Starting medications
Unlike many other types of medications, antidepressants often take several weeks to reach peak effectiveness. This means that psychiatric symptoms are unlikely to remit immediately. Therefore, parental vigilance and regular psychotherapy should not be decreased until substantial improvement and prolonged stability of the adolescent’s condition has been achieved.
Furthermore, research has shown that antidepressant medication may lead to increases in suicidal thoughts and behaviors for a small minority of the population (Reeves & Ladner, 2010). Even though it is very unlikely to occur for most people, because the negative consequences would be so serious, it is worth discussing. Increased suicidality is more common in individuals who experience the following symptoms soon after starting on an antidepressant:
- Uncomfortable energizing/activating symptoms (such as increases in restlessness, agitation, jitteriness, inner tension, irritability, anxiety, panic, hostility, hypomania, mania);
- Insomnia;
- Increased impulsivity; or
- Worsening of depressive symptoms
Therefore, if your child reports increased suicidality or any of the changes mentioned above, please relay this information to their psychologist and to their prescribing physician immediately. It is particularly important to monitor patients for these changes at the start of their medication treatment (especially in the first 10 days) and whenever dosage changes occur. Visits with the prescriber should be frequent at the start of pharmacological treatment. Regular visits with a therapist during the titration period will also be beneficial, and will help to assess and mitigate risk.
Regular usage
Psychiatric medication should always be taken exactly as prescribed. Failing to take these medications consistently and as directed can result in suboptimal outcomes or even worsening of symptoms. Adolescents may have difficulty remembering to take their medications regularly, so parents may need to develop a system for motivating and keeping track of usage if their child cannot handle this responsibility on their own. Most adolescents will need help to ensure that prescription refills are ordered on time so that they do not run out of medication. If they do unexpectedly run out, contact your pharmacist to see if an emergency supply can be temporarily provided until a refill is written by their doctor. Some adolescents may also be likely to experiment with taking a higher dosage than prescribed or sharing their medications with friends. This should be discouraged and monitored by parents.
Drugs and alcohol
It is generally best to avoid drugs and alcohol if you are depressed or anxious, as these substances often aggravate symptoms. Furthermore, they may interact negatively with antidepressant medication. Individuals taking an antidepressant should ask their prescribers whether using drugs or alcohol while on their medication would be unwise or dangerous.
Discontinuing medications
Individuals who want to go off of their medications should discuss this with their prescriber and work with them to create a specific plan. Abrupt discontinuation is often not recommended with this class of medications, and may lead to symptom rebound. Discuss with your child’s doctor.