DD 14 depressed and on sertraline. Effectiveness?

[fifietta]

My lovely daughter has been depressed and self-harming on and off for a year or so. We first went to CAMHS just under a year ago where she saw a nurse practitioner for a few sessions, then decided to tell her everything was alright when clearly it wasn't. In June things came to a head again when I received an email from her school saying she had told them she was hearing voices telling her to kill herself. My fantastic GP spent an hour with her (apparently my DD said that I couldn't help her) and said that she needed something to happen now, so I reluctantly agreed to antidepressants - sertraline, 25mg initially - she's now on 50mg. She did an urgent referral to CAMHS where we have been seeing a psychiatrist. My daughter said she didn't want to talk to anyone, but showed some interest in the idea of art therapy which we have been waiting for ever since - we now have an appointment in 3 week's time. Things did get a bit better.

What I'd really like to know is whether anyone has had any experience of anti-depressants (and sertraline) really changing things. My daughter seems to define herself by her depression and tells many people that she is on medication. She has had some horrible lows recently...these seem to happen in the evenings, usually when she has homework to do and she just lies in her bed with a look that turns me cold. Tonight she told me that I could never understand (I have a feeling that there are historical feelings to do with a boy involved) and I just feel desperate not knowing how to help or deal with her. She is chaotic and she's not really on top of things at school. And life for me is that cliched roller-coaster (single mum, don't want to burden others).

She feels that she wants to increase her dose and I feel that the psychiatrist is rather eager to do this. He says it is more damaging for the brain to be depressed than to be on anti-depressants. Part of me thinks that I just want her to experience feeling more positive, but I also want her to realise that life has ups and downs that can't all be fixed by medication. I feel that she will end up taking a higher dose but I'm so confused.

Can anyone tell me about their experiences?

[Brightspark1]

DD was on fluoxetine for a while, and it was effective, while she was taking it. Problems started when she refused to continue, then she rapidly deteriorated. From what I remember, NHS NICE guidelines don't recommend ADs as a first line intervention for depressed teens, but recommend talking therapies such as CBT and counselling and art therapies first. But they do recognise that in some circumstances ADs can be safely and effectively prescribed, in DD's case they allowed DD to engage in talking therapy, which she couldn't do at first.
Try to see your DD's openness about her depression and medication as a positive thing, it has to be better than being ashamed about it. Seeing your DD self harm is so hard, try and make sure you get support as well.

[mamalovesmojitos]

Sorry to hear about your dd's depression. It must be hard for both of you. Is she attending talk therapy?

[perceptionreality]

I've been on sertraline - I found it very effective, perhaps too effective for me as it made me quite cocky! I felt I could literally do anything while on it. However, I have a bipolar diagnosis so slightly different from unipolar depression. But yes it does work. I hope your daughter feels better soon. Mental illness is so awful.

Has counseling been suggested for her? I say this because after 2 years of psychotherapy I no longer have bipolar episodes, am totally off ADs and APs and consider myself cured. Medication can help as a short term solution but sometimes psychotherapy can help to heal what has caused the illness in the first place.

[MrsMcCave]

I have just come off sertraline after 2 years. Am not a teen (by a long way!) but the gp told me the 'effective' dose was 50mg? It helped me through a bad patch, combined with CBT, and I didn't have any bad side effects with it. Hope your DD is ok: it definitely is a good thing that she can talk about it. Xx

[fifietta]

Thanks for all your replies.

She's still depressed on 50mg which is why she wants to increase...she had said she didn't want to 'talk' i.e. therapy or counselling as she didn't think it helped the first time when she saw the nurse practitioner. So when she said she would consider art therapy I thought that would be better than nothing, though it still hasn't started. The psychiatrist said CBT required a lot of motivation which she didn't have at the time...I don't know if I could say to her that she must do this alongside any increase - I can see her flatly refusing.
Oh, and what I didn't mention was that she has said she has attempted suicide 'many times' (I found this on her Tumblr page)

I'd really like to know if anyone has any positive experience of AD use in teenagers.

[perceptionreality]

Yes, I would agree that to start therapy you need to be reasonably well at the time you begin, which was where the medication helped me.

I am so sorry that you are going through this, it must be heart breaking for you. I hope that someone in a similar situation will be able to advise you more.

[perceptionreality]

Also is your dd's psychiatrist sure of her diagnosis?

[fifietta]

Thanks, perceptionreality, yes it feels desperate. I think it is depression and the voice hearing was part of this, although this has now stopped...are you thinking bipolar?

I just can't find anything that tells me about the prognosis for teens on AD's. I don't know if an increased dose will improve things, but certainly when she first went on them she did seem to feel a bit better, though this may have been just the fact of being on them if you see what I mean. She has a great deal of pain and struggles with many things in her life...

[Brightspark1]

DD also attempted suicide and was hearing voices, it was a desperate and frightening time. The psychiatrist explained that for her, the 'voices' were the only way she could express negative emotions, not a symptom of schizophrenia or anything. They stopped as she began to recover.
Art therapy really helped as it was a way she could express herself, as at the time she could do it with words, the therapist was amazing.
Slowly, very slowly she began to recover, it was a long hard road, but she is now discharged from CAMHS and is coping well.
There is hope and there will be a positive ending to this.
Make sure you look after yourself too. Sending a virtual hug.

[perceptionreality]

fifietta, no I didn't mean to suggest I suspect the diagnosis - just that mental health problems are very difficult to get a hold on and it took about 2 years before all the doctors I saw agreed on my diagnosis. I think if you experience psychosis of any kind (which means that you experience 'unreality') it's frightening. Sending a virtual hug here too.

