130717 Depression in Chidlren.It’s easy to feel ambivalent about psychotropic medication.  Pharmaceutical manufacturers, insurance companies, and the American Medical Association are some pretty undesirable sorts, and their misdeeds are well documented.  In 2007, Purdue Pharma, its president, top lawyer and former chief medical officer paid $634.5 million in fines for claiming that Oxycontin wasn’t dangerous. There have been reports of unethical experimentation and clinical trials by pharmaceutical companies in Africa using spurious informed consent methods.  And insurance companies? Don’t get me started.  Michael Moore did a scathing expose of this unholy trio in the documentary Sicko.

But it’s also true that psychotropic medications serve a valuable role in the treatment of mental illness.  With suicide as the 10th leading cause of death in this country, and depression affecting one in five people sometime during their lifetime, we can’t let our prejudice get in the way of saving lives. 

Our antipathy toward psychiatric medication is never more acute than when we talk about treating our children.  The field suffered a setback several years ago when it was suggested that the use of antidepressants in teenagers actually increased the risk of suicide.  The correlation was not conclusive, however: a 2003 study by the U.S. Food and Drug Administration (FDA) found that no completed suicides occurred among nearly 2,200 children treated with SSRI medications. But about 4 percent of those taking SSRI medications experienced suicidal thinking and some suicide attempts, twice the rate of those taking placebo.  Still, everyone agrees that the risk should not be ignored.

130718 depressed teenAnother complicating factor is that – as every parent of a teen knows – emotional lability is one of the hallmarks of adolescence.  So what do we expect “normal” to look like in our youth?  Certainly we don’t want to medicate away developmentally appropriate teenage angst because we find it inconvenient.  But sadness and depression are not synonymous, and we ignore depression in children at their peril.

This week, the science of brain chemistry helped dislodge some of the fear and prejudice related to depressed kids.  The news, published in the July issue of The Journal of the American Academy of Child & Adolescent Psychiatry, stunned lay observers and professionals alike.   Using functional magnetic resonance imaging, researchers have found brain changes in preschool-age children with depression that are not apparent in their nondepressed peers. Researchers examined 23 children 4 to 6 years old who had been diagnosed with depression and 31 of their healthy peers. Researchers used well-validated tests to diagnose depression.  None of the subjects were taking antidepressants.

130718 teen depressionThe children underwent M.R.I. brain scans while viewing pictures of happy, sad, fearful or neutral faces. The researchers found that the right amygdala and right thalamus activity was significantly greater in the depressed children than in the others, a finding that has also been observed in depressed adolescents and adults.  This may be the earliest evidence of alterations in functional brain activity in depression using Magnetic Resonance Imaging.  The findings also raise the intriguing possibility that disrupted amygdala function is a depression-related biomarker that spans development.

As an addictionologist, this study is particularly fascinating to me.  Successfully treating depression at an earlier age might prevent teens from self-medicating with alcohol and drugs and progressing into active addiction.  What an exciting time it is to be working in this field!

If you are concerned that your child might be depressed and want to know what do to, read on.