Helping Kids Cope Without Antidepressants

By Rob Waters, Natural Solutions

In the wake of reports on the potentially serious side effects of antidepressants on children and teens, parents and physicians are looking to alternative traditions to help kids cope with mental and emotional distress.

Sofia never really had been a nervous or anxious child–until she suffered a mysterious illness five years ago, when she was seven. She ran a high fever for two solid weeks, and her parents and doctors never figured out exactly what had afflicted her. Was it back-to-back viral infections? An undetected strep infection? What became clear is that after her sickness ended, Sofia’s personality changed.

“Coming out of the illness, she had an anxiety that was completely unlike her previous temperament,” says Joyce Wright, her mother. She didn’t want to separate from her parents or even let them out of her sight. She wouldn’t go to friends homes or allow her parents to leave her with a babysitter.

As the weeks and months went by, Sofia’s anxiety grew steadily worse, and she began to suffer panic attacks. Her heart would race, she would become agitated and unable to sit, and she had an overwhelming sense of feeling trapped. During one attack at school, she told her parents she felt as if she were caught in a black hole, surrounded by monsters.

Desperate to help their young daughter, her parents tried for a year and a half to figure out what was wrong. They consulted with a psychologist and worked at managing her fears, but nothing seemed to help. At the beginning of fourth grade, her anxiety worsened, and her parents took her to a psychiatrist. He prescribed Luvox (fluvoxamine), a selective serotonin reuptake inhibitor (SSRI) and antidepressant similar to Prozac (fluoxetine) that is approved by the Food and Drug Administration for the treatment of children with obsessive-compulsive disorder. The drug backfired almost immediately. They stopped the medication after only four days, but Sofia now was unwilling to go anywhere and was completely housebound for six weeks. “We could not leave the house, or she would escalate to full-blown panic,” Joyce says.

A midcourse correction
The psychiatrist then prescribed a second antidepressant from a different class of drugs, and while it did not trigger outright panic attacks, it, too, seemed to worsen Sofia’s anxiety, and she stopped taking it after two weeks. At that point, the family switched doctors and consulted a psychiatrist at Childrens Hospital and Research Center in Oakland, Calif. This time, they insisted on no medications. “It seemed so risky, and we were just not willing to put her through that,” Joyce says. The new psychiatrist suggested the family see Joanne Yeaton, a licensed clinical social worker in the psychiatry department who uses biofeedback.

Yeaton at first treated Sofia at home, gaining her confidence after conducting several biofeedback sessions in the family’s kitchen. With Yeatons coaching, Sofia was able to slow her breathing and heart rate, and, as she relaxed, to increase the temperature in her fingers, generally considered a sign of improved blood flow.

According to Joyce, after a few sessions, Sofia felt comfortable enough with Yeaton to visit her at the office, as long as her mother was present. Once there, however, she gradually allowed her mother to leave the room and wait in the hallway. Without medication, and after three months of working with Yeaton, Sofia was able to return to school on a limited basis.

It’s important to note that Sofia’s symptoms are unique to her. Children suffering from mental and emotional disorders experience widely varying levels of distress. No matter the severity of the pain or panic, however, parents increasingly are looking for ways to help their children deal with their symptoms without psychiatric medications.

Two sides of one coin?
The number of children diagnosed with depression and anxiety has exploded in recent years. The use of antidepressants increased 50 percent between 1998 and 2002. In 2002, for example, some 11 million children and teenagers were prescribed antidepressants, according to the Food and Drug Administration, primarily for depression, anxiety or a combination of both.

Although they often appear together, these two conditions manifest themselves quite differently. Like adults, children suffering from depression tend to feel sad and lethargic, often without knowing why. They have a hard time playing and engaging with friends and often do poorly in school because they lack energy and motivation. Depressed kids, more than adults, are often irritable and tend to act out as a result. Anxiety disorders cause a broad range of behaviors, but what they have in common is fearfear of people, animals, situations or events such as separating from parents. Rather than sending children hiding under the covers, these disorders overstimulate the central nervous system, send cortisol coursing through the body, and cause the heart to race, palms to sweat, and arms and legs to twitch. Despite the differences in these conditions, antidepressants are widely used to treat both.

But families like the Wrights, dissatisfied with the results of these drugs, and alarmed by reports of adverse effects–including an increase in suicidal thinking among children and teens taking them–are looking to alternative approaches such as biofeedback, relaxation, nutritional changes and psychotherapy.

For answers, they are turning to integrative medical doctors like Tim Culbert, MD, a behavioral/developmental pediatrician and medical director for the integrative medicine program at Childrens Hospitals and Clinics of Minnesota in Minneapolis, and Michael Cantwell, MD, MPH, a pediatrician at the Institute for Health and Healing at California Pacific Medical Center in San Francisco. These doctors are among a growing number of practitioners who mix alternative techniques into their often eclectic approaches to helping distressed children. While some practitioners dont rule out the use of psychiatric medication in some cases, most tend to see it as a last resort. Those who do use medications say that by combining them with other strategies, they can keep dosages low and get patients off the drugs more quickly.

For Cantwell, the key to working effectively with depressed or anxious children is to understand whats going on in both their bodies and their liveseverything from what they eat to relationships and events in their families. “When you see a kid whos depressed, you have to ask, Whats the cause?” he says. Holistic medicine tries to look at causes a little more closely, not to just take depression and say, We have a pill for that.

For some children, Cantwell says, the underlying problem may be biological: For some unknown reason, they are not making enough neurotransmitters, the brain chemicals that affect mood and emotion and are the targets of psychiatric medications. Other kids are depressed because of the stress or unhappiness in their lives, and the key to helping them is to aid them in addressing these life problems, he says. But the once sharp lines between environmental and biochemical factors increasingly are blurred; by now, it has become clear that they are not isolated from each other but rather are interactive. Grief from the death of a loved one can decrease the levels of the neurotransmitter serotonin; poor attachment between a mother and infant can have a lasting negative impact on the structure of a childs brain.

“The question is not whether depression or anxiety is biological,” says James Gordon, a psychiatrist and director of the Center for Mind-Body Medicine in Washington, D.C. “The question is how you approach biology. For example, if you can use exercise to lower levels of cortisol or increase neurotransmitter levels, why use drugs?” Because he believes there are other more holistic ways to address childrens mental health problems, and because of the risk of side effects, Gordon almost never uses psychiatric medications with children.

For some kids, rapid improvement can come from simple changes, “getting them off high-sugar diets and making sure they get more sleep,” Cantwell says. For most children, though, a combination of different approaches is likely to be needed, including dietary change, relaxation techniques, biofeedback and some form of counseling or therapy.

In his practice, Cantwell refers many kids and families to therapists. But he also practices what he calls spiritual counseling, which explores with kids ways they can identify and use their own resources to both cope with stress and connect with friends and family. For example, he says he helped one depressed boy who was acutely sensitive to the judgments of others create a force field that meanness and judgments would hit and wouldnt penetrate. When Cantwell learned from a 9-year-old girl that her daily stomach aches often surfaced when her mother’s boyfriend, like the ex-husband before him, yelled at Mom, Cantwell worked with her using guided imagery–asking her to visualize a safe, peaceful place, he says. From those instructions, the girl visualized a favorite playground, and when she visited it in her imagination, she told him she got a nice, warm pink feeling. After three sessions, Cantwell says, she was free from pain.