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CNN Sunday Morning
Weekend House Call
Aired August 31, 2003 - 08:29 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Good morning and welcome to WEEKEND HOUSE CALL. It's time to go back to school. And while most kids may be depressed that summer's over, it's a good idea to watch your child closely to see if the back-to-school blues last longer than just a couple weeks. Depression is being diagnosed in more and more kids, today, and as Dr. Sanjay Gupta reports, teenagers can be the hardest hit.
(BEGIN VIDEOTAPE)
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT (voice-over): 18- year-old Jake Novak knows the darkness that severe depression brings.
JAKE NOVAK, SUFFERS FROM DEPRESSION: I just didn't want to live anymore. I took a box cutter to my left wrist one evening, it was a Sunday night. And, the shock and the horror just looking at myself and what I'd done to myself, was enough to make me stop the bleeding.
GUPTA: It's more than a bad test score or a fight with friends. Severe depression is a biochemical change in the brain that affects nearly 10 percent of teenagers in the U.S. And Dr. Cynthia Pfeffer, a specialist in teenage depression, says every years, three to 4,000 teens kill themselves.
DR. CYNTHIA PFEFFER, WEILL MEDICAL COLLEGE: Depression we know, is amongst the most important misfactors for suicide and non-fatal suicidal behaviors.
GUPTA: Shortly after Jake's attempt at suicide, a fellow classmate killed himself.
NOVAK: My heart sank and I wasn't sure what to think at that point because I saw somebody else go through the same thing I had gone through. I got to school the next day and saw everybody crying and saw how upset everyone was.
GUPTA: That devastation prompted Jake to launch a group called SWAT, Students Working Against Depression.
NOVAK: I didn't know what depression was. I thought -- man, I'm really sad. I just must be this loser that doesn't -- you know, get to be happy. I've been told left and right about HIV, AIDS, where to go if I want to become openly homosexual and nobody's ever told me about depression.
GUPTA: Through awareness, SWAT is showing teenagers it's OK to admit they have depression.
NOVAK: People say -- you know, you're not supposed to talk about depression and I say -- why not? And, I haven't heard a good answer yet.
GUPTA: Pfeffer says depression is under-recognized in teens, but there are symptoms.
PFEFFER: The hallmark is sad, low, blue mood and another hallmark is loss of interest in usual activities, and specifically, teenagers who may not like to do their usual activities.
GUPTA: Other warning signs include sleep disturbances, appetite and weight changes, and difficulty concentrating. And, when these symptoms last beyond two weeks, it's time to get treatment. That's what SWAT is all about. To help students suffering depression before they take their lives.
Dr. Sanjay Gupta, CNN, reporting.
(END VIDEOTAPE)
COHEN: More than three million teenagers suffer from depression and a whopping 80 percent never get help. That's mainly because of the stigma associated with mental illness. Most parents and kids simply don't want to acknowledge there's a problem. The National Institutes of Mental Health estimates 8 percent of teens and 2 percent of children, some as young as age 4, have symptoms of depression. Early onset of depression in kids has become increasingly common. No one knows whether there are actually more depressed kids today or if there's just a greater awareness of the problem. But, some researchers think that a high divorce rate, rising school expectations, and social pressures may be pushing kids over the edge.
We'll talk about troubled teens first and look at younger children struggling with depression later in the show. We'll also be talking about treatments. Are medications the way to go, or is therapy the right way or both?
Call us with your questions about your kids. Our number is 1- 800-807-2620 or you can e-mail us as HOUSECALL@CNN.com.
To help answer our questions, Dr. Harold Koplewicz joins us from New York City, he's a child psychiatrist and author of the book "More than Moody: Recognizing and Treating Adolescent Depression."
Thanks for joining us, Doctor.
DR. HAROLD KOPLEWICZ, AUTHOR "MORE THAN MOODY": Good morning.
Good morning.
COHEN: Our first question, actually, has to do with the title of your book. Renee, from New Jersey, is on the line.
Welcome to WEEKEND HOUSE CALL, Renee. RENEE, NEW JERSEY: Good morning. I'm the mother of a teenager and I have two younger children. My question is -- what are the signs of depression in a teacher -- teenager versus their normal mood swings? And, part two of that question -- is the answer always medication? Because, when you talk to a doctor, usually that's the first thing these days, the insurance wants to give them medication as opposed to counseling.
KOPLEWICZ: Well, I think the most important part, for us as parents, is to recognize that teenagers will get moody. There's no doubt there are lots of things going in their lives, particularly the fact that they have to adjust to separating from their mom and dad, more or less. They have to start getting educational or vocational goals, they have to figure out sexual orientation, there's a whole bunch of adjustments to puberty. So, clearly, all those stressors make teenagers more moody than kids or than adults. But, it's very different than depression. Depression, while misused all the time, because we say "It's going to rain tomorrow on Labor Day, I feel so depressed," is really not what we're talking about, that's demoralization.
