Hello to all
I am a Child and Youth Care student in BC Canada, and recently came across an issue that struck a chord of deep concern in me.
I am privileged to know a young woman (17 years old) who has been struggling with anger, rage and depression issues. Her family life has been tumultuous in the last 5 years, and her emotional and physical health is really suffering.
Recently, her physician diagnosed her with depression, and prescribed a pharmaceutical anti-depressant. She was lucky, in that he seems to have found the right anti-depressant for her right away, and she started to feel a little better within a few days. I have spent a lot of time with this young woman, and have noticed that her rage and behaviour improve dramatically when she is taking her anti-depressant. She feels better able to cope with her emotions and her despair and even starts planning future activities, whereas when she is off her medication, she crashes quite quickly and becomes very difficult to interact with normally.
There are a couple of things that I am hoping others in the Child and Youth Care net community might enlighten me on:
1. First of all, I understand that pharmaceutical anti-depressants are banned for adolescents in the UK, due to the heightened risk of suicide for teens taking them. (we have a warning for them here in Canada, but physicians that I have met recently still seem to prescribe them as a first course in treatment).
Does anyone know what is being used an the alternative to pharmaceutical anti-depressants in the UK or other parts of the world? I am hoping to get a good perspective on common practices from various parts of the world.
2. Secondly, are there any Child and Youth Care practitioners who have had experience with teens using alternative methods for anti-depressants, and can you send me any links or information on this?
There are some books available in Canada on using St. Johns Wort, and amino acids such as tryptophan and so on, but I have yet to find a physician who knows much about using these substances or will perscribe them.
Any feedback, suggestions or ideas from the Child and Youth Care community would be very much appreciated and welcomed. Even though the young woman I know who is using the anti-depressants did not have a suicidal reaction to them, the risk is there for other adolescents, and I believe it is important to advocate for safer, alternative methods to help with biochemical depression in adolescents. Having information from other communities would be incredibly helpful when advocating for safer practices here in BC.
Thank you all, in advance. I look forward to hearing your suggestions and ideas.
Page 10 National Institute for Clinical Excellence guidelines for treating depression in children and adolescents (read full guidance here:
"there are no antidepressant drugs with a current UK Marketing Authorisation for depression in children and young people (under 18 years).2 However, in 2000, the Royal College of Paediatrics and Child Health issued a policy statement on the use of unlicensed medicines, or the use of licensed medicines for unlicensed applications, in children and young people. This states that such use is necessary in paediatric practice and that doctors are legally allowed to prescribe unlicensed medicines where there are no suitable alternatives and where the use is justified by a responsible body of professional opinion"
Don't assume non-tested medicines (often called alternative medicines) are safe – for all the risks around licensed meds, that have at least had rigorous trials. Just because something is "natural" it is not necessarily safe (bubonic plague is natural). St John's Wort should not be taken with SSRIs
Hope this helps
The argument/question you are referring to here is of critical importance and is similar to the recent one asked about whether to administer medication to children for treatment of troubling behaviors. When reflecting on the most effective and efficient ways to deal with young people with anger, rage and/or depression challenges, it is important for one to know in the first place why the kind of intervention is used. As much as anti-depressants are helpful, they at times remain effective during the period within which they are administered and that is why the young person relapses immediately after stopping using anti-depressants. I would suggest that while the young person is on anti-depressants that more developmental and appropriate interventions be introduced that aim at assisting the young person to cope, on a long term basis. In my 20 years' experience as a Child and Youth Care Worker, a combination of interventions is at times more effective than just relying on one aspect of treatment. The question we need to ask ourselves as Child and Youth Care Workers is, "What should we do now that a child is on medication?". Anti-depressants produce, in some cases, immediate anticipated results and not necessarily on a long term basis.
There is a place and time for every intervention and often, as CYCW's we employ these in the child's living environment, in the moment. Administering of anti-depressants is one kind of intervention amongst many others. What would also help is trying all the Child and Youth Care techniques to engage, build rapport, identify needs etcetera that would ensure improvement in a child's behavior. As much as there are no clear cut answers to your question, we however need not create a scenario where the teenager solely relies on kind of intervention like anti-depressants as this might not be sustainable means to dealing with such challenges.
Hope this helps.
SOS Children's Villages South Africa
Thanks for your important question. Many years ago I came to the conclusion that Child and Youth Care and Psychopharmacology are incompatible approaches. Everything I've seen over recent years has served to confirm this belief. For me, Child and Youth Care is a relational model that works from the premise that our life-challenges are created in relationships and can only be resolved in relationships.
