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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Noa on May 30, 2001, at 17:04:37
I was wondering how you would know when a child's depression warrants medication? My understanding is that prevention of current or future episodes of depression is important in preventing a worsening chronic course, but would you try to intervene through parent guidance or psychotherapy, or both, before recommending medication? How would you determine if changes in the child's enviroment (home, school life, for example) and psychotherapy would be sufficient to treat the depression and prevent relapse, and when the child would need medication?
How hard should professionals push for environmental change and intervention before medication is considered?
Posted by SalArmy4me on June 3, 2001, at 18:05:16
In reply to RYAN: how to know when a child needs meds, posted by Noa on May 30, 2001, at 17:04:37
I or you can't make any diagnosis now. I would suggest taking him to the HMO's Internist and after, he will be referred to a specialist (Psychiatry). Seeing the internist means checking blood-levels of tryptophan, T4 Thyroid Exam--these are used to find out whether the person has an organic cause of the disease.
Posted by Willow on June 3, 2001, at 21:35:13
In reply to RYAN: how to know when a child needs meds, posted by Noa on May 30, 2001, at 17:04:37
And what if your child asks for medication? My ten year old has always been cautious, but about the same time I became ill she started becoming anxious, around seven years of age. She saw an ad for an AD and asked what it was. The best way I could explain it that she would understand was to say it was a medication to help with anxiety. She asked if she could get some? I asked if she felt that her anxiety was so bad and she replied that it was constant. She has gone to a psychologist who had suggested that she see someone who could help her through play therapy, but we had at the time thought it wasn't so bad. Now what??
Willow
Posted by Bill L on June 4, 2001, at 11:59:13
In reply to Re: RYAN: how to know when a child needs meds, posted by Willow on June 3, 2001, at 21:35:13
I can only say what I would do if it were my kid. I would skip the play therapy and see a child psychiatrist. You already tried a psychologist. If you don't know of one, ask her pediatrician for a referral. Many pediatricians feel comfortable prescribing drugs for anxiety and depression. If they are not successful, then they will refer the child to a psychiatrist.
My child takes 10 mg of Celexa per day which is a small dose. It has definitely reduced her anxiety and put her in a better mood. I just hope that it keeps working.
> And what if your child asks for medication? My ten year old has always been cautious, but about the same time I became ill she started becoming anxious, around seven years of age. She saw an ad for an AD and asked what it was. The best way I could explain it that she would understand was to say it was a medication to help with anxiety. She asked if she could get some? I asked if she felt that her anxiety was so bad and she replied that it was constant. She has gone to a psychologist who had suggested that she see someone who could help her through play therapy, but we had at the time thought it wasn't so bad. Now what??
>
> Willow
Posted by Willow on June 7, 2001, at 10:35:27
In reply to Re: RYAN: how to know when a child needs meds, posted by Bill L on June 4, 2001, at 11:59:13
"My child takes 10 mg of Celexa per day which is a small dose. It has definitely reduced her anxiety and put her in a better mood. I just hope that it keeps working."
Bill, thank you so much for replying. It sounds like you understand what we're going through. May I ask how old your daughter is. Mine has always been somewhat different, more reserved and serious than her classmates. Her anxiety seems to be almost constant, though she is coping better with it. She is ten years old now. Does the scenario sound similar?
Whispering Willow
Posted by Dr. Bob on June 12, 2001, at 10:01:34
In reply to RYAN: how to know when a child needs meds, posted by Noa on May 30, 2001, at 17:04:37
There is not yet consensus in the field on this question. Two large studies will complete over the next 4 years or so and will give us better information on psychotherapy versus pharmacotherapy versus the combination. I personally use medications relatively early but some of the colleagues that I admire most typically use psychotherapy first and medications second.
Posted by Bill L on June 18, 2001, at 8:29:25
In reply to Bill,, posted by Willow on June 7, 2001, at 10:35:27
I'm sorry it took me so long to reply. This is my first time back to this board in a while. My daughter is 19. Her pediatrician put her on Zoloft when she was 14. It didn't work as well as we hoped and we then sent her to a psychiatrist. She was put on Prozac which helped but once again not as much as we hoped. Then she was put on Celexa. This has helped her the most. She has always been a high strung nervous type. Celexa is more relaxing for her than Zoloft or Prozac was. She is doing very well on Celexa. The psychiatrist put her on drugs right away. Then saw her once a week for 2 months to do psychotherapy. But it appeared that there were no particular bad experiences that had caused her to be anxious and depressed. So then we brought her in once every few months. Now we mostly just call when she needs a refill.
Since your daughter has constant anxiety, maybe Celexa would be a better first choice than Prozac which is a more activating drug. But really trial and error is the way to tell which drug is best since drugs affect people in different ways. Right now with the school year ending is an ideal time to start a drug. Feeling tired and sleep problems are common side effects when starting drugs so at least your daughter would not have to get up early for school right now.
> "My child takes 10 mg of Celexa per day which is a small dose. It has definitely reduced her anxiety and put her in a better mood. I just hope that it keeps working."
>
> Bill, thank you so much for replying. It sounds like you understand what we're going through. May I ask how old your daughter is. Mine has always been somewhat different, more reserved and serious than her classmates. Her anxiety seems to be almost constant, though she is coping better with it. She is ten years old now. Does the scenario sound similar?
>
> Whispering Willow
Posted by Willow on June 18, 2001, at 20:45:01
In reply to Re: Bill,, posted by Bill L on June 18, 2001, at 8:29:25
I guess I'll discuss it with her psychologist and the family doctor. With my daughter, her anxiety got worse when I became ill. During a bad spell when I quit working I believe she had a bout with depression. I was in a bad way so didn't notice, but several months later on her report card it said that she was crying at school and having a hard time doing her work. My heart broke, you would think that a teacher would notify a parent when there's a severe change in a child's behaviour?
Anyway she had inquired about the medication, but right now she seems pretty upbeat. It's hard to say what is normal and when they need extra help. Gees!
Thanks for replying! Glad you made it through those teen-years. Give yourself a pat on the back and a happy belated Father's day!!
Willow
Posted by Bill L on June 19, 2001, at 8:36:12
In reply to Re: Bill,, posted by Willow on June 18, 2001, at 20:45:01
I know how tough it is to decide whether or not to give them a pill. If she is upbeat in general then I would not give the medication. I don't see antidepressants really being the best thing for situational problems. Only if extended periods of feeling down, extreme anxiety, or antisocial behavior becomes the norm. Good luck!
> I guess I'll discuss it with her psychologist and the family doctor. With my daughter, her anxiety got worse when I became ill. During a bad spell when I quit working I believe she had a bout with depression. I was in a bad way so didn't notice, but several months later on her report card it said that she was crying at school and having a hard time doing her work. My heart broke, you would think that a teacher would notify a parent when there's a severe change in a child's behaviour?
>
> Anyway she had inquired about the medication, but right now she seems pretty upbeat. It's hard to say what is normal and when they need extra help. Gees!
>
> Thanks for replying! Glad you made it through those teen-years. Give yourself a pat on the back and a happy belated Father's day!!
>
> Willow
This is the end of the thread.
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