Depression: Youth, Counselling and Antidepressants
Depression: Youth, Counselling and
Gary Direnfeld, MSW, RSW
The advent of modern antidepressant medication has been
a lifesaver to many. Recent research demonstrates that a combination of counselling
and medication can provide the most effective treatment for youth suffering
from depression. However, there is evidence to suggest that in the early stages
of medication treatment, there is an elevated risk of suicidal thought, which
for some persons may lead to suicidal behaviour. This is causing a great many
people to reconsider their use of medication, even when indicated.
This issue is determining which youth will benefit
from one or the other or both treatments. To this end a good assessment will
look for exogenous factors and endogenous factors.
Exogenous factors are those things outside of the individual
that may contribute to depression. These include; family dysfunction, abuse
or neglect, parental separation, school related problems and relationship problems.
If it can be determined that one or more of these kinds of factors are at play,
then counselling alone may be sufficient to treat depression. Such counselling
includes family therapy, or in the case of separated and fighting parents, mediation
to help them resolve their conflict, so that the youth is no longer subject
to their turmoil. If the youth is in a difficult interpersonal relationship,
then counselling for the youth to address the difficulty may be in order. If
the youth is abused or neglected, these issues must be addressed and the youth’s
safety must be attained.
Endogenous factors generally relate to biological or neuro-biochemical
factors. If there is a history of depression in the family and there are no
known exogenous factors, then medication alone may be the treatment of choice.
Often though, with endogenous depression, the sufferer has difficulty controlling
depressive thoughts and as such, in this situation a very specific form of counselling,
CBT or Cognitive Behavioural Therapy, is also indicated.
There are times of course when both endogenous and exogenous factors are at
play. In these circumstances a combination of counselling and medication could
be in order and should seriously be considered.
Parents and youth are cautioned against making their decision
solely on the basis of newspaper articles proclaiming the good or the bad about
any treatment. Depression is a serious disorder, which left untreated can lead
to suicidal thoughts, action, injury and death. If you or your child is depressed,
obtain a good assessment by qualified professionals that will look at both endogenous
and exogenous factors and devise a treatment plan accordingly. Further, the
counsellor and the prescribing physician should be working hand-in-glove following
the individual to manage safety issues and communicating regularly about progress.
It is important to know that with antidepressant medication,
it can take a good thirty days before the therapeutic effect is achieved. During
this time, counselling may be of benefit to resolve other issues as listed above
or to simply provide support until the medication reaches effectiveness.
If you or your child is depressed, get help. It is often
advisable to start with your family doctor or community clinic. A physician
can make the diagnosis and direct you to treatment.