![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by nellie7 on March 29, 2009, at 7:29:13
Hi,
My 12 year old niece suffers from chronic dysthymia and has occasional suicidal thoughts. It has been recommended that she start taking celexa 20 mg.
Any thoughts about the effect of SSRIs on developing brains?
Thanks,
Nellie.
Posted by bleauberry on March 29, 2009, at 8:12:34
In reply to celexa for 12 year old?, posted by nellie7 on March 29, 2009, at 7:29:13
> Hi,
> My 12 year old niece suffers from chronic dysthymia and has occasional suicidal thoughts. It has been recommended that she start taking celexa 20 mg.
> Any thoughts about the effect of SSRIs on developing brains?
> Thanks,
> Nellie.I believe Prozac is the only one FDA approved for youngsters? But I'm sure there are many adolescents on all sorts of antidepressants.
Clinical studies show a general trend that younger folks respond more favorably to serotonin meds while older folks respond more favorably to norepinephrine meds. Celexa is a serotonin med.
20mg is a lot for a 12 year old, assuming the body size is small.
Long term damage on a developing brain? Well, who knows. Nobody. It hasn't been studied. And probably won't be, because if the results were not favorable then a whole lot of billion dollar companies and executives and the FDA would be in big trouble.
Anecdotal evidence here at this board suggests that longterm changes do occur regardless of age, varying from person to person.
It has to be considered that depression itself causes negative disruptions and changes in the brain, hormones, nervous system, and immune system. So it is a balancing act, meds versus no meds, risk versus benefit. I think the decision has to be made with the best clinical intuition at the time on a case by case basis.
If Celexa is started, I would suggest cutting the pills in half for a 10mg dose instead of 20mg. Or even better, quarters for a 5mg dose. My personal theory is that the suicide warnings on all antidepressants are partially due to traumatic things being done and felt when biochemistry is changed too much too fast. Regardless of the med in question, for a youngster I would be on the conservative side, starting at a quarter of the normal starting dose and staying there for at least 6 weeks before considering adding another quarter.
My general opinion is that while all of these meds are like shooting darts at a target while blindfolded, Zoloft has better odds of hitting a bullseye than Celexa does, when speaking of dysthymia. But, any of them might work, and any of them might not.
A final note, and this is very important. Many doctors will scoff at it, but I am serious as a heart attack. OK? This is not just my own experience, but that of my expert doctor who has had a lot of very tough cases. Here it is. Insist on brand medication. Refuse generic. If the child does well, you can always try a switch to generic months later. But if the trend that is often seen holds true, the child will deteriorate on the generic after being stable on the brand. If you get nothing else from this post, just remember, brand only. No generics. Pay the extra money. It is worth it for your child.
I'm not trying to be discouraging or encouraging, but just trying to paint a realistic picture of the way it is.
Posted by Alexanderfromdenmark on March 29, 2009, at 12:22:52
In reply to celexa for 12 year old?, posted by nellie7 on March 29, 2009, at 7:29:13
I'm not an expert, but to be honest, I would keep your 12 year old far away from Pmedication until she is at least 21 years old. SSRI's can stunt growth through lower levels of human growth hormone, and cause low testosterone. I think it's vital not to infere in this process, espscially in her age. Also, simply interefering with her neurochemistry in that age is really risky. Find a good CBT therapist for your niece or exhaust your options before you use medication.
Posted by Phillipa on March 29, 2009, at 12:27:10
In reply to Re: celexa for 12 year old?, posted by Alexanderfromdenmark on March 29, 2009, at 12:22:52
I agree with above poster. Phillipa
Posted by Zana on March 29, 2009, at 14:34:24
In reply to Re: celexa for 12 year old?, posted by Phillipa on March 29, 2009, at 12:27:10
What a terrible delimna. I would agree that you should try therapy first. I know CBT is the most studied treatment for depression but I am a self psychologist myself and feel strongly that relational therapy, therapy where the relationship is the curative factor, is the way to go. It must be very hard to see a child suffer this way. I hope you can find her a rherapist who is emotionally available, someone your neice can feel close to and emotionally held by. She is lucky to have your concern.
Zana
Posted by nellie7 on March 29, 2009, at 15:35:55
In reply to celexa for 12 year old?, posted by nellie7 on March 29, 2009, at 7:29:13
Posted by herpills on March 29, 2009, at 19:34:17
In reply to Re: celexa for 12 year old?, posted by bleauberry on March 29, 2009, at 8:12:34
>
> I believe Prozac is the only one FDA approved for youngsters?
>Just went to Lexapro website today, says it is now approved for acute and maintenance treatment for major depression in adolescents 12 to 17 years old...
herpills
Posted by desolationrower on March 30, 2009, at 0:20:35
In reply to Re: celexa for 12 year old?, posted by herpills on March 29, 2009, at 19:34:17
i think other than stimulants or antiepiletics, there is not enough evidence of saftey or efficacy, and enough animal evidence about problems from immature brains being given drugs, that it should be avoided except a last resort.
-d/r
Posted by fakecanuck on April 2, 2009, at 15:07:16
In reply to Re: celexa for 12 year old?, posted by desolationrower on March 30, 2009, at 0:20:35
> i think other than stimulants or antiepiletics, there is not enough evidence of saftey or efficacy, and enough animal evidence about problems from immature brains being given drugs, that it should be avoided except a last resort.
>
> -d/r
Medicine can permanently alter the body regardless of age. Definitely, long-term and in-depth studies are still wanting.Growing up ill can deform a child, too, though.
I was that child. My parents did not treat me at 10. They were somewhat in denial, and as a child, I didn't know how to stick up for how I felt.
Luckily, my childhood suicide attempts were not successful. Yes, multiple, because I hid them from my parents because they seemed ashamed at how I felt, anyways. It should never have have had to reach that point.
