A 16-year-old Red Lion student had been treated with medication and counseling for a mental illness, yet he allegedly attacked another student last week.

His case could be viewed as illustrating the challenges of treating teenagers, whose bodies and worlds are changing. Or it could have been a response to being bullied, one local psychiatrist said.

The student’s father said his son struggled with depression, attention deficit disorder and post-traumatic stress disorder. He had been receiving treatments and was taking two anti-depressants, the boy’s father said.

The boy had complained about being picked on, but didn’t have a history of fighting, his father said.

Treatment for mental illnesses such as depression can include using anti-depressants, individual counseling, family counseling, and if needed, as in the 16-year-old’s case, in-patient psychiatric treatment.

Counseling challenges

Psychiatrists know teenagers are different from adults. Teenagers are dealing with hormones and new social pressures, said Dr. Douglas Chen said, a Springettsbury Township psychiatrist.

From imaging technology brain scans, doctors can tell that the teenage brain has not reached what is considered adult development in the prefrontal cortex, which sits in the forehead area, Chen said. That’s where maturity and judgement decisions are made, he said.

Dr. Leslie Lundt, a psychiatrist who practices in Boise, Idaho, said pairing counseling whenever medication is prescribed for teenagers is important.

With teens, willingness to take part in counseling may create an obstacle, Lundt said.

“A lot of times the kids don’t want to be in counseling so they don’t want to talk,” she said. “They are afraid you are going to rat on them to their parents.”

For a counselor that can be a sticky issue. A counselor needs to explain to a teenager how confidentiality works, she said. If a teen says he’s suicidal, the parents must be notified, she said.

And then a counselor needs to be able to work out teenage exaggeration during sessions. A teen might say, “I’m so angry I could kill someone,” but he doesn’t mean it, she said.

Medication not a guarantee

Individuals respond differently to drugs. But because of teens’ biological changes and social pressures, there is even more of a need for doctors to have an open mind when treating teenagers with medication, Chen said.

Any illness - cancer, for example - can worsen even with treatment, he said.

Lundt said research has not been strong to support using anti-depressants in teenagers and children.

“We know that medicines, statistically, don’t work as well in kids as in adults,” she said.

Lexapro, one of the drugs the student had taken, is a member of a class that increases the level of serotonin in the brain. Some studies have found these drugs have produced an increased risk that children and adolescents will have suicidal thinking.

For that reason last year, the Food and Drug Administration had a black box warning placed on all antidepressants - the strongest measure the federal agency may take before pulling drugs from the market.

Certain individuals - whether children, adolescents or adults - have a negative reaction to medicines that contain serotonin, Lundt said. They may experience agitation and feel jumpy or out-of-their skin, she said.

“Some people feel compelled to hurt themselves or others,” Lundt said. This happens to about 1 to 3 percent of people using those medications, she said.

Doctors prescribe anti-depressants to children and adolescents off-label, meaning the drugs have been FDA-approved for adults for a specific use and research may support that same use in younger patients, but the drug company hasn’t specifically sought FDA approval for that particular use, Lundt said.

They are relatively safe, she said, and can prompt turnarounds in younger patients - including students going from failing to earning straight A’s, being able to sleep better and returning to social lives they once had enjoyed.

Although concerns have been raised about anti-depressants in the past year, those drugs have been shown to have benefits. A new UCLA study shows American suicide rates have dropped steadily since Prozac and other serotonin reuptake inhibitor drugs have been introduced into the market.

In the case of the Red Lion student, Chen, who did not treat the student, said it’s possible the student’s reaction related more to a response to bullying than because he was depressed or on medication.

Think of a cornered cat hissing, he said. Sometimes the animal attacks.

“Anger happens when someone feels insecure,” he said.

Antidepressants at a glance

A 16-year-old boy accused of attacking another student at Red Lion Area Senior High School Monday had been treated for depression, attention deficit disorder and post-traumatic stress disorder, according to his father. The boy had been taking two anti-depressants, Wellbutrin and Lexapro, his father said.

Wellbutrin: This antidepressant is designed to help balance the levels of two brain chemicals called neurotransmitters, dopamine and norepinepherine.

Side effects include loss of appetite, dry mouth, skin rash, sweating, ringing in the ears, shakiness, agitation, anxiety, dizziness and trouble sleeping.

Lexapro: This antidepressant is a member of a class of medications known as serotonin reuptake inhibitors. It is designed to treat depression by increasing the supply of the chemical serotonin in the brain.

Side effects include nausea, insomnia and fatigue.

Questions

What have been the recent warnings concerning antidepressants?

Antidepressants and their use in treating children and adolescents received some attention last year when the Food and Drug Administration told manufacturers of these medications to add a black box warning to all anti-depressants.

The warning states antidepressants increase the risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders.

No suicides occurred during short-term medication trials, but during the first few months of treatment a greater risk of an adverse event occurred in those taking antidepressants than those taking a placebo, according to the FDA.

These labeling changes are applicable to the entire category of antidepressants because the current available data is not adequate to exclude any single medication from the increased risk of suicidality.

What is a black box warning?

It’s the strongest precaution the FDA may take before pulling prescriptions from the market, said William Kautz, pharmacy manager at Memorial Hospital.

The warning is the first item a person would see in a package insert, he said.

Kautz was not involved in the treatment of John Meisky, but spoke generally about what some of the discussion has focused on regarding anti-depressants and teens during the past year.

Some anti-depressants increase levels of serotonin in the brain, which makes a person feel better, giving them more motivation, Kautz said.

It’s possible that antidepressants give children and adolescents more energy to act on negative thoughts - if the source of their depression has not been removed, Kautz said.

During the first two weeks of use, a person on these medications would be most at risk for experiencing a dangerous effect, he said.

Overall, antidepressants are relatively safe and provide relief to many patients, he said.

The question professionals are looking to answer is whether the medications are causing children and adolescents to act on negative thoughts or if they are acting on them because of their mental illness, he said.

Source: Wellbutrin, Lexapro Web sites, Food and Drug Administration, William Kautz, Memorial Hospital