Depression is when it lasts for more than two weeks and you see a real change in your teen's behavior, so they're no longer passionate about the music they cared for, their sleep pattern has changed dramatically, their concentration has changed, and their big change is their mood is chronically irritable, versus depressed, they're cranky and nasty. And, that's a very important distinction to make for parents, because they're very good at telling us when their teens have changed their behavior. We don't think teens, Renee, should be the ones who can tell -- the teens are the only ones who can tell us how they feel, but parents are the ones who can tell us if they see a change in the way they've behaved before.
COHEN: Dr. Koplewicz, Renee mentioned something I've heard from many child psychologists and psychiatrists, which is that the insurance company will pay for the medicine, but they won't pay for the therapy or they won't pay for very much. Is that a real problem?
KOPLEWICZ: Right. Well, I think the big problem is that in real estate, we say the three most important criteria are location, location, location, well in child mental health, it's diagnosis, diagnosis, diagnosis. So, the first thing you want is to make sure you took your teenager to qualified individual, that's a child psychologist or a child psychiatrist.
And, once they've decided what your child has, and you agree with them, well, there are really two options. And, parents have to be great advocates for that is kids, because if your child has a mild to moderate depression, there's lots of evidence that cognitive behavioral therapy, CBT, works and it works in 12 to 16 sessions, and in fact, after four weeks, your child or teenager should look better, and if your teenager is getting better with that treatment, then that treatment should be continued. If your child or teen is not better after four weeks, then medicine should be added.
And, the fact that an insurance companies can dictate to us when they will and won't, really requires then, parents to be terrific advocates for their kids and get on the phone and complain that the first treatment of choice for them and for their teen may be CBT. But, it's not average psychotherapy, it's a type of psychotherapy best given by psychologist, but people who are trained in this technique.
COHEN: We have a question from Ann from Philadelphia, who recently took her child to a practitioner.
Ann, go ahead with your question.
ANN, PHILADELPHIA: Good morning. Recently, I took our teenage daughter to a newly established family doctor. And I mentioned to this doctor that I thought our daughter might have some of the symptoms of depression. She -- this doctor quickly issued a prescription for the medication called Paxil, and so this takes me to my two-part question. Is there a new way of thinking and dealing with mental health issues, because I always thought that therapy had to be part of the medication process? Second question is -- I have recently read that Paxil might be very dangerous, in particular for teenagers. Could you give me some information regarding these two concerns?
KOPLEWICZ: Sure. Well, it's very disconcerting when you hear that a teenager goes to see a physician and a mother mentions in passing that they show signs and symptoms of depression, and a prescription is written. That would be like saying that -- you know you go into see a doctor and you mention that you have a rash, and they start treating you for cancer -- skin cancer. In other words, just because you have a set of symptoms doesn't mean you have a disease. And, so the diagnostic process takes a lot of time. It usually takes up to two hours at the very best when you have a good historian; you have a parent, and a cooperative teenager to talk to you about what's been going on. So, that's the first part of the story that's troubling. But, the second part is about this controversy about Paxil.
Paxil is one of these medicines that are called SSRIs, Selective Serotonin Reuptake Inhibiters. And, they really are quite remarkable compared to the old antidepressants which had a lot more side effects and which also were potentially lethal, so that if you overdosed on the old antidepressants, the tricyclics, you literally could cause death, and they were never found to be helpful in teenagers.
The new antidepressants, the SSRIs, which include Prozac, Paxil, Luvox, Celexa, Lexapro, all of tease medicines that we've heard about, these seem to be relatively safe. They have nuisance side effects. But, there has been some controversy about Paxil, particularly a study that was never released, but that the British have decide, based on a study of looking at teenagers who were depressed, that the kids receiving Paxil...
COHEN: Dr. Koplewicz, as we'll be talking about Paxil as we come back, because it was an important letter issued by the FDA and we want to get to that.
KOPLEWICZ: Great. COHEN: Callers, in the meantime, stand by while we take a break. When we come back, children and depression, the warning signs are a little different for younger kids. We'll tell you what to look for and answer your questions.
Call us at 1-800-807-2620 or e-mail us at housecall@CNN.com. We'll be right back.
(COMMERCIAL BREAK)
COHEN: Did you know the number of children in the United States prescribed medications to treat depression, attention deficit disorder, and other behavioral conditions nearly tripled between 1986 and 1996? That's according to a study from Columbia University in New York.
This is WEEKEND HOUSE CALL and we're talking about kids and depression. Call us with your questions, our number is 1-800-807-2620 or you can e-mail us at housecall@CNN.com
While we are getting phone calls lined up, let's check the "Daily Dose Health Quiz." Today's question: Among teenagers who's more likely to develop depression, girls or boys?
We'll have that answer in 30 seconds, so stay with us.
(COMMERCIAL BREAK)
COHEN: Checking our health quiz, we asked among teenagers who's more likely to develop depression, girls or boys? The answer: Girls are twice as likely to develop depression. Studies suggest if girls don't receive treatment in adolescence it's likely their depression could continue into adulthood.