Unfortunately, I knew others in the same boat.
There were permanent effects to growing up unmedicated. It effectively "trained" my brain to feel defeated, fearful, despairing, and in intense pain. I came to expect to suffer somatic symptoms. I don't fight things I should fight. Including for recognition and plain fair treatment that would have advanced my career. Including the spells of insomnia and other symptoms that became recurring before I hit 21.
I have been trying to re-train myself for years now. I am tough, so I have had success. :) But I suspect some bad mental health habits may have become permanently lodged in my personality. When I read about how the brain can be physically shaped by how we think, I believe it.
So... I wouldn't be prejudiced for or against medicine for a 12 year old, if I were you. But go in with copious research, and your eyes very wide open. It seems that the biggest problem with prescribing (or not) psychoactive medicines to children is that they are left alone.
Posted by desolationrower on April 2, 2009, at 16:23:12
In reply to Re: celexa for 12 year old?, posted by fakecanuck on April 2, 2009, at 15:07:16
ran across this today, the TCA didn't cause permanent problems
Development Produces Delayed, Persistent Perturbations of Emotional Behaviors in Mice
Mark S. Ansorge, Emanuela Morelli, and Jay A. Gingrich
Sackler institute for Developmental Psychobiology, Division of Developmental Neuroscience, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York 10032
Correspondence should be addressed to Jay A. Gingrich, Sackler Institute for Developmental Psychobiology, Division of Developmental Neuroscience, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032. Email: jag46{at}columbia.edu
Serotonin (5-HT) acts as a neurotransmitter, but also modulates brain maturation during early development. The demonstrated influence of genetic variants on brain function, personality traits, and susceptibility to neuropsychiatric disorders suggests a critical importance of developmental mechanisms. However, little is known about how and when developmentally perturbed 5-HT signaling affects circuitry and resulting behavior. The 5-HT transporter (5-HTT) is a key regulator of extracellular 5-HT levels and we used pharmacologic strategies to manipulate 5-HTT function during development and determine behavioral consequences. Transient exposure to the 5-HTT inhibitors fluoxetine, clomipramine, and citalopram from postnatal day 4 (P4) to P21 produced abnormal emotional behaviors in adult mice. Similar treatment with the norepinephrine transporter (NET) inhibitor, desipramine, did not adversely affect adult behavior, suggesting that 5-HT and norepinephrine (NE) do not share the same effects on brain development. Shifting our period of treatment/testing to P90/P185 failed to mimic the effect of earlier exposure, demonstrating that 5-HT effects on adult behavior are developmentally specific. We have hypothesized that early-life perturbations of 5-HT signaling affect corticolimbic circuits that do not reach maturity until the peri-adolescent period. In support of this idea, we found that abnormal behaviors resulting from postnatal fluoxetine exposure have a post-pubescent onset and persist long after reaching adult age. A better understanding of the underlying 5-HT sensitive circuits and how they are perturbed should lead to new insights into how various genetic polymorphisms confer their risk to carriers. Furthermore, these studies should help determine whether in utero exposure to 5-HTT blocking drugs poses a risk for behavioral abnormalities in later life.
-d/r
Posted by fakecanuck on April 2, 2009, at 16:59:11
In reply to Re: celexa for 12 year old?, posted by desolationrower on April 2, 2009, at 16:23:12
d/r: Have you seen anything similar for treatment of subjects that were already showing depression at an early age? You seem to have luck with articles!
That's something I've wanted to see -- it's just that a baseline of non-depressed young animals taking antidepressants doesn't seem like a good comparison, because non-depressed young humans wouldn't be taking antidepressants in the first place... I want to see this experiment but with a different control group. Not that I know how you would even judge depression in 4-day old mice, heh!
Posted by desolationrower on April 2, 2009, at 19:30:55
In reply to Re: celexa for 12 year old?, posted by fakecanuck on April 2, 2009, at 16:59:11
but ADs aren't normalizing things, at least initially, so you may jsut end up with twice as much problems. What i remember of human adolescent studies is that placebo is very high. Things like therapy will probably work better, both because habits are less entrenched, and self-regulatory systems aren't as well developed, so the the cognitive and behavioral things have more room to improve.
-d/r
Posted by fakecanuck on April 2, 2009, at 23:18:26
In reply to Re: celexa for 12 year old?, posted by desolationrower on April 2, 2009, at 19:30:55
Well, I did hear the therapy push often, too. Wish it would have worked for me. At 17/18, it was just someone telling me a bunch of things I already knew, but I just couldn't stop my brain from doing what it was doing. I wasn't running the show any more. Huge disconnect from what I suspected was real and what I was feeling. But it was nothing more than suspicions. Because at that point, I'd been in the hole for as long as I could remember, and I couldn't remember what "normal" was supposed to feel like. Like describing the color of the sun to someone blind.
Only when my parents accepted that I needed stronger help did I get any better. Celexa finally interrupted the spiral long enough for my own thoughts/therapy to do some good. I finally had solid evidence that the pain could really stop, and how I could think when it did. Just even being able to envision myself some other way than drowning helped tremendously. It gave me evidence that it really could stop, and there didn't have to be only one way out.
I can definitely see that not every kid's experience would be like mine, and therapy may really work for other kids with less severe cases, maybe with no family history, etc... But I do think that in my case, so much of the misery was just pointless damage. I could have had a childhood.
That kind of call -- how bad is it and what kind of intervention does the kid need -- I don't envy parents that have to make it, but obviously from personal experience I think that at some point, the risk of long-term damage only matters if the kid survives to see the long term.
I kind of like the idea that you (I think) were alluding to before: if it is Celexa specifically that is a worry, but suicide is a definite threat, maybe try some other medicine with therapy.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.