Teenagers, Medication and Suicide

Parent Cafe
21

Romani, I want to thank you for your continued courage on this topic :slight_smile:

My father was depressed in the “good ole days” in 1966 and locked himself in his hardware store and ate rat poison. He was 46. Antidepressants as we know them were not yet available, nor was Lithium.

One of my kids would not be here today without Lexapro (and Lithium). Her life is like night and day, and she has been restored to her self. True clinical depression is biochemical and often genetic. She works harder on herself and is more resilient than most, so her depression is certainly not a character defect.

That said, sure,these drugs are overprescribed. I left a new doctor when I went in after an injury that was painful, and had trouble sleeping. Her response was to try to prescribe an SSRI and I refused. I was not even ordinarily unhappy. There is certainly a tendency in the medical establishment to pathologize normal feelings like grief, and it is possible that the media-created short attention spans might mean less tolerance for temporary suffering. Etc. Etc.

But let’s make sure not to give the message that those who are truly clinically depressed should pull themselves up by the boot straps- the proverbial chiding from the past.

I am sure some of you are aware that people who have been truly depressed often cannot attempt suicide: they do not have the initiative or the energy. The most dangerous time is when they start to get better. I have always thought that might explain the blip in suicidality with SSRI’s, which would mean it is not really a side effect of the drug but an effect from the improvement it provides.

I worked for many years in a large homeless shelter filled with deinstitutionalized psychiatric patients, some of whom were depressed enough to be catatonic. It is these medications that allowed deinstitutionalization, which meant freedom from incarceration in “asylums” for many. But some slip through the cracks and end up on the streets and off meds. Every day I got to see the effects of people not on medications.

22

compmom, I am so sorry for your father.

Just to be clear, I do believe that we over-prescribe meds. Maybe not anti-depressants specifically (I don’t follow specific drug categories) but certainly other mood-altering drugs. But we also over-prescribe chemo and antibiotics but I don’t see people telling us to let cancer and infections go by the wayside.

I have spent the last 2 years digitizing and standardizing 20,000+ patient records from California’s state hospital system from the 20s through the 50s. Anyone who thinks mental illness is anything new is ignorant (to put it mildly). Almost all of the conditions that these people spent their lives in institutions for are treatable today. Today, they would be able to live near-“normal” lives. The records are heartbreaking. They detail how families abandoned the patients and the grotesque treatments that they were subjected to. It hits home especially when it’s a young person who had symptoms like I did
 and paid for it with their reproductive autonomy, physical health, and, too often, their lives.

This is interesting and makes a lot of sense. I’ve had a theory that people think anti-depressants are like a magic bullet so they stop monitoring family members once they start
 without considering that it takes time to adjust. (Not that that’s their fault. Our medical education to the public is atrocious.)

I have lost at least one friend a year for almost 10 years to depression. I have been to too many funerals of young people to have any tolerance for the whole “it’s just in your head” crap.

I also absolutely agree that there is a biological component. My mom has 3 brothers and all are clinically depressed (though only one is in treatment). One brother self-medicated with drugs and alcohol starting in his teens and succumbed to drugs after a miserable life about 10 years ago.

23

Let me note that I have background in this area in several way - having been clinically depressed, cut myself, and also suicidal, but also with scientific knowledge. Let me know that in my case, I feel that anti-depressants would have killed me. I had serious issues with apathy and self-harm. I had to work around a very destructive abuse situation that I had to eventually solve myself through violence. Even to this day, there is no honesty about what happened to me and the surrounding circumstances. If I did not have a supportive spouse, the outcome could be different.

Anyway, the problem is that people want to throw pretty much any psychoactive drugs at kids and hope it “fixes” the problem. My friend’s daughter has been on SSRI’s, DARI’s, and now is on Adderall, which seems to help her. While on Strattera, she was thrown out of school for saying she dreamed she would hurt another child (named by her) with an ax. While on another drug, she began pulling out her hair. Note that she is in a very difficult family situation, that really no child should be in, so the crux of the matter really does seem to be situational, and that situation is not going to change in the next 5 years, at least not for the better. What drug can take a dysfunctional (but on the surface upper middle class and the kids get anything they want) family and make it all better?

A friend of my son was on medications including Zoloft, but switching back and forth between ADHD and depression medications. He finally went off all medications completely and is doing fine with counseling only. He had gone from a 4.3 GPA student when on one medication, but still not “doing his best” plus acting out, down to failing several classes when on Zoloft. His parents decided to make a “clean slate”, although he ran away for a short time when off medication.

Psychoactive medications are not the same, and what I am seeing is that if one does not work “enough”, switching and combining are very common with no concern for toxicity or negative interactions. My SIL was institutionalized when being switched between psychoactive medications; two weeks in a “clinic” away from her husband and special needs son because she wasn’t told clearly how to wean herself off of one medication, and start on the new medication.

And back to me, I worry that of the “90%” the author mentioned, quite a few are like me - kids subject to abuse (mine was physical and verbal only) or other very dysfunctional situations that create mental distress which would absolutely read as a mental disorder. Heck, my parents told me I would be taken away if I reported that my broken shoulder was caused by my brother - what kind of mental state does that create?