Drug therapy, on the other hand, is a branch of the medical model that treats emotions as medical conditions that can be manipulated or 'cured' through chemical intervention. From this perspective there can be no convenient compromise since one approach can only serve to sabotage the other. Your 17 year old, for example struggles with anger, rage, depression and despair created through a 'tumultuous' family life. Of course she feels better after medication, much as I might feel better after a glass of malt scotch, but this short-term fix does nothing to address the underlying relational injuries.
More medication, or more scotch might, might continue to
trick body and mind for a while but, ultimately, there will be a price to be
paid. Meanwhile, working relationally with someone whose
faculties are distorted by drugs (legal or otherwise) is a lost cause.
Physicians who diagnose 'depression' and prescribe medication don't need to know anything about the background of their patients, or have any kind of relationship with them, before calling upon the Pill Fairy. For them, 'depression' is just another medical condition to be treated. Child and Youth Care practitioners, on the other hand, must come to know and recognize their 'clients' as unique thinking and feeling human beings who have the inner resources to take charge of their own lives in their own way. From a relational perspective, depression is state of mind that arises from all the conditions you mention in your email. This means that the task of the Child and Youth Care worker is far more complex and demanding than that of a physician: there's no 'quick biological fix' to be had – not even St. John's Wort.
As it happens, your question coincided with my article on this topic published in the current (April) issue of CYC-online. If you're interested in finding out why I am so opposed to the legalized drugging of children and adolescents, you may wish to take a look.
I guess this is a recurring theme in our practice – the matter of the use of medication, especially psychotropics. While there are those who believe that psychotropics should never be prescribed to children, there are others who believe that it could be an effective treatment under the right circumstances.
Generally speaking, the dangers of prescribing psychotropics to children is well known, which is why it is banned in some placed and warnings issued against its use. These drugs basically alter brain chemistry, and it is not an exact science (which is why prescriptions are changed so many times to find the "right" dosage). I am very concered the with over-prescription of drugs to children, especially by general practitioners. I generally don't believe that children should be prescribed psychotropics – but will also admit that I cannot know the special circumstances of each case, and there may be reasonable exceptions to this rule. However, I think in such instances it has to include at least a multidisciplinary team of practitioners – not all from the medical field – and that medication should never be a first course of treatment.
There are studies that have found that psychotherapy can be as effective (if not more) than drug treatment – so prescribing as a first course of treatment is really rolling the dice – it may or may not work. Sadly, in South Africa many people (this is not a "children-problem" by the way) undergo "psychiatric treatment" which basically consists of prescribed medication which is occasionally monitored – without any kind of counselling or therapy. Ironically, this kind of treatment is by far the most expensive, but that does not matter so much because it is the treatment best supported by medical aid companies – which is why it is a growing market.
For example, in South Africa, you could pay around
R1000+ for a consultation with a psychiatrist, around R600 for a
consultation with a psychologist, around R350 for a consultation with a
social worker, and around R0 for a consultation with a child care worker
(because it is not YET recognised as an option for private practice).
You can see the trend: the less medical and the more psychosocial as
treatment becomes, the less it is "valued" as reflected in the monetary
value of the treatment. Working in milieu of the child in terms of
planned therapeutic environments is not even on the chart (yet). What
does all of this mean? Just what we already know – that the
"treatment" of depression – as long as it is defined in medical terms – will
remain in the domain of the medical practitioner. The language we use
to describe the problem also defines the solutions that are possible within
this definition of the problem.
Then there are those instances in which a child receives medical treatment, and it works so well...
I think (but stand to be corrected) that in a previous thread it was Gerry Fewster who wrote about drugging kids into compliance – to use the phrase as I remember. That is really the greatest risk, and it is also the current trend. Basically I am saying that depression is not a medical problem first and foremost, so medical treatment does not make sense. Of course, there are many who will disagree.
It also seems (from my limited knowledge) that diagnoses in the DSM tend to be expanded rather than narrowed – new diagnoses are also "discovered" – so the medical hold on the domain of psychological and social functioning is growing. Now we need – probably more than ever – for child care workers to contribute to publications in order to provide alternative explanations and interventions that can counter a medical-dominated worldview of children and their development.
Well I think I have rambled on for long enough, and I am sure this debate will be around for a long time.
Werner van der Westhuizen
Port Elizabeth, South Africa
I actually just did a presentation on youth taking medication to treat depression and anxiety in my Child and Youth Care class tonight. I am appending below my written portion of the presentation for you. I hope you find it helpful and I wish you the best of luck in helping the youth suffering from this. Also, my partner added holistic approaches as well but I don't have her written portion but I can give you (see references below) all the links where we got our information from. Personally I found the BCGuidelines.ca to be the most informative. I hope this helps.
Should Children/Youth be Medicated to Treat Depression/Anxiety?