This is WEEKEND HOUSE CALL and we're talking about kids and depression. The symptoms of childhood depression are little different from teenagers. Look for frequent complaints of vague physical ailments like, headaches, stomach aches, and fatigue, sudden drop in school performance or lack of interest in play, excessive concern with failure and frequent irritability or crying. Lack of social interaction and boredom are also warning signs, as well as attempts to run away from home or reckless behavior.
Dr. Harold Koplewicz, a child psychiatrist and director of the New York University Child Study Center, joins us.
Doctor, do children have all or just some of these symptoms to be diagnosed with depression?
KOPLEWICZ: They need to have some of them, but the more important part is it has to last for several weeks and parents have to see a change from baseline, so what we want is we want all parents to know their kids. We want them to know how their kids sleep, how their kids eat, how their kids play, what is their temperament or mood, so they can see when there's this shift and change in their behavior, because that's the first red flag. COHEN: We have a question, now for -- in an e-mail from Michele in Minnesota. She asks, "Are the symptoms of depression the same in children as adults? What is the youngest age that a child might have clinical depression? In other words, if a young child is show symptoms, at what point do you seek medical help or do young children generally come out of it on their own?
KOPLEWICZ: In general, we see that depression usually occurs after children reach puberty. So, you're much more likely to get depression when you're a teenager than you are as an adult or even a child. But, children are capable of having depression. Very often, it looks like anxiety, they'll be afraid of going to school, they'll be overly self-conscious about what other people think of them, they'll have unrealistic worries about the future. And again, what you really want to wait for is around two weeks or three weeks, but don't be fooled, most parents will keep telling themselves, it's just a phase. The worst thing you can do is wait too long. The easiest thing you can do is go to your pediatrician and then go to a child psychiatrist or child psychologist and get an evaluation and be told it's nothing more than just a temperamental change or just part of normal development.
COHEN: We have a phone call now, from Liz in New Jersey.
Liz, welcome to "WEEKEND HOUSE CALL." What's your question for Dr. Koplewicz?
LIZ, NEW JERSEY: Hi, good morning. I have a 5-year-old son who's been diagnosed with depression, post-traumatic stress, ADHD et cetera, and they have him on Zoloft. I'm -- to be honest with you, quite uncomfortable having him on that when I see the commercials that say, 12 and up. What is your feedback on that?
KOPLEWICZ: Sure. I think you should know that most medications that are -- have been developed not only in psychiatry, but even in pediatrics for asthma, were never received approval from the Food and Drug Administration for use under the age of 12. Now, that's not because the Food and Drug Administration was saying "No." It was that the pharmaceutical companies never asked them for permission. So quite clearly, if a child is going to get this medicine under the age of 12, a parent has to be very aware of the side effects and the pediatrician or the psychiatrist who's giving the medicine has to carefully monitor for both the positive and the negative side effects. More importantly, children like that usually need very low doses. Again, it's a rare event when a very, very young child needs an SSRI.
COHEN: Dr. Koplewicz, let's talk a minute about that FDA letter regarding Paxil and children.
KOPLEWICZ: Well, it's based on a study that unfortunately, we can't get ahold of all the data; we just get some of the data. And, essentially, they were looking at teenagers who were depressed and found that the teenagers who got Paxil, three percent of them had suicidal ideation and so some kind of suicidal behavior and the kids who got placebo one percent of them had the same kind of symptoms. So, clearly, it's 3 to 1, but they're tiny, tiny numbers, there were small numbers in the study and we have to remember, unfortunately, that suicidal thoughts are very common among teenagers.
In fact, last year, three million kids, in surveys, admitted they had suicidal thoughts, one million teenagers stated they had a suicidal plan, and last year, 400,000, more than 1,000 everyday, teenagers made a suicide attempt. So, this is truly not a mental health problem, this is a national health problem. The fact that depression affects so many of our teenagers and the worst outcome of depression is when you'd hurt yourself or hurt others.
COHEN: We have an e-mail now, from Lindsay in California, who wants to know, "I suffer from depression, not severe, just mild to moderate. I have two young girls ages four and two. What are the changes they'll inherit my depression, is there anything I can do to prevent it?"
KOPLEWICZ: Well, I think that's a great question because we know that depression has a genetic component to it. There's no doubt it runs in families, yet the average teenager here has depression doesn't have a family member. So, that means it's a very common disorder that affects lots of people in the population, but clearly, if you have depression, that puts your kids at further risk. But it's not Mendelian genetics, it doesn't mean if you have a red and white, you're going to have pink roses. It really -- it's kind of DNA roulette.
But what you can do is you can teach optimism. You can talk to your kids about: What's positive? What's correct, today? What made you happy, today? And, give them models, by the way, of also good social skills, because we know that kids who are socially phobic, kids who are pathologically self-conscious, who can't speak in front of others, are more at risk for depression, as well. And, so kids who learn how to have a conversation with others, how to ask you questions, have a step up from other children.
COHEN: When we come back, how do you help a child who really doesn't want anything to do with you? Some innovative ideas when WEEKEND HOUSE CALL continues.
