DD Depression Treatment

[teenhelp]

DD (16) has just been diagnosed with depression and we are discussing and considering treatment. Medication in the form of anti depressants has been mentioned as well as therapy.

This is all new to us and we will be having further sessions to discuss further. I would
Really welcome any advice and both the pros and cons of anti depressants for an adolescent in terms of your experience. I want to consider everything before we decide how to proceed.

I can't explain how overwhelming this all is.

Also any advice on what we should be asking the doctor?

Hi there, hope you’re OK. In general, talking therapy should be used in the first instance, though if depression is treatment resistant then there is evidence that adding an anti-depressant can help some people.

Check if she is at risk of harming herself and don’t be afraid to compassionately remove sharps, medicines or anything she might use to harm herself with, or increase supervision or watchfulness if indicated. Don’t be afraid to ask about this, but do it in a calm containing way, get alongside her.

‘Behavioural activation’ is the best thing first (reduce stress, build a good sleep routine, have a good balance of activity, rest, quiet social activities - build it up gradually if she is finding it hard to get out of bed, or reduce activity if she is working too hard). Increased enjoyable time with family is massively important (assuming good relationships). Find a box set you both love and commit, dig out a jigsaw puzzzle, play cards, walk the dog, take some time off work. Plan ahead if you need to speak to sixth form. Remember, most depression will get better in time. (Sorry if this is too much info and I wish her well).

All of the treatment highlighted is on NHS choices, if you look up depression there is also links to other info and videos talking about the treatment rather then just masses of text. Hope things improve.
Antidepressants is a really personal choice as they may not help and if they do they may not help straight away and have side effects but if they do work could be really helpful and be a life saver so she needs to way up if they are worth trying

Some anti-depressants do occasionally increase thoughts of self-harm in the initial weeks. They can have other side effects. They take 4-6 weeks to have any effect, and may not, even after a dose increase. Look at ‘Head meds’ or young minds for useful information. I’m not against them in young people, but they should not be the first line treatment usually. Maybe if in the severe range of symptoms.

Think of depression as a ‘reset’ - time to pause and reassess life, stress, family stuff and committments and make stronger bonds and changes that will benefit her long term and maybe you all.

At 16 your dd is almost certainly Gillick competent (able to understand information well enough to make an informed decision) which means she will (almost certainly) be the one making decisions about her treatment.

Questions to ask might include:

What are the medication(s) the doctor is talking about?
How long do they take to work?
What are the common and rare side effects?
How often do they work?
How long would dd expect to be taking them for?
What is the procedure for stopping taking them?
Are there withdrawal effects?

What kinds of talking therapies are on offer? How long is the waiting list?
How do they work?
How often will dd have to attend?
Where is the therapy centre?
What are its opening hours?
What if dd doesn't like the therapist?
What if the talking therapy doesn't work?

NB your GP may not know the answers to some questions about talking therapies, but should be able to put you in touch with someone who does.

Depression/low mood is very common, unfortunately. Your dd is not alone, although she may feel that way. If she needs to talk to someone confidentially she can call Childline or the Samaritans, among others.

Sources of useful information include the NHS website, moodjuice, wellbeinginfo.org

Finally, if your dd needs emergency care, you can take her to A & E for mental health needs as well as physical ones.

At 16 it is your daughter's decision on what treatment she wants, but I'm sure you know that.
Therapy is usually done first, in accordance with Government guidelines. However if the depression is particularly bad then sometimes anti-depressants are started first.
The Psychiatrist will be able to decide which is the best antidepressant for your daughter, but fluoxetine is most usual as the first to try first.

Thank you for all of this. It does help and I will consider all. We are seeing a psychiatrist rather than just a GP. DD is having suicidal thoughts hence the reason for medication. I am nervous about going down the medication route. DH and I feel so alone in coping with this. It's so lonely. Can't tell many people and don't want to tell.

But all of this is so helpful so thank you very much. Please keep giving any other advice

Is the psychiatrist NHS or private?

Private

Pp are absolutely right that guidelines state talking therapies should be tried first (and I agree). Medications are not without their downsides. Many people experience side-effects (these vary a lot from person to person though. It's not unusual to try a couple of different medications to find one that suits). Talking therapies are less intrusive and can teach skills that the person then carries with them throughout life. Sometimes, if there is a good connection between patient and therapist, you can see dramatic results very quickly.

