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Depression, suicide rates have increased among our young

By Cynthia Beaudette of the Muscatine Journal

MUSCATINE, Iowa - Strong families, a feeling of acceptance, physical exercise and a variety of interests.

Two Muscatine psychologists say these factors enhance the quality of life for children and adolescents.

However, if a young person becomes one of the 3 to 5 percent of U.S. children who suffer from depression, psychiatrists and psychologists may recommend prescription drugs that target the biochemical triggers of this medical problem.

More kids depressed

According to the National Institute of Mental Health (NIMH), depression in children and adolescents has increased throughout the past several decades and the suicide rate in young people has increased dramatically.

By 1996, suicide was the third-leading cause of death in 15-24-year-olds and the fourth-leading cause among 10-14-year-olds.

Dr. David Fassler, trustee at large for the American Psychiatric Association, said that, in recent years, more than 500,000 depressed children attempt suicide each year in the United States. Their need for professional help may include a prescription for an antidepressant.

Sieg Hoppe of Family Resources in Muscatine and Ruth Evans, owner of Four-Seasons Counseling Clinic, are two licensed psychologists who work in Muscatine. Both say they are seeing more children and teens who are dealing with depression, and they do recommend prescriptions for some of their young patients in combination with other forms of therapy.

While they had no current local statistics, Evans said that, in 2001, there were at least 1,883 U.S. children ages 10-19 who committed suicide.

Disturbing link

Evans and Hoppe answered the Muscatine Journal's questions about prescribing antidepressant medication following recent reports that Food and Drug Administration officials suspect a link between the use of antidepressants and increased suicidal thoughts in young people.

A Columbia University study indicated that 2 to 3 percent of young people using antidepressants such as Luvox, Effexor and Paxil have increased suicidal thoughts.

"The jury is still out," said Hoppe about the effects of those medications.

"But it is fair to say we're over medicating and there are better, healthier solutions. Almost all medicines, with the exception of antibiotics, treat the symptoms but not the cause."

Hoppe also said that sometimes those symptoms are severe enough to warrant a faster form of relief than

therapy can provide.

Another study's view

Evans also referred to results gleaned from the Treatment for Adolescents With Depression Study (TADS), coordinated by Duke University Medical Center and sponsored by the National Institute of Mental Health.

The results, posted in August, apply to the antidepressant fluoxetine, or Prozac, that was tested in this study and cognitive-behavioral therapy (CBT).

Participant groups were tested in four different ways.

The study showed that 71 percent of those receiving medication and therapy improved after 12 weeks. Medication alone produced a success rate of 61 percent. Those receiving therapy alone improved at a rate of 44 percent.

Another group of patients received a placebo, which is a pill that actually has no medical properties. The persons in a placebo study do not realize they are receiving a placebo. These groups are used to determine whether or not a form of medication has a high rate of suggestive properties. This placebo group had the lowest rate of improvement at 35 percent.

A cautious approach

Evans and Hoppe recommend medication when it is warranted but combine it with regular therapy sessions and close monitoring.

Psychologists, unlike psychiatrists, do not prescribe prescription drugs, but they can call a patient's medical doctor and ask that professional to order a prescription.

Most students can take antidepressant medications at home, Hoppe said, because they are usually dosed in the morning and evening. However, school officials should be made aware the student has started medication so they will be alert to any significant change in the child's behavior.

Hoppe said he also places patients on an exercise program because exercise can help create chemical changes in the brain similar to those initiated by prescription drugs.

Evans and Hoppe said antidepressants can be effective in lifting a person from depression but they should be prescribed judiciously for children and adults.

"A person using antidepressants needs to be monitored," said Evans. "But it would be a shame not to continue using these medications. They do have their use."

Evans pointed out that none of the children referred to in the Columbia study actually committed suicide, but for every 100, there were two or three that had heightened suicidal tendencies.

And both psychologists said it isn't unusual for depressed persons of all ages to have suicidal thoughts.

"Some experts say the natural course of depression can increase the tendency of suicidal thoughts and that's not always because the person is using medication," said Evans.

Hoppe said the target of antidepressant medication is to increase neuro transmitters to the brain that deliver chemicals such as serotonin and norepinephrine.

As these chemicals increase, the person's energy level follows suit.

"A person finally gets the energy to get out of bed but they don't feel any better," said Hoppe. "It's possible that the antidepressants affect the vegetative symptoms first and give people the energy to carry out suicide."

Evans said family members sometimes look at the increased physical activity as a sign that the person is coming around. But in fact, the individual may be more focused because he or she now has the energy to concentrate on a plan to end their pain.

"When we look at people who commit suicide, family members sometimes will say, 'They were just starting to feel better,'" said Evans.

The key factors

Both psychologists said the family of a child battling depression can be one of the most important parts of a return to a brighter outlook on life.

"Adolescents don't have life experiences that give them the coping mechanisms we have," said Hoppe. "A 16-year-old breaks up with a girlfriend or boyfriend for the first time and that was the love of their life. They don't understand it."

Moving away from the television and closer to one another can promote the kind of conversations that allow teens to develop trusting bonds and an emotional safety net with their parents and caretakers, the psychologists said.

"The media often dwells on violence or problems. We even see beheadings on TV now," said Evans. "And in many homes, there's a TV in everyone's bedroom."

Evans also cited an increased incidence of street drug use among parents as a factor that can contribute to a child developing depression.

"We're seeing more second and third-generation people using these drugs," said Evans. "It creates instability in the family."

Hoppe said more mental health professionals are also studying the long-term effects of a parent's street drug use on unborn children.

Although the evidence of the effect of drug abuse is often evident in a baby born to a mother who used drugs during pregnancy, there are also concerns that parents of both sexes may damage their own genetics by abusing drugs and that may affect children born to them.

Evans and Hoppe said they strive to assist families in developing stronger relationships that extend into the next generation.

Contact: 563-263-2331 Ext. 323. E-mail