Most doctors do not have enough pharmacological education to understand why some medications work and some do not. However, the idea that lithium can do amazing things is worth reading up on:
http://www.nytimes.com/2014/09/14/opinion/sunday/should-we-all-take-a-bit-of-lithium.html

Could it be that the absence of, or low levels of, lithium in water and other sources leads to mental illness? Can lithium supplementation help people with mental illness across the board? Rather interesting topic.

I hear that others have been significantly helped by psychoactive medications, that is great. And I agree that forcing a child to go through years and years of therapy without the family being included and without entertaining the idea of medication at all seems counter-productive. But YMMV, I know too many people who have been hurt by psychoactive drugs (legal and illegal).

My son’s 2nd grade teacher called me “after hours” to tell me her nephew was doing great on Ritalin. I was offended but didn’t report her. As my son got older, we found that he has a medical condition that caused his negative behavior, and once that was treated, his behavior has evened out tremendously. The medication he is on is not psychoactive at all, but it treats his “psychiatric symptoms” by addressing the root cause. He would have been on medication for 12 years if we had just said “okay, if your nephew is doing it, then I guess it must be right for my son”.

YMMV. The best thing any of us can do is treat mental and psychiatric issues like any other sub-specialty, and go to a specialist. And treat the prospect of long-term medication exactly as you would surgery - would you have surgery without a second opinion? Would you let your GP do brain surgery on you?

24

Im sorry for your loss compmom.
Your dad wasn’t on tricyclics? Those can actually be more effective than SSRis, allowing that they can be more sedating.

25

I have seen this so many times.

Even I gave up very heavy drinking ~16 years ago when I realized I was self-medicating.

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Emeraldkitty, he had a seizure disorder and I believe the meds available to him then were not appropriate because of that. Lithium also would have helped him. He had late onset bipolar 1 (with mania) and my daughter had early onset. She has had time while still living with me to adjust to her diagnosis and has meds available that help tremendously. She is living with friends this year and thriving. An SSRI is a part of the picture, but Lithium allows the stability to take it.

I agree with the idea of medical and societal overuse but also think the black box warning may be preventing some from getting relief, or even safety. Every individual has individual reactions to medications, and SSRI’s can cause unbearable anxiety for some.

I am sorry for those who felt harmed by the same meds that help others.

27

I think the same meds can both help and hurt the same population.
The first med I was prescribed was doxepin. Incredibly sedating. That was probably 1987. My father had been on Meprobamate, Tofranil, & Quaaludes, not sure if all at the same time. This was early 70’s, he died 40 years ago.

I also was on Imipramine & Desaprimine, ( not same time), in the late 80’s but it lowered my blood pressure quite a bit, plus made me gain weight, which was depressing. Then we tried the newer SSRIs, but this coincided with a rash of articles calling them happy pills for people who were trying to hide from life. I really hated taking medication anyway, given my mother was on Thorazine and my father had died from an overdose, and I was vulnerable to the idiot ideas in the newspapers, so I quit Paxil cold turkey, which resulted in a hospitalization. Two actually.
Paxil is particularly bad for discontinuation syndrome, unfortunately, because it actually helped the most.
http://www.xojane.com/healthy/paxil-withdrawal-flu

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Withdrawal is a whole other topic. MD’s will say “cut in half for a week, then stop.” Seriously. Some people need to take months to get off these meds, tapering both via amount and timing. The last 5mg is the hardest and some have to use liquid in order to continue the taper with the smallest increments. Another tactic is to substitute a small amount of a med like Prozac, which has a very long half life and makes withdrawal easier, and is easier to stop at the end of the discontinuation process.

I know all this because someone in my family had all kinds of bizarre effects from withdrawal: “brain zaps”, “Alice in Wonderland syndrome”. MD’s had no idea. Then again, she got a lot of benefit while on the drug, a whole year’s worth.

29

@Hanna, @flynn4meghan, thank you for sharing your stories. And @compmom I’m so sorry to hear about your father’s suffering.

As for the “good old days” and people growing up during the Great Depression being able to cope without medication–well, maybe in retrospect life in the early 1900s looks simpler, but in many ways that’s false nostalgia. I just read a biography of L.M. Montgomery, author of Anne of Green Gables, (1872-1942) and the account of her depression and dependence on bromides and barbiturates is so terribly sad. She wrote cheerful, sunny, uplifting books while struggling with unbearable psychological pain. As I read it I kept wishing that she’d had access to better mental health care.

30

I have very strong opinions about the use of psychiatric drugs or not, but will not get into that here yet.

However, as far as an increase in medication use, I suspect one of the biggest reasons is, people who might have situational depression/anxiety, etc., who might otherwise do well with talk therapy alone, are finding it increasingly more and more difficult these days to get their insurance to cover it. So one of the first things that happens is, someone suggests a medication that only requires office visits every few months, instead of encouraging them to work through these issues in therapy. Insurance companies should be lambasted for how manipulative they are in denying services.