However, NHS services are severely underfunded. In many parts of the country there is a significant wait for treatment (although this does vary greatly by area). You don't have to wait for pills.

Thanks tangerine. One of the reasons Dr feels medication is the right option is because she feels DD may benefit more from the talking therapy if initial symptoms have been addressed with medication. I completely understand what you have said Re NHS. We are doing this privately as We didn't get the support we need via NHS and maybe it may be quicker to get sessions.

Aagh should have checked before posting all that!

OK - if you can go private, I'd definitely suggest you investigate talking therapies first.

Cognitive behavioural therapy (CBT)
Behavioural activation (ba)
Interpersonal therapy for adolescents (ipt-a)
Systemic family therapy
Counselling

...are evidence-based treatments the NHS funds, and worth Googling. I'd expect your psychiatrist to be able to put you in touch with a suitably qualified, experienced and accredited practitioner. The first three are quite structured, relatively short term treatments. The last two can be a bit more open ended.

X-posted again! Sorry about that. I'm not disagreeing with the psychiatrist and I'm not recommending any particular course of treatment for your dd.

Having said all that about "talking therapy first" it is true that if people are feeling very low then it can be very difficult for them to engage with therapy, and medication can help address that.

I'm sorry the NHS hasn't helped. I hope your dd feels better soon

Thank you so much tangerine.

This is really hard.
DD was similar at 16, including self harm including poisoning.
GP refused to help with private referral whilst telling me to get a counsellor off the internet! CAMHS assessed after about an eight week weight because I pushed. The PMHW then lost our number and later recommended group therapy in the middle of the school day having confirmed in a letter that dd was principally unhappy due to achievement at school, and once she had settled into a new school she may be happier. It was inadequate and inaccessible but CAMHS refused to renegotiate the offer and would not listen.

We managed to source a very good psychiatrist and I'd say you are lucky to have done this. In my experience the CAMHS practitioners most young people get to see are nurses or social workers and are not clinically expert or qualified enough to make independent decisions and yet the multi-disciplinary teams to whom they repirt and which include suitably qualified doctors, are dependent on their assertions and observations, which in our experience, were generally inaccurate and did not represent comprehensive information or evidence of listening to the young person and understanding the salient issues.

Dd's psychiatrist did initially recommend some sessions with a therapist, nice chap, but dd didn't bond and had only 3. Looking back she wasn't in a great place and needed the anti-depressants to get her to the point where she could engage so I suspect your dd's psychiatrist is doing the right thing. Remember too NICE guidelines are based on whole population outcomes rather than on a case by case 1:1 basis. In assessing those outcomes all experiences are tsken into account and there is no monitoring of what an outcome might have been if the intervention had been personalised and opimal .Your psych is well qualified to know what is best for your dd and her personal circs and presenting symptoms. Unlike with CAMHS the psychiatrist will be able to monitor your dd closely on a very regular basis and from a fully qualified clinical perspective.

Dd's psychiatrist also checked things like vit d and her endocrine results identified a serious underlying condition which neither CAMHS nor the GP would have even thought to consider. Indeed her GP refused a full endocrine screen on the NHS.

It took dd a long time to recover and she still had a crisis at exam time when she took a small od after not harming for 6 months. I knew the trigger, her psych knew the trigger but goodness A&E where dd took herself 48 hours later to check herself over physically, she wanted so much not to have caused permanent harm, went truly overboard reporting us to ss, and wanting her to stay overnight with a 1:1 nurse - to facilitate a CAMHS assessment. (We refused to stay) it's really interesting that the NHS has up to £1k to spend disproportionately in those circumstances but has no money to spend on preventative interventions. It may have been worthwhile had CAMHS done anything helpful afterwards but after three assessments, CAMHS laid on 8 sessions of v mediocre counselling and closed her case after delivery of the first - so much for the integrity of being unable to recommend therapists due to not knowing outcomes.

Meanwhile her psychiatrist had assessed for ADHD/ADD and ASD. It turned out that dd had ADD and once treated completely turned the corner. She had told CAMHS at the v beginning her worries centred on school and achievement.

There are happy endings OP. You are doing your very best for your dd by getting her the help she needs. I am just sorry you have had to seek it orivately because high quality care should be available for all young people.

