to limit screen time”

Lesson #5: Delay and restrict smartphone use

There are few struggles in parenting that have plagued me more than the topic of smartphone use. For those with kids younger than my own, I have some hard-earned parental wisdom: delay and restrict smartphone use for as long as possible. Because once that genie’s out of the bottle, it’s really hard to put her back.

Are smartphones destroying our kids?

My daughter had relatively unrestricted access to a smartphone and social media accounts long before Dr. Jean Twenge’s story Have Smartphones Destroyed a Generation? appeared in the September 2017 issue of The Atlantic.

If you’re unfamiliar with Twenge’s research, here’s a quick summary: Twenge studies generational differences, and noticed that in 2012, there was an abrupt shift in adolescent behaviour and emotional states. That same year, the proportion of Americans who owned a smartphone surpassed 50 percent. By 2017, three of four American teens had smartphones. As smartphone use shot up, adolescent well-being plummeted.

Graph showing decline in teenagers' well-being after 2012
Research conducted by Jean M. Twenge and Gabrielle N. Martin, Department of Psychology,
San Diego State University; W. Keith Campbell, Department of Psychology,
University of Georgia shows declines in teenagers’ well-being, as reported by 8th, 10th and 12th-graders,

She argues that while teens are safer physically, the post-millennial generation is “on the brink of the worst mental health crisis in decades.”

There are many who disagree with Twenge’s siren call.  Dr. Sarah Rose Cavanagh, in her column for  Psychology Today, argued Twenge cherry picked her data, that her research showed mere associations vs correlations.

Similarly, Elizabeth Nolan Brown on BuzzFeed called bullshit on Twenge’s theory citing that suicide rates have fallen dramatically since the 1990s. So has the use of alcohol, smoking, car accidents and teenage pregnancies. She writes, “the kids, by almost all measures, are more than alright.”

In Nature, an international journal of science, author Candice Odgers reports that smartphones are bad only for some kids, not all. Online activity, the author argues, is only reflecting and potentially worsening existing vulnerabilities.

So, what’s a parent to do?

I’m not a scientist, but here’s what I know for sure: My daughter was a Snapchat fanatic by the age of 13 with thousands upon thousands of snaps under her belt. She seemed fine. Until she developed clinical depression.

Continue reading “Lesson #5: Delay and restrict smartphone use”

Lesson #4: Shawn Achor on how to train your brain to be happy

If I’ve learned anything over the past few years it’s that there is  no one way to fix depression. For Shawn Achor, positive psychology worked for him.

I first learned of Shawn Achor, the author of The Happiness Advantage and founder of GoodThink Inc. at The Globe and Mail’s Executive Performance Summit in 2016. Achor was the keynote.

He was easy to spot in the crowd. In a room full of type A personalities, all  suited and taut, he was dressed business casual. He had a friendly air  and a hypnotic smile that he would cast on anyone within five feet of him. My immediate thought was that he was either on something or on to something.

Shawn Achor
Photo courtesy of GoodThink Inc.

Right off the top of his presentation, he asked the audience to turn to the person next to them and smile at them for sixty seconds. Everyone shifted in their seats reluctantly, clearly somewhat horrified at having to do this, but equally determined to succeed.

About twenty seconds in, the silent room started to get noticeably uncomfortable. Staring into someone’s eyes, a stranger’s or worse, a colleague’s, smiling, for twenty seconds is a really weird thing to do. At thirty seconds, hearing they were only halfway there, a few people started snickering. When we hit the one-minute mark, the room erupted with relief. People were laughing and chatty. They looked happy and satisfied,  proud of what they’d just accomplished.

And that was his point. That was all it took to reset the dynamics of an entire room. No money. No spreadsheets. Just sixty seconds of smiling to make two hundred people, individually and collectively, feel good, happy and optimistic. It wasn’t even 9am and already the day was looking up. Continue reading “Lesson #4: Shawn Achor on how to train your brain to be happy”

Lesson #3: Listen to podcasts

When things were really down and out for me on this road of parenting depression, I started to listen to podcasts. They helped.

If you ask a parent the one thing they truly want in life for their children, they’ll undoubtedly say happiness. But what if your child isn’t happy? What if your child is questioning whether their life is even worth living? It kind of messes you up as a parent.

When my daughter was hospitalized for her depression, I asked the social worker assigned to her, how did this happen? We were getting help. She was on medication, she had a therapist.  He told me depression is like a whirlpool. It can turn and turn and turn and then, out of nowhere, it can quickly suck someone under. I thought about this a lot in the months that followed.

As a parent, above the waterline, suicidal depression is more like a tornado. It lifts the roof off your world, scattering your emotions and sense of self in a million directions. All the while the storm is raging, you have to stand still and steady.  And when the flood waters rise, you tread furiously to keep you both afloat, not letting on that you’re tired and worn out and not sure you can save either one of you.

In the aftermath of this crisis, I started crying. Mostly in my car on the way to work. It was odd and sort of fascinating to me. I’d never been a crier. It was as if my body had filled up with so much water during the storm that even the smallest bump in the road was enough to push a few drops over the edge.

I know uncontrollable crying is a sign of depression, but in lieu of  spare change, time and emotional energy to fix myself, I started to listen to podcasts. I needed a distraction, but more, I needed to learn how to be happy again. I needed to make sense of my life and my choices. To understand why I was making this same drive to work, day after day, when I was failing at my most important job.

Continue reading “Lesson #3: Listen to podcasts”

Lesson #2: Requesting academic accommodation

Requesting academic accommodation for my teenager daughter who lives with depression wasn’t easy, but it was necessary. Here’s what happened.

At some point, you may need to request academic accommodation for your child.

Accommodations are based on the premise that school is not about how you learn, but what you learn. They’re designed to “level the playing field” by recognizing that people with mental health disabilities or physical disabilities may be at a disadvantage.

In our case, the need for accommodations arose when my daughter was in grade ten. She was having trouble writing tests, and later that same year, the weekend before final exams she felt unable to write them at all. With her first exam scheduled for 9am on Monday morning and worth 30% of her final mark, my husband and I and her therapist scrambled to figure out how to handle the situation. Continue reading “Lesson #2: Requesting academic accommodation”

Lesson #1: How to spot signs of depression

I’ve been over dozens of checklists for depression dozens of times. Still, I’m not sure I would have recognized signs of depression in my own daughter.

Years ago, I worked with a woman who had a teenage daughter who had dropped out of school and refused to leave her basement. In the morning, over coffee, she’d give me the latest on the home front, jokingly referring to her daughter as the basement dweller. On the odd occasion, that same daughter would come to work, curl up and sleep in the corner of her office.

Withdrawal from everyday activities. It a classic sign of depression.

It was 2004 and by today’s standards, I was likely the worst colleague in the world. I had no idea what she was going through. I didn’t recognize her own struggle or her daughter’s for what it was, but I do now. Continue reading “Lesson #1: How to spot signs of depression”