(COMMERCIAL BREAK)
(NEWSBREAK)
(COMMERCIAL BREAK)
COHEN: This is WEEKEND HOUSE CALL and we're talking about kids and depression. The key for dealing with depression, as parents, is to observe your child's behavior. Know your child well enough to notice weight loss or loss of concentration. The other key thing the parents should do is get professional help for your child, if necessary.
Child psychiatrist, Dr. Harold Koplewicz joins us from New York.
Doctor, we want to talk a bit about being on -- children being on medications. Are they going to be on them for the rest of their life? It's a question from Barbara in Massachusetts, who joins us now. BARBARA, MASSACHUSETTS: Good morning. Hi.
KOPLEWICZ: Hi, Barbara.
BARBARA: My son was diagnosed with depression and ADHD when he was very young. I finally put him on medication about six years ago and I feel that he's gotten worse. He hasn't gone out of the house one day this entire summer, and I -- the doctor doesn't seem to think a change of medication is necessary. What should I do?
KOPLEWICZ: Well, I certainly think that a mother who tells me that their son hasn't gone out of the house the entire summer that's a very, very bad sign and if the doctor doesn't think that it's time for a change in medicine, it may be time for a change in doctors or at least get a second opinion. Because while these medicines are remarkable in the respect that they can really change a child's life or a teenager's life, they don't always work and sometimes you need to monitor the dose, sometimes kids need more or less of the medicines, and sometimes, unfortunately, the medicines stop working. So quite clearly, there's no reason to take medicine unless it's productive and helpful. And so in this case, Barbara, I think you need to get a second opinion and get someone with fresh eyes to take a look and maybe re-diagnose and maybe reassess the treatment.
COHEN: Dr. Koplewicz, when medicines do work do you worry, at all, about the effect they might have on a developing brain when you're giving them to a child or teenager?
KOPLEWICZ: Yeah, well, I think that's definitely one of the sides, Elizabeth, is that we want to worry about what potential side effects are, but what we've learned recently is that depression itself is most probably bad for the brain, and so that if you've had one episode of depression that goes untreated, you're 60 percent more likely to get a second episode and if you have two episodes, you're 90 percent more likely to get a third episode.
So, therefore, leaving a teenager who has depression untreated really gives them a higher risk of lots of bad things occurring. In fact, we know the teenagers who have depression in general are more likely to have depression as adults and are even more likely to become suicidal as adults which means, again, that this depression sensitizes or affects the brain in a very negative way, so it's a cost/benefit ratio. Clearly, no medicine is better than medicine, but for a teenager with depression, medicine can truly be a lifesaver.
COHEN: We have an e-mail now, from Nancy from Iowa, who wants to know, "How can we help teenagers who refuse to accept psychiatric and/or medical treatment for depression?"
KOPLEWICZ: Well, I think that's one of the hardest things. In fact if you remember, when you're a teenager, you don't want to be anything, but just like everybody else. Your mantra is "I am the same," and so admitting you are psychiatrically ill, mentally disturbed is the last thing a teenager wants to hear, especially from their parents. But I think the parent has to talk to their teenager and tell them they're worried about their behavior. That they specifically are concerned that they're sleeping differently, eating differently, that they're having difficulty more in school or concentrating and then say, it's my job, as a parent to make sure you're OK, and if you were bleeding or if you had a rash, I'd take you to a doctor, you're not behaving the same. Let's go together and let's find out what's causing this, really trying to partner with the teenager instead of accusing them of being crazy.
COHEN: That's good advice, Dr. Koplewicz, for parents who have children who aren't so cooperative when it comes to mental health issues.
When we come back, we'll have some final thoughts from Dr. Koplewicz about children, teenagers, and depression.
(COMMERCIAL BREAK)
COHEN: If you'd like more information on kids and depression, check out our Web site at CNN.com/health. You'll find links and helpful related sites. Also, check out the National Mental Health Association's Web site, go to: www.nmha.org and click on the "back- to-school chalkboard icon to find a whole host of suggestions to monitor your child's mental health.
Welcome back to "WEEKEND HOUSE CALL," we've been talking to Dr. Harold Koplewicz in New York City.
Dr. Koplewicz, if your child is given antidepressant medications, as so many children are today, does that mean that they'll be on those medications for the rest of their lives?
KOPLEWICZ: Absolutely not, in fact, the majority of teenagers and kids who respond stay on it for six months to one year. It's the kids who take -- who had two episodes or three episodes of depression that have to be on for much longer. And again, it has to be carefully monitored. But the good news is, depression is treatable. Parents just have to look out and watch for the signs and symptoms.
COHEN: That's all we have time for today. Dr. Koplewicz, thank you so much for joining us. And, everybody, join us...
KOPLEWICZ: It's my pleasure.
COHEN: Next weekend for WEEKEND HOUSE CALL Saturday and Sunday at 8:30 Eastern time.
Watch CNN for all your medical news. This week, we have a whole bunch of wonderful stories coming up. We'll tell you how one hour of exercise a week can lower your blood pressure and how the spice sage can improve your memory.
