Antidepressant can be a scary word. This is especially true for children, teens, and their parents. Although I personally cannot prescribe medication in my practice, I often make referrals for medication consults, and I talk many families through their concerns about medication. Today, I want to address some of the concerns I have heard related to Selective Serotonin Reuptake Inhibitors (SSRIs), commonly known as antidepressant medications.
I shared a version of this piece through my group practice a few years ago, but the conversation is still relevant. It is written for parents seeking information about medication for their children, but this information is relevant for anyone considering antidepressant medication.
Talk to your primary physician for more information on antidepressant medication.
What if the medication changes my/my child’s personality? The goal of any psychotropic medication is not to change who you are, but to treat the mental illness that prevents you from being yourself. I have spoken before about Van Gough, who created some of his most famous paintings while in treatment for his mental illness. This suggests to me that he was his most true self when his underlying illnesses were being treated. Think about it like this: would you tell a diabetic that the insulin changes who they are? Of course not! SSRIs just treat a different organ.
What about side effects? Of course, any medication comes with a risk of side effects. In the case of SSRIs, these risks are relatively mild. The good news is, there are several antidepressant medications that are FDA approved, so if one medication causes sleep problems, there is a high chance that your physician can prescribe a different medication that helps you without this side effect.
It can take a few trials to figure out which SSRI is the best fit, but most people are able to find something that benefits them. New research in genetic testing will make this even easier in the future. Please keep open communication with your prescriber about any side effects you experience.
I don’t want a Band-Aid solution, I want to address the underlying problems. Fantastic! Although there is no one universal treatment plan for any mental illness, I rarely recommend that someone go on antidepressant medication without ongoing therapy intervention. Research of treatment outcomes suggests that a combination of medication and therapy is most beneficial. Not only does this help you work through symptoms on two levels (emotional and physiological), but your therapist can continue to monitor your response to the medication, give you objective information about what to expect, and monitor for side effects. Medication isn’t a Band-Aid for mental illness, especially when combined with therapy.
How long will it take before I start to feel different? SSRIs can take up to four to six weeks before you fully feel their effect. This is because of complicated brain chemistry, which someone with a medical degree can speak to much more effectively than I can. I always advise that people be patient and allow themselves to experience the full effect of the medication (barring side effects that they deem unbearable, of course). Ask your prescriber any and all questions you have about your medication and its effectiveness.
How long will my child have to take medication? It varies. For some people, taking an SSRI for a year or two helps their brain learn how to properly balance the neurotransmitters that affect mood. After a period, they can taper off the medication and not experience symptom relapse. For others, they benefit from the medication for decades at a time. Some people take SSRIs for a while, taper off, and then feel that they need them again in the future. All of these situations are okay. It boils down to what the individual finds helpful, and what they and their doctor decide is best based on their needs.
What happens when I stop taking an SSRI? SSRIs are not psychologically addictive. However, because the medication builds up in your system, it is important to taper rather than going “cold turkey” from an SSRI. Although withdrawal from SSRIs is not dangerous, it can be unpleasant and can include head zaps, insomnia, or flu-like symptoms lasting one to two weeks. Always consult your prescribing physician about changing doses or stopping medication.
I read that SSRIs can cause suicidal thoughts in teenagers. This is a very, very valid concern, and I commend parents for putting their teen’s safety first. SSRI medication comes with a warning that they “may cause suicidal thoughts or actions,” particularly in teenagers. How can medication for mental illness cause suicidality? Suicide is linked to antidepressants because fatigue is a symptom of depression. If someone feels that their life is not worth living but lack the energy to act on their thoughts, an SSRI might increase their energy level before the self-harm thoughts are treated. So, someone who has passive suicidal thoughts might start taking an SSRI and suddenly have the motivation to act on them.
SSRIs will not magically cause you to want to die, so people with no history of passive suicidal ideation are low risk for these behaviors. However, if your teenager has a history of suicide behavior or talks about wanting to die, they will need to be closely monitored during the early stages of treatment. This is typically managed by creating a safety plan, fostering open communication, and committing to ongoing therapy. This does not mean that they can’t benefit from SSRI medication, but the family and treatment team will need to be cautious.
Some people might experience intrusive thoughts as a medication side-effect; sometimes, this can mean they experience intrusive suicidal thoughts. Usually, these thoughts are distressing and not something that the person wants to act on. If your child reports this side effect, talk to their physician right away. They might need an adjustment to their prescription.
SSRI medication, when appropriate, can be a beneficial part of a treatment plan for mental illness. Education is an important piece in helping families and teenagers decide if this is an avenue that they want to pursue.