It is a hard and confusing time and v difficult to take on board all the different interventions and outcomes at the same time as dealing with the fact that your child is ill, indeed has a mh problem and going through your own grief in relation to that. It is an illness and most likely is not as a result of your parenting.

DD eventually bonded with a counsellor through Relate who are getting more involved in adolescent counselling. They were superb and their kindness and care was immediately evident both at personal and organisational level.

Go well OP. You are doing all the right things to help your dd recover and provide the support to make things go well for your dd. Remember to be kind to yourself.

Hi - I’ve onky just found this thread (previously have sent not looked through the parenting teenage one).

Firstly - hugs to everyone. I never knew how tough parenting a DD with MH issues could be.

Too long a story to tell all - but our wait list for CAMHs has been so long. We finally now have an appointment with a third party appointed by CAMHS to help clear the backlog.
As earlier post says - initial assessments are usually an ex-social worker or a nurse. We thought she was going to see a clinician. 9 months later our DD (waiting for an ADD diagnosis) has failed her GCSEs, and Just had the worst year ever - self harm, unable to regulate emotions. We tried going private but the psychiatrist was £500 per visit and we just can’t afford it. We’ve tried private counselling but DD is fine for first couple of sessions then refuses to engage.

We have lost our beautiful, funny, clever DD to MH that is crippling her. Pray we get the help we need (appointment is next week) and don’t end up seeing another inexperienced non-clinician who can’t help us to move forward, but a treatment plan that will help us out if our living nightmare. X

Just thought I'd send my support and give you my experience of having a teen on antidepressants.

DS is 14 and has ASD, anxiety and depression. He had been struggling since he was 10. We got an ASD diagnosis at 12 and he had about a years talking therapy for anxiety induced violent meltdowns. It stopped the violence but didn't really do too much for the anxiety. He also talked a lot about suicide and would sometimes self harm.

By last summer he could barely leave the house. He would stand at the door trying to.force himself to step over the threshold. I managed to get him to his camhs appointment. Fluoxetine had been offered before, but because they told him all the side effects he was too anxious to take it. In his appointment he was so anxious he had to write everything down because he couldn't talk and they managed to persuade him to take the meds.

He can now leave the house and sometimes even goes out for a little walk on his own. His anxiety is so much improved its astounding. But he is now depressed and still talks of suicide. I do however think that this depression has been there all along, but masked by the anxiety. They are considering upping his dose as he is still on the lowest dose so we shall see.

That is just our personal experience of ADs, but I thought you might find it helpful.

I wanted to come back to this thread. I can't thank you enough for the posts that you all put. Some of them very close to home and I just couldn't get myself to reply. This has been the most heart wrenching time of my life. I feel helpless and heartbroken. And I never expected this.

DD did eventually get diagnosed for depression and started medication. It started to work but lately things have gone all over the place. She is really on edge and nervous and has had a few meltdowns. She has also started therapy with a new therapist and this is going well. We are possibly looking at doing an assessment for ASD/Aspergers. DD is struggling to function normally, get to school and stay on top of things. I can't understand why things have gone bad again after starting to get better. I can't understand whether getting the help in therapy is triggering this or is this a side effect of the meds. I am just so confused.DH and I are struggling with all of this. DS has been affected and has had erratic behaviour at school as a result. It is so out of character. We are getting counselling for DS too. I too am looking at counselling via work for me.

I just feel like I am losing hope and what the future holds. Will she finish her a levels? I feel like I am having to make important decisions for her and I just don't know what I am doing.

Sorry for what you're going through OP, my DD has similar problems. I work in mental health and my overall feeling is that we are in the dark ages right now. Very little is understood about what causes some people to have debilitating anxiety and depression while most of us experience these things to a degree but can get on with life. The drugs work for some people but only as well as a placebo - did you know that? You and your family can have more impact on getting her better than any doc and your knowledge of her is just as important than the 'scientific' view if not more so. This is both scary and heartening as there's so much we can do to help th through. Don't defer to the experts as they are basically guessing

Medication is a bandage. Therapy is the healing work. Unfortunately sometimes therapy stirs up a lot of messy stuff that has to get sorted out before you can go forward. Maybe reassure her that it's no big deal if she takes a levels late, or if she wants to delay university.