Thanks for watching, I'm Elizabeth Cohen. "CNN Sunday Morning" continues now.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
Aired August 31, 2003 - 08:29 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Good morning and welcome to WEEKEND HOUSE CALL. It's time to go back to school. And while most kids may be depressed that summer's over, it's a good idea to watch your child closely to see if the back-to-school blues last longer than just a couple weeks. Depression is being diagnosed in more and more kids, today, and as Dr. Sanjay Gupta reports, teenagers can be the hardest hit.
(BEGIN VIDEOTAPE)
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT (voice-over): 18- year-old Jake Novak knows the darkness that severe depression brings.
JAKE NOVAK, SUFFERS FROM DEPRESSION: I just didn't want to live anymore. I took a box cutter to my left wrist one evening, it was a Sunday night. And, the shock and the horror just looking at myself and what I'd done to myself, was enough to make me stop the bleeding.
GUPTA: It's more than a bad test score or a fight with friends. Severe depression is a biochemical change in the brain that affects nearly 10 percent of teenagers in the U.S. And Dr. Cynthia Pfeffer, a specialist in teenage depression, says every years, three to 4,000 teens kill themselves.
DR. CYNTHIA PFEFFER, WEILL MEDICAL COLLEGE: Depression we know, is amongst the most important misfactors for suicide and non-fatal suicidal behaviors.
GUPTA: Shortly after Jake's attempt at suicide, a fellow classmate killed himself.
NOVAK: My heart sank and I wasn't sure what to think at that point because I saw somebody else go through the same thing I had gone through. I got to school the next day and saw everybody crying and saw how upset everyone was.
GUPTA: That devastation prompted Jake to launch a group called SWAT, Students Working Against Depression.
NOVAK: I didn't know what depression was. I thought -- man, I'm really sad. I just must be this loser that doesn't -- you know, get to be happy. I've been told left and right about HIV, AIDS, where to go if I want to become openly homosexual and nobody's ever told me about depression.
GUPTA: Through awareness, SWAT is showing teenagers it's OK to admit they have depression.
NOVAK: People say -- you know, you're not supposed to talk about depression and I say -- why not? And, I haven't heard a good answer yet.
GUPTA: Pfeffer says depression is under-recognized in teens, but there are symptoms.
PFEFFER: The hallmark is sad, low, blue mood and another hallmark is loss of interest in usual activities, and specifically, teenagers who may not like to do their usual activities.
GUPTA: Other warning signs include sleep disturbances, appetite and weight changes, and difficulty concentrating. And, when these symptoms last beyond two weeks, it's time to get treatment. That's what SWAT is all about. To help students suffering depression before they take their lives.
Dr. Sanjay Gupta, CNN, reporting.
(END VIDEOTAPE)
COHEN: More than three million teenagers suffer from depression and a whopping 80 percent never get help. That's mainly because of the stigma associated with mental illness. Most parents and kids simply don't want to acknowledge there's a problem. The National Institutes of Mental Health estimates 8 percent of teens and 2 percent of children, some as young as age 4, have symptoms of depression. Early onset of depression in kids has become increasingly common. No one knows whether there are actually more depressed kids today or if there's just a greater awareness of the problem. But, some researchers think that a high divorce rate, rising school expectations, and social pressures may be pushing kids over the edge.
We'll talk about troubled teens first and look at younger children struggling with depression later in the show. We'll also be talking about treatments. Are medications the way to go, or is therapy the right way or both?
Call us with your questions about your kids. Our number is 1- 800-807-2620 or you can e-mail us as HOUSECALL@CNN.com.
To help answer our questions, Dr. Harold Koplewicz joins us from New York City, he's a child psychiatrist and author of the book "More than Moody: Recognizing and Treating Adolescent Depression."
Thanks for joining us, Doctor.
DR. HAROLD KOPLEWICZ, AUTHOR "MORE THAN MOODY": Good morning.
Good morning.
COHEN: Our first question, actually, has to do with the title of your book. Renee, from New Jersey, is on the line.
Welcome to WEEKEND HOUSE CALL, Renee. RENEE, NEW JERSEY: Good morning. I'm the mother of a teenager and I have two younger children. My question is -- what are the signs of depression in a teacher -- teenager versus their normal mood swings? And, part two of that question -- is the answer always medication? Because, when you talk to a doctor, usually that's the first thing these days, the insurance wants to give them medication as opposed to counseling.
KOPLEWICZ: Well, I think the most important part, for us as parents, is to recognize that teenagers will get moody. There's no doubt there are lots of things going in their lives, particularly the fact that they have to adjust to separating from their mom and dad, more or less. They have to start getting educational or vocational goals, they have to figure out sexual orientation, there's a whole bunch of adjustments to puberty. So, clearly, all those stressors make teenagers more moody than kids or than adults. But, it's very different than depression. Depression, while misused all the time, because we say "It's going to rain tomorrow on Labor Day, I feel so depressed," is really not what we're talking about, that's demoralization.