31

Absolutely.
My psychiatrist, schedules me for 6 visits of about 20 minutes a year, and it is my impression it is because that gets him the best ratio of minutes to fee, it’s not that my condition warrants such a short visit. Imo, anyway.
But few Drs even accept insurance anymore, let alone our plan.
And if we had a wider selection of Drs, I would prefer going to one for therapy, rather than medication management.

32

There are a few amazing psychiatrists out there. My son’s is one of them. This man, Dr. S., does not accept Medicaid in his private practice, but he does see patients at a public clinic that does. When my son got on Medicaid, I asked Dr. S. if he would see my son at the clinic. “Well, that clinic is a good drive for your son, and my local office is more comfortable, so I will see him there and not charge him.” So he has been seeing him for over two years for NOTHING. During that time, he has also come to our house when my son was having an episode while my husband and I were away. My son gave me permission to talk to Dr. S., so I stay in touch with him by email and phone. Sometimes I really think he is an angel sent down to help my son!

My son is another person who WOULD NOT BE HERE if it were not for lithium and anti-psychotic drugs. I hated the idea of meds, but boy, your views change when you see your firstborn waiting by the curb for God to come pick him up in a chariot.

33

^^^^@2bikes1beach, yeah, I’m pretty sure these kids are not mentally ill because they are not shown enough love B-)
Mental illness has been around as long as people have been around IMHO. There are a number of factors which make it SEEM like it is more prevalent today.

I will say, though, that while I believe these conditions are biologically based, that doesn’t mean that environment cannot influence whether a person develops a condition. Much like you can be predisposed to high blood pressure but if you keep your weight down, eat right, exercise etc it may not develop into a dangerous BP situation.

I AM NOT BLAMING ANYONE FOR THEIR MENTAL ILLNESS however! I think in the past, say, during times of less comfortable existences, people may have been working very hard physically on the land (exercise is a proven anti-depressant), spending much more time outdoors and in natural light (nature and sunlight are proven anti-depressants) and lived in small, close communities (connection to other people is an essential ingredient in mental health) so that SOME people’s illnesses never had conditions to allow them to develop.

Another pet peeve of mine: When people or newspaper reporters or whomever say that a person has a good job/finances/marriage etc and would not seem to have reason to be depressed or anxious etc. The true clinical conditions of anxiety and depression are not situationally caused. Sure, situations can exacerbate them or precipitate them, but people are not depressed because they lose their jobs. If it were only that easy, then we could readily identify people who would need help AND know how to cure them!

34

The “good-old days” just weren’t as good as people would like to believe. Morphine, heroin, and cocaine addiction was prevalent starting in the 1800’s. Alcohol abuse was off the chain.

I do not recall a time in my life that my grandmother was not addicted to Valium. My other grandmother died from alcoholism. Both a way of numbing emotional pain.

In my opinion the reason so many children/young adults are being treated more for mental illness is that parents are LISTENING to their children more. When I was a kid, you went to the doctor when you were in mortal danger from an illness, or for shots, and that was it. My parents had absolutely NO idea of the pain I went through from years of bullying in high school, nor would they have had much sympathy if they had. The culture was just not of listening to children’s feelings. They were just supposed to follow the rules and behave for the most part. I don’t think I am only speaking for myself in this type of upbringing.

Now parents who were raised this way are actually involved in what their children are experiencing in their lives. We want of kids not to suffer what we did growing up.

This generation is also growing up in the post-9/11, being brought up on a steady diet of dystopian fiction and global warming. It’s a lot to figure out.

35

I absolutely think that depression is increasing in the world and not just the diagnosis of it.

“The World Health Organization reports that suicide rates have increased 60 percent over the past 50 years, most strikingly in the developing world, and that by 2020 depression will be the second most prevalent medical condition in the world.”

From a piece in the Times last year:
http://www.nytimes.com/2014/03/25/opinion/a-great-depression.html

And from a piece in Psychology Today:

“The increased psychopathology (5 to 8 times as many high school and college students meet the criteria for diagnosis of major depression and/or an anxiety disorder as was true half a century or more ago) seems to have nothing to do with realistic dangers and uncertainties in the larger world. The changes do not correlate with economic cycles, wars, or any of the other kinds of world events that people often talk about as affecting children’s mental states. Rates of anxiety and depression among children and adolescents were far lower during the Great Depression, during World War II, during the Cold War, and during the turbulent 1960s and early ‘70s than they are today. The changes seem to have much more to do with the way young people view the world than with the way the world actually is.”

https://www.psychologytoday.com/blog/freedom-learn/201001/the-decline-play-and-rise-in-childrens-mental-disorders

36

I know a person whose ~20 years old daughter has committed a suicide a few days after changing her anti-depressant mediation. This happened just months ago.

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Increase in population, in crowding, in stress level contribute to increased levels of anxiety and depression.
http://www.theguardian.com/cities/2014/feb/25/city-stress-mental-health-rural-kind