Hi all. This is my first post about my DD's problems and experiences. She started self harming about 18 months ago and it came as a huge shock to me, but I managed to remain calm and listen to her. The following day I broke down on the phone to the school nurse and we were given the name of a private counsellor. After a few weeks/sessions this lady admitted that she was out of her depth and recommended that we contact CAMHS! We must have been lucky because we got to have an assessment almost immediately and then a follow up appointment with a psychologist, who she still sees almost every week. DD has been diagnosed with depression/anxiety. It has been a roller coaster with me often getting warned that my lovely child is thinking of suicide and that we should hide knives and medication. After about a year of this DD decided that she was unable to fight this with just counselling alone and that she wanted to go on AD's. We saw the CAMHS psychiatrist and were recommended 10 mg (light dose) of Citalopram. DD had no negative effects from this at all, but within a few weeks we noticed a big change in her. She was much more like her old happy self. Everyone commented on it. She was sleeping properly, going to all lessons, wanting to spend time with friends, making plans for the future. She still has some very dark times and had her dose upped to 20 mg. We are a long way from being out of the woods, but my view is that the AD's may not be the cure, but have certainly helped enormously. I am concerned that she started them at such a young age and may be dependent on them for many years, but do think the positives in her case outweigh the negatives. This is the hardest thing I have ever had to deal with in my life and I send love and support to all you others out there who are suffering. You are not alone...

Teenhelp I feel your pain. My lovely funny very dyspraxic DD has nosedived over the last two years, and just done poorly in GCSEs where she was predicted very high grades, all because of severe anxiety. Has tried counselling three times through school but quit each time saying it was unhelpful. Has just been assessed by private psych who specialises in adolescent MH who wants DD to start on fluoxetine and says it will probably be for two years. I am so torn as I want her so much to get well through therapy alone, but from this thread I am hearing that the ADs can kick-start that process. DD has been diagnosed with depression and anxiety even though from my perspective she demonstrates a mix of volatility, aggression and social withdrawal. Clinging on here just so I don't feel so alone!

I wanted to come back and post an update.

We have been at the medication and the therapy for a few weeks now. We are also
Kicking off the ASD assessment. But things have been very up and down. So we are considering changing medication as not sure there has been enough benefit. We are thinking of changing from fluoxetine to setraline. Does anybody have any experience of changing meds - how did you know when one just wasn't right? It is a little frightening thinking of how she may respond to coming off and starting another.

We have good days and bad days. Both DD and us as a family. It is draining us and ageing us but we are trying to stay positive and take each day at a time. I am trying to not get overwhelmed or to catastrophise. I have to believe that things will be better for her.

We are in exactly the same boat. My 16 year old DD3 has been diagnosed with severe depression. She is very down, very tired all of the time, has at times self harmed, is unable to see any joy anywhere in life and has had suicidal thoughts. Apparently a persistent voice in her head telling her to die.

There have been a few issues since she was about 10 or 11. Mixed results with talking therapies via CAMHS. One dreadful counsellor who's approach seemed to be to wait until she had the child alone (once parent had gone to the waiting room to allow the child to open up more to them) and would apparently then stare hard at them before telling them that they had no problems and she could fill the entire room with children in a worse state than them. DD was just 11 at the time and it must have been very intimidating. I didn't know this until a couple of years after it happened, though did suss out that DD was not responding well to the therapy I thought she was getting and we decided to stop going. DD was relieved to stop going, but took years to tell me what had really happened. Thankfully that person no longer seems to be on our local mental health teams. We have since come across other young people at different schools who experienced her and all have told the same or similar stories.

This latest depression though seems to be by far the worst. Thankfully we saw a counsellor yesterday who seems much better, took DD seriously and is also recommending her for fluoxetine (should be prescribed in the next week). She will also receive counselling in school, which is what she was hoping for.

I was ready to go private this time had that not happened as quickly as it did.

Good luck to OP and all in this situation. It is horrible, but I guess it is good to know that we aren't alone. It does feel very frightening and lonely, both for the depressed teenagers and for us parents.

DD not eating, sleeping a lot, struggling with College. She has been seeing CAMHS with mixed results.

Earliest Dr appointment I can get is in the New year, DD reluctant to start AD because of the side effects. She only wants to take herbal products. DD doesn’t want me to go into Dr with her but I’m afraid she will come out with nothing