Depression is when it lasts for more than two weeks and you see a real change in your teen's behavior, so they're no longer passionate about the music they cared for, their sleep pattern has changed dramatically, their concentration has changed, and their big change is their mood is chronically irritable, versus depressed, they're cranky and nasty. And, that's a very important distinction to make for parents, because they're very good at telling us when their teens have changed their behavior. We don't think teens, Renee, should be the ones who can tell -- the teens are the only ones who can tell us how they feel, but parents are the ones who can tell us if they see a change in the way they've behaved before.
COHEN: Dr. Koplewicz, Renee mentioned something I've heard from many child psychologists and psychiatrists, which is that the insurance company will pay for the medicine, but they won't pay for the therapy or they won't pay for very much. Is that a real problem?
KOPLEWICZ: Right. Well, I think the big problem is that in real estate, we say the three most important criteria are location, location, location, well in child mental health, it's diagnosis, diagnosis, diagnosis. So, the first thing you want is to make sure you took your teenager to qualified individual, that's a child psychologist or a child psychiatrist.
And, once they've decided what your child has, and you agree with them, well, there are really two options. And, parents have to be great advocates for that is kids, because if your child has a mild to moderate depression, there's lots of evidence that cognitive behavioral therapy, CBT, works and it works in 12 to 16 sessions, and in fact, after four weeks, your child or teenager should look better, and if your teenager is getting better with that treatment, then that treatment should be continued. If your child or teen is not better after four weeks, then medicine should be added.
And, the fact that an insurance companies can dictate to us when they will and won't, really requires then, parents to be terrific advocates for their kids and get on the phone and complain that the first treatment of choice for them and for their teen may be CBT. But, it's not average psychotherapy, it's a type of psychotherapy best given by psychologist, but people who are trained in this technique.
COHEN: We have a question from Ann from Philadelphia, who recently took her child to a practitioner.
Ann, go ahead with your question.
ANN, PHILADELPHIA: Good morning. Recently, I took our teenage daughter to a newly established family doctor. And I mentioned to this doctor that I thought our daughter might have some of the symptoms of depression. She -- this doctor quickly issued a prescription for the medication called Paxil, and so this takes me to my two-part question. Is there a new way of thinking and dealing with mental health issues, because I always thought that therapy had to be part of the medication process? Second question is -- I have recently read that Paxil might be very dangerous, in particular for teenagers. Could you give me some information regarding these two concerns?
KOPLEWICZ: Sure. Well, it's very disconcerting when you hear that a teenager goes to see a physician and a mother mentions in passing that they show signs and symptoms of depression, and a prescription is written. That would be like saying that -- you know you go into see a doctor and you mention that you have a rash, and they start treating you for cancer -- skin cancer. In other words, just because you have a set of symptoms doesn't mean you have a disease. And, so the diagnostic process takes a lot of time. It usually takes up to two hours at the very best when you have a good historian; you have a parent, and a cooperative teenager to talk to you about what's been going on. So, that's the first part of the story that's troubling. But, the second part is about this controversy about Paxil.
Paxil is one of these medicines that are called SSRIs, Selective Serotonin Reuptake Inhibiters. And, they really are quite remarkable compared to the old antidepressants which had a lot more side effects and which also were potentially lethal, so that if you overdosed on the old antidepressants, the tricyclics, you literally could cause death, and they were never found to be helpful in teenagers.
The new antidepressants, the SSRIs, which include Prozac, Paxil, Luvox, Celexa, Lexapro, all of tease medicines that we've heard about, these seem to be relatively safe. They have nuisance side effects. But, there has been some controversy about Paxil, particularly a study that was never released, but that the British have decide, based on a study of looking at teenagers who were depressed, that the kids receiving Paxil...
COHEN: Dr. Koplewicz, as we'll be talking about Paxil as we come back, because it was an important letter issued by the FDA and we want to get to that.
KOPLEWICZ: Great. COHEN: Callers, in the meantime, stand by while we take a break. When we come back, children and depression, the warning signs are a little different for younger kids. We'll tell you what to look for and answer your questions.
Call us at 1-800-807-2620 or e-mail us at housecall@CNN.com. We'll be right back.
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COHEN: Did you know the number of children in the United States prescribed medications to treat depression, attention deficit disorder, and other behavioral conditions nearly tripled between 1986 and 1996? That's according to a study from Columbia University in New York.
This is WEEKEND HOUSE CALL and we're talking about kids and depression. Call us with your questions, our number is 1-800-807-2620 or you can e-mail us at housecall@CNN.com
While we are getting phone calls lined up, let's check the "Daily Dose Health Quiz." Today's question: Among teenagers who's more likely to develop depression, girls or boys?
We'll have that answer in 30 seconds, so stay with us.
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COHEN: Checking our health quiz, we asked among teenagers who's more likely to develop depression, girls or boys? The answer: Girls are twice as likely to develop depression. Studies suggest if girls don't receive treatment in adolescence it's likely their depression could continue into adulthood.
