Treating depression in preschoolers

From Sara Reistad-Long at The Daily Beast:

Carissa Morgan's 11-year-old son, Dylan, has been on antidepressants since the age of 6, and in that time, she's heard all the accusations. “I think it’s just so easy for somebody who’s not dealing with a mental-health disease to throw stones,” Morgan says. “From every perspective—financial to emotional—this is pretty much a last resort. Believe me, I’d love the luxury to say, ‘I’m choosing meds because we’re all too busy to deal. The pressure of gymnastics, math, plus viola lessons just got too much.’ But, oh my God.”

Extreme as putting a child on antidepressants may sound, according to new research, parents like Morgan may have science on their side. Some experts now believe that chronic depression can affect children as young as 3 years old. The groundbreaking study, published this month in the journal Archives of General Psychiatry, found that an astonishing 40 percent of depressed 3- to 6-year-olds remained so over the course of two years, an eternity on a child’s clock.

The response to the study has been swift and largely hostile. “It’s ridiculous, the kinds of feedback we’re getting,” says lead author Joan Lubin, a professor of psychiatry at the Washington University School of Medicine in St. Louis. “People immediately assume that we’re pushing some kind of preschooler Prozac thing.” Far from hawking snack-time sedatives, Lubin says her study’s actual aim is to help parents identify when and how to make behavioral adjustments within their family to best support a depressed child.

What’s happened, however, is that Lubin’s findings have shed light on a truly jaw-dropping statistic: Preschoolers comprise the fastest growing psychiatric-drug-using demographic in the United States. Indeed, as many as three in 1,000 children age 6 and under are taking some kind of mental-health medication. And it's not just Ritalin. Prozac and Zoloft are close behind—research now shows that their usage among preschoolers has more than doubled in recent years.

Even in adults, the effects of antidepressants are poorly understood, and virtually nothing is known about the way they work in children. Moreover, controlled clinical studies have never been performed on minors. As a result, no medication is actually FDA approved to treat depression for the pre-K set. (Or, for that matter, young children at all. Prozac, uniquely, can be prescribed to patients age 8 and up, but that’s it.)

But children are being prescribed such pills anyway. Evan Perry (pictured) was one such child, having been prescribed antidepressants from the time he was 7 years old, not long after he’d climbed onto his school’s rooftop in what appeared to be a serious suicide attempt. Perry was the subject of a recent documentary made by his filmmaker parents, Boy Interrupted, which aired recently on HBO. At times heart-wrenching, the film chronicles Evan’s brief life and his struggles with both depression and psychiatric medication.

“I think the first dramatic turning point was one that didn’t even make it into the movie," says Evan’s mother, Dana Perry, of her experience interviewing for preschools. “Not only did we not get in anywhere, we came away with a serious mental-health referral."

Young Evan’s condition is so palpable it’s chilling. In one scene, he spontaneously breaks into a song about suicide. In another, he pauses from frolicking on the beach to confide that he has a gun and is preparing to kill his little brother and his parents. There is eerie footage of Evan, at age 7, demonstrating how he plans to hang himself. At age 15, during a reduction in his lithium dosage, Evan jumped to his death from a window.

Part of what makes Boy Interrupted so shocking is that it flies in the face of how we think of early childhood: the brief, carefree period of life before we accumulate tragedies, anxieties, and general neuroses. But if online discussion boards are any indication, depression in very young children is at least as common as current research estimates. Over the few short weeks since Boy Interrupted aired on HBO, Internet forums have mushroomed with parents claiming similar issues in their own children. Overwhelmingly, these comments stem from mothers, their language eerily similar: “Constantly talks about death,” “found a knife,” “I didn’t want to leave the kids alone together,” “walking on eggshells.”

Still, given the research, the notion of doling out mind-altering medicine to the very young remains disturbing to many parents. “Medications can't even be safely proven for adults, most of the time. Years of research and trials are needed. I say suffer the bad days and appreciate the good, as they grow they change and let them decide later in life,” reads one pragmatically worded post by a nurse who works with children. In terms echoed time and again across the Internet, she writes, “if they are not happy and you are in tune, hopefully you will see it, but masking with medications may not be the best.”

But Carissa Morgan, 11-year-old Dylan’s mother, disagrees. “Until you have lived this, you really don’t know, and can’t honestly say what you would do,” wrote the 32-year-old military wife and mother of four in an impassioned Facebook post on the topic. And while Dylan’s symptoms have been mitigated somewhat with medication, the list of behaviors he’s engaged in—from leaping onto a car with a kitchen knife to muffling his younger brother with a blanket to breaking Carissa’s nose and several bones—is troubling. Particularly given the fact that the other three Morgan children seem relatively stable.

“The first time the police came to our house, Dylan had smashed through most of our walls with a golf club. He was so fast, I couldn’t stop him. The cop came and I could tell he thought something else was going on,” Morgan says. “My thought was, look at this situation. I’m standing here with three other kids and we’re all in the same boat. Don’t you think if there was some secret, psycho-parenting thing going on there’d be some other thing?”

During the altercation—in which Dylan didn’t let up on the police officer—a social worker was called in. It turned out the boy had been hearing voices. The Morgans, who had staunchly resisted antidepressant treatment in the past, relented. Since that time, Dylan’s problems haven’t disappeared, but they’ve lessened considerably. “We have to continue to adjust the meds, he’s not completely better, but something positive is happening,” says his mother. “Nothing about this situation is ideal. It’s not at all what I imagined for my son, or my family, but we’re working with what little we have, and slowly, some answers are coming.”