I just wanted to start off with a poem I got from Teen Help.org about how depression makes particular teen feel.
"This is how I describe depression :
Something you can't see, but something so clear something so overwhelming, that it makes you fear something thats sad, downmooded with no will no achievements to complete, no goals to fulfill something thats painful, chains you want to break a smile you wish you had, but only one you can fake something thats here and there, following your every step something you really wish you could forget something that makes me cry tears from my eyes, something that makes me want to die."
Depression and anxiety is something a lot of our children and youth have to deal with. According to Bayridge (Anxiety & Depression) Treatment Center, A nationwide survey of Canadian youth by Statistics Canada found that 6.5%- which is more than a quarter million, met the criteria for major depression in the past year. It is a growing concern for today's children and youth and it is important for us as Child and Youth Care practitioners to know what options are available to those that are suffering.
Most people that are around those who are suffering want to cure them with a quick fix to make the problem go away instantly. That quick fix is given by
medication.(POP!) The problem with medication is that the issues are still there when the medication wears off. It can also have some negative side effects. The following side effects have been reported; Headache, Stomach Ache, Nausea, Difficulty sleeping, Dependency, Drowsy/Unmotivated, Blurred Vision, and Impaired Balance, AMONG OTHERES. Medication works differently on every person, therefore, it may take a couple of tries of different medications to find one that will help. Medication also doesn't help the child or youth learn how to cope with their symptoms. They are just given the drug without any coping strategies to teach them how to manage their anxiety and depression.
My sister grew up with anxiety and was diagnosed with it at the age of 13.
She took a couple different medications to find the right one that would help her manage her anxiety attacks and her anger outbursts. Although it did help, she didn't like being on medication because it made her feel like there was something wrong with her. She didn't like the fact that she couldn't stop taking them when she wanted to. If she did stop taking them, she would experience uncontrollable emotions. She would become violent and very emotional. Taking medication was the only way she was told she would feel normal. She was never given any other coping strategies. She finally decided that she didn't want to be on medication anymore and started to wean herself off of them. It took her 5 years to get off her anti-anxiety medication. She is doing fine now because she had discovered ways other than medications to help her cope with her anxiety. Introducing drugs to kids so young as a means to fix their problems and numb their feelings, can give them the wrong idea about the proper way to cope. If they are learning that this is an acceptable way to cope, it could lead them to believe drugs will make things better. This way of thinking could get misconstrued when pressured with more dangerous drugs like Perkasets, Oxy Cotin, Valume, etc.
The following is a statement from Health Canada about anti-depressants and anti-anxiety medication for children and youth: "It is important to note that Health Canada has not approved these drugs for use in patients under 18 years. The prescribing of drugs is a physician's responsibility. Although these drugs are not authorized for use in children, doctors rely on their knowledge of patients and the drugs to determine whether to prescribe them at their discretion in a practice called off-label use. Off-label use of these drugs in children is acknowledged to be an important tool for doctors.
Doctors are advised to carefully monitor patients of all ages for emotional or behavioural changes that may indicate potential for harm, including suicidal thoughts and the onset or worsening of agitation-type adverse events." To prevent possible further harm to children and youth suffering from anxiety or depression by administering medication, there are some other alternatives that can prove to be just as effective.
One of these alternatives according to BC Guidelines and Protocols for Anxiety and Depression in Children and youth is psychotherapeutic interventions. Psychotherapeutic Interventions are a slower, in depth approach that gets to the root of the problem. It takes time to learn and heal but the problem doesn't come back as quickly as it does with medication use. It consists of Cognitive Behavioral Therapy (CBT) or Interpersonal Psychotherapy (IPT). CBT is a directive therapy that gives children a more realistic approach in their thinking patterns. It gives them tools to build behavioral competence by graduated exposure. It assumes that anxiety disorders are largely learned, therefore they can be unlearned.
There are 4 main components to CBT.
1.Education – giving parents and youth the information they need to hep normalize the fear of dealing with the illness.
2. Behavioural Exposure – Physician guided therapeutic approach which is responsible most of the treatment outcome.
3. Cognitive Self-Control – Helping youth and children identify the difference of emotional thinking and critical thinking.
4. Somatic Self-Control – Controlled breathing, recognizing anxiety and depression through memory, and they also learn detailed muscle relaxation techniques.
IPT is similar to CBT but it focuses more on interpersonal problem solving.
Parents can also help by encouragement, remaining calm and confident, reinforcing the CBT and or IPT, follow normal routines, help set goals, think positive, and increase socialization. If this alternative does not work for the child or youth, there is still another alternative that can be explored before succumbing to medication use which brings us to our next point – Holistic alternatives