This is WEEKEND HOUSE CALL and we're talking about kids and depression. The symptoms of childhood depression are little different from teenagers. Look for frequent complaints of vague physical ailments like, headaches, stomach aches, and fatigue, sudden drop in school performance or lack of interest in play, excessive concern with failure and frequent irritability or crying. Lack of social interaction and boredom are also warning signs, as well as attempts to run away from home or reckless behavior.
Dr. Harold Koplewicz, a child psychiatrist and director of the New York University Child Study Center, joins us.
Doctor, do children have all or just some of these symptoms to be diagnosed with depression?
KOPLEWICZ: They need to have some of them, but the more important part is it has to last for several weeks and parents have to see a change from baseline, so what we want is we want all parents to know their kids. We want them to know how their kids sleep, how their kids eat, how their kids play, what is their temperament or mood, so they can see when there's this shift and change in their behavior, because that's the first red flag. COHEN: We have a question, now for -- in an e-mail from Michele in Minnesota. She asks, "Are the symptoms of depression the same in children as adults? What is the youngest age that a child might have clinical depression? In other words, if a young child is show symptoms, at what point do you seek medical help or do young children generally come out of it on their own?
KOPLEWICZ: In general, we see that depression usually occurs after children reach puberty. So, you're much more likely to get depression when you're a teenager than you are as an adult or even a child. But, children are capable of having depression. Very often, it looks like anxiety, they'll be afraid of going to school, they'll be overly self-conscious about what other people think of them, they'll have unrealistic worries about the future. And again, what you really want to wait for is around two weeks or three weeks, but don't be fooled, most parents will keep telling themselves, it's just a phase. The worst thing you can do is wait too long. The easiest thing you can do is go to your pediatrician and then go to a child psychiatrist or child psychologist and get an evaluation and be told it's nothing more than just a temperamental change or just part of normal development.
COHEN: We have a phone call now, from Liz in New Jersey.
Liz, welcome to "WEEKEND HOUSE CALL." What's your question for Dr. Koplewicz?
LIZ, NEW JERSEY: Hi, good morning. I have a 5-year-old son who's been diagnosed with depression, post-traumatic stress, ADHD et cetera, and they have him on Zoloft. I'm -- to be honest with you, quite uncomfortable having him on that when I see the commercials that say, 12 and up. What is your feedback on that?
KOPLEWICZ: Sure. I think you should know that most medications that are -- have been developed not only in psychiatry, but even in pediatrics for asthma, were never received approval from the Food and Drug Administration for use under the age of 12. Now, that's not because the Food and Drug Administration was saying "No." It was that the pharmaceutical companies never asked them for permission. So quite clearly, if a child is going to get this medicine under the age of 12, a parent has to be very aware of the side effects and the pediatrician or the psychiatrist who's giving the medicine has to carefully monitor for both the positive and the negative side effects. More importantly, children like that usually need very low doses. Again, it's a rare event when a very, very young child needs an SSRI.
COHEN: Dr. Koplewicz, let's talk a minute about that FDA letter regarding Paxil and children.
KOPLEWICZ: Well, it's based on a study that unfortunately, we can't get ahold of all the data; we just get some of the data. And, essentially, they were looking at teenagers who were depressed and found that the teenagers who got Paxil, three percent of them had suicidal ideation and so some kind of suicidal behavior and the kids who got placebo one percent of them had the same kind of symptoms. So, clearly, it's 3 to 1, but they're tiny, tiny numbers, there were small numbers in the study and we have to remember, unfortunately, that suicidal thoughts are very common among teenagers.
In fact, last year, three million kids, in surveys, admitted they had suicidal thoughts, one million teenagers stated they had a suicidal plan, and last year, 400,000, more than 1,000 everyday, teenagers made a suicide attempt. So, this is truly not a mental health problem, this is a national health problem. The fact that depression affects so many of our teenagers and the worst outcome of depression is when you'd hurt yourself or hurt others.
COHEN: We have an e-mail now, from Lindsay in California, who wants to know, "I suffer from depression, not severe, just mild to moderate. I have two young girls ages four and two. What are the changes they'll inherit my depression, is there anything I can do to prevent it?"
KOPLEWICZ: Well, I think that's a great question because we know that depression has a genetic component to it. There's no doubt it runs in families, yet the average teenager here has depression doesn't have a family member. So, that means it's a very common disorder that affects lots of people in the population, but clearly, if you have depression, that puts your kids at further risk. But it's not Mendelian genetics, it doesn't mean if you have a red and white, you're going to have pink roses. It really -- it's kind of DNA roulette.
But what you can do is you can teach optimism. You can talk to your kids about: What's positive? What's correct, today? What made you happy, today? And, give them models, by the way, of also good social skills, because we know that kids who are socially phobic, kids who are pathologically self-conscious, who can't speak in front of others, are more at risk for depression, as well. And, so kids who learn how to have a conversation with others, how to ask you questions, have a step up from other children.
COHEN: When we come back, how do you help a child who really doesn't want anything to do with you? Some innovative ideas when WEEKEND HOUSE CALL continues.