[Eurostar]

It sounds tremendously difficult for you OP. As far as I know, for under 18s, guidelines are that meds should not be used without concurrent talking therapy. However, if your daughter was at risk of suicide and refusing talking therapy, it is understandable that they tried meds. 100mg Sertraline would be a standard adult dose (Sertraline comes in higher mg doses than the other SSRIs), perhaps not ideal for her to be taking it, however, if she feels sure it will help and the psyc closely monitors her while on it, there may be more benefits than disadvantages to following that course? Guidelines are definitely that under 18s should be closely monitored when on SSRIs.

If she has started to feel a bit better after a long period of feeling very down, it is understandable that she would want to see if meds can help to feel a bit better still?

[fifietta]

You're right Eurostar it is so hard to make a decision on meds without any real evidence for outcomes etc. And I can't help feeling the psychatrist is drug focused - also that's cheaper than talking isn't it? Good point about wanting to feel even better - she still struggles with feeling on the outside of things and has lost a very old friend who doesn't seem to be able to cope with her depression (particularly when she heard about the voices).

Brightspar, thanks, it really helps to know that there can be light at the end of the tunnel. And people do survive with depression. I have.

[fifietta]

Brightspark!

[perceptionreality]

I agree that psychiatrists are drug focused generally. After I had a spell in hospital, the psychiatrist in charge of my care there said that iho I would be far less likely to need further admissions if I had psychotherapy. When I got home my psychiatrist there refused to refer me, saying it wouldn't help I just needed the medication. I ended up having to pay for it myself.

[fifietta]

I spoke to my GP today. My DD is very up and down and has so many circumstantial and life issues to deal with that she feels therapy is essential, but she also said that if she's really down for more than a few days at a time, then increasing the dose may be the way to go too. Every conversation and message gets me thinking in different ways. I'll pay for some sort of therapy if the art therapy isn't helpful or is short-lived, but it's a minefield choosing the therapist and type too. A lot is about me trying to be positive - with myself and with DD. Thanks for all the kind words!

[hoochymama1]

Fifietta, much love to you. My DS- 22- put on Sertraline 4 months ago after a MH crisis. We're still waiting for CBT. It takes time to work, but he's already lots better. The best thing she's got is your love and care, but it takes time. It's scary when you know about suicide attempts etc but her expressing it is part of the getting better process. Don't neglect to look after yourself too. X

[fifietta]

Thank you hoochymama. I'm thick...what is MH?

What's so hard is that she's going through things, worries, relationship difficulties etc that no child of 14 should have to. It's just awful when she should be enjoying life...

[Brightspark1]

MH = mental health. I understand your concerns over medication, but if it helps to get her to a place where she can engage in talking therapy, it has to be worth while.
In my experience, psychiatrists semi to act as gatekeepers for other therapies and services but do not spend enough time with their patients to really understand the issues. It is the psychologists, therapists and nurses who make the real difference.
You have touched on one of the things that I have found so hard ... That DD has missed out on normal teenage life. Her issues have not been around boys, exams or parties but around self harm and wanting to end her life.
Your GP sounds helpful, if you go down the private route , they may be able to guide you in finding an appropriate therapy.
Keep hanging on! Better times are round the corner, it just takes time.

[Eurostar]

They are breaking NICE guidelines to medicate an under 18 without concurrent talking therapy, however, I had understood that she refused it before? Sounds like the art therapy is starting very soon? If not, they need to be pushed on it. Hopefully it will be someone good and it is a great therapy for a teen if they enjoy art. If you do go private, I'd say look for someone with experience of working with teens, you can ask therapists if they ever had a placement in a school for instance.

[LongTimeLurking]

I had/have MH issues (anxiety, depression) ever since a young teen. I was put on seroxat(Paroxetine) and to be honest I felt it did nothing or maybe even mad things worse. However a combination of a different medication and a talking therapy did turn things around eventually.

Over the years I've tried quite a few different medications and found Sertraline to be one of the better ones. However, I really think with MH medications it really is a case of suck it and see, so it may be that your DD needs an increased dose but it may also be that she needs to try and entirely different medication if Sertraline isn't helping her.

Also, medications aren't really a cure but more of a temporary support. As others have said, they are really effective when they lift your mood enough that you can try other therapies.

[fifietta]

Thank you all again for the positive words - it really does help to hear other's stories and that things can get better.

DD is particularly low at the moment and was poisonous yesterday, although she later apologised (it was because I insisted she come out to the town we were staying in this weekend, rather than lying in bed watching TV).

Many of her issues stem from a huge insecurity around friendships and family. She is mixed race and is not able with the West Indian side of her family as her dad, who is very ill, has decided to sever all contact with them. She hasn't seen her dad since the summer...she gets very distressed by seeing him and I think is now avoiding it, but feeling guilty at the same time. She feels that she doesn't fit in, doesn't have friends who 'understand' and is always on the outside of things. Her oldest close friend was disturbed when DD told her about the voices and hasn't contacted her since, even though she lives a few doors away - DD is is devastated by this. I think there was a boy involved about 18 months to 2 years ago and, unfortunately, she's held on to negative feelings about that and he has resurfaced, though not as a 'boyfriend'. It's a very complicated situation. Really it's been building over a couple of years and I wonder if I could have done something different.

I do think I'm going to agree to an increased dose of AD's - it's unbearable to see her so unhappy - and hope that the art therapist is good.

Brightspark - you particularly have helped, although I know for you too this ongoing. Thank you.