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COHEN: This is WEEKEND HOUSE CALL and we're talking about kids and depression. The key for dealing with depression, as parents, is to observe your child's behavior. Know your child well enough to notice weight loss or loss of concentration. The other key thing the parents should do is get professional help for your child, if necessary.
Child psychiatrist, Dr. Harold Koplewicz joins us from New York.
Doctor, we want to talk a bit about being on -- children being on medications. Are they going to be on them for the rest of their life? It's a question from Barbara in Massachusetts, who joins us now. BARBARA, MASSACHUSETTS: Good morning. Hi.
KOPLEWICZ: Hi, Barbara.
BARBARA: My son was diagnosed with depression and ADHD when he was very young. I finally put him on medication about six years ago and I feel that he's gotten worse. He hasn't gone out of the house one day this entire summer, and I -- the doctor doesn't seem to think a change of medication is necessary. What should I do?
KOPLEWICZ: Well, I certainly think that a mother who tells me that their son hasn't gone out of the house the entire summer that's a very, very bad sign and if the doctor doesn't think that it's time for a change in medicine, it may be time for a change in doctors or at least get a second opinion. Because while these medicines are remarkable in the respect that they can really change a child's life or a teenager's life, they don't always work and sometimes you need to monitor the dose, sometimes kids need more or less of the medicines, and sometimes, unfortunately, the medicines stop working. So quite clearly, there's no reason to take medicine unless it's productive and helpful. And so in this case, Barbara, I think you need to get a second opinion and get someone with fresh eyes to take a look and maybe re-diagnose and maybe reassess the treatment.
COHEN: Dr. Koplewicz, when medicines do work do you worry, at all, about the effect they might have on a developing brain when you're giving them to a child or teenager?
KOPLEWICZ: Yeah, well, I think that's definitely one of the sides, Elizabeth, is that we want to worry about what potential side effects are, but what we've learned recently is that depression itself is most probably bad for the brain, and so that if you've had one episode of depression that goes untreated, you're 60 percent more likely to get a second episode and if you have two episodes, you're 90 percent more likely to get a third episode.
So, therefore, leaving a teenager who has depression untreated really gives them a higher risk of lots of bad things occurring. In fact, we know the teenagers who have depression in general are more likely to have depression as adults and are even more likely to become suicidal as adults which means, again, that this depression sensitizes or affects the brain in a very negative way, so it's a cost/benefit ratio. Clearly, no medicine is better than medicine, but for a teenager with depression, medicine can truly be a lifesaver.
COHEN: We have an e-mail now, from Nancy from Iowa, who wants to know, "How can we help teenagers who refuse to accept psychiatric and/or medical treatment for depression?"
KOPLEWICZ: Well, I think that's one of the hardest things. In fact if you remember, when you're a teenager, you don't want to be anything, but just like everybody else. Your mantra is "I am the same," and so admitting you are psychiatrically ill, mentally disturbed is the last thing a teenager wants to hear, especially from their parents. But I think the parent has to talk to their teenager and tell them they're worried about their behavior. That they specifically are concerned that they're sleeping differently, eating differently, that they're having difficulty more in school or concentrating and then say, it's my job, as a parent to make sure you're OK, and if you were bleeding or if you had a rash, I'd take you to a doctor, you're not behaving the same. Let's go together and let's find out what's causing this, really trying to partner with the teenager instead of accusing them of being crazy.
COHEN: That's good advice, Dr. Koplewicz, for parents who have children who aren't so cooperative when it comes to mental health issues.
When we come back, we'll have some final thoughts from Dr. Koplewicz about children, teenagers, and depression.
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COHEN: If you'd like more information on kids and depression, check out our Web site at CNN.com/health. You'll find links and helpful related sites. Also, check out the National Mental Health Association's Web site, go to: www.nmha.org and click on the "back- to-school chalkboard icon to find a whole host of suggestions to monitor your child's mental health.
Welcome back to "WEEKEND HOUSE CALL," we've been talking to Dr. Harold Koplewicz in New York City.
Dr. Koplewicz, if your child is given antidepressant medications, as so many children are today, does that mean that they'll be on those medications for the rest of their lives?
KOPLEWICZ: Absolutely not, in fact, the majority of teenagers and kids who respond stay on it for six months to one year. It's the kids who take -- who had two episodes or three episodes of depression that have to be on for much longer. And again, it has to be carefully monitored. But the good news is, depression is treatable. Parents just have to look out and watch for the signs and symptoms.
COHEN: That's all we have time for today. Dr. Koplewicz, thank you so much for joining us. And, everybody, join us...
KOPLEWICZ: It's my pleasure.
COHEN: Next weekend for WEEKEND HOUSE CALL Saturday and Sunday at 8:30 Eastern time.
Watch CNN for all your medical news. This week, we have a whole bunch of wonderful stories coming up. We'll tell you how one hour of exercise a week can lower your blood pressure and how the spice sage can improve your memory.
Thanks for watching, I'm Elizabeth Cohen. "CNN Sunday Morning" continues now.
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