JANE'S MHSP ARCHIVES: 2005

Medication: Cymbalta v. Lexapro Study

This may speak more to my ignorance of intracies of antidepressant clinical study design – but why did Eli Lilly choose a head to head (H2H) study with Lexapro – an SSRI class antidepressant – instead of another SNRI like Effexor? Google News / Google Search

Whatever the reasons may be, there were no significant differences in efficacy between the two drugs although there are some safety differences (more dry mouth and nausea on the Cymbalta arm than sugar pill or Lexapro arm). The study was a double-blind radomized placebo controlled trial, which gives a high level of clinical confidence (i.e. how much you can trust the results of the study as true results and not because of other factors including biases or spurious effects). At the very least it means patients with depression have another drug that works so that if one cannot tolerate the side effects of a drug, there are others to choose from.

Ethics is Behavior not a Statement

In line with my previous post, I became aware of a call for ethical standards for bloggers of healthcare information. Now, I’m not sure I consider myself a “healthcare blogger” although I’ve been using blogging software to support this website for the past two years. The closest I came to blogging on this website was chronicling my experiences with medications back in 1998 – and by no means was I trying to inform or make any statements. My purpose was sharing my experiences – the good, bad, and ugly sides of depression.

This site has been adhering to the HONcode, which includes many of the ethical standards called for in sharing healthcare information. Of course if I had to stick to how often the site is updated my site wouldn’t make the cut, since I update the site sporadically. However, the most important elements include disclosure – who pays for what and how much and when. Disclosing present and past associations and potential conflicts of interest are key – I’ve been employed in the pharma industry in the past, and I disclose what therapeutic areas I used to work in. What ultimately matters is not what I say on the website but how I conduct myself consistently over the years. I think patients and consumers and most web visitors can spot a phony a mile away no matter what the phony claims in any “standards” page.

Some may say that HONcode is a start and we can always have more developed and clearer guidelines. I can’t argue with clarity. I just think right now, we need consistency and transparency more urgently than additional clarity. Half the time we can’t really prove what we claim without making public our financial statements or records that have traditionally been demanded of publicly traded companies. Ultimately the patients are still dependent on our verbal and blogging claims at face value.

Interestingly, around the same time I learned of this topic was when I had been mulling over an idea that I wanted to implement for almost 3 years. Like all of my ventures, this idea came from an unmet need that still isn’t being well-met. This need is the shroud of mystery that continues to surround medical and drug information. It goes along with my previous post about the transparency of information.

If you as a patient goes on a clinical trial website and click on the clinical trial links that drug companies now have to offer to the public, would you actually know what you’re looking for? Do you know what inclusion/exclusion criteria means to you, and why you can’t be included in the study for what reasons?

Even more basic, let’s take a package insert (what docs commonly refer to as “PI”) of a drug you’re taking. It’s a piece of paper with text printed the size of baby ants. There is small text on both sides, some are bolded, some aren’t. You may even notice a black box that looks a bit menacing. Do you, the patient, even know what you’re looking for on this piece of paper if you get a hold of it? This piece of paper represents all the clinical studies that drug companies had done to prove that their drugs are safe and that their drugs work for the condition the drug is approved for. Sometimes docs will even look at the PI to make sure that the drug isn’t interacting with some other drugs you’re taking if you are prescribed the drug.

With the internet and globalization of information, we have no shortage of information. But what we still lack is basic understanding of what all this information means for our patients.

Can You Trust the Information?

I’ve noticed that as our access to information increases, our confusion to the information and our suspicion of the agenda behind available information also increases.

Can we trust the information we get from our many options? Even before trust – do most people actually understand the information with all the scientific jargon and technical speak?

One of the reasons I founded this website was in response to a father who was reading a scientific journal on a study that has some implications on bipolar disorder, and he didn’t understand what the study was talking about. The science was extremely abstract and practically inaccessible to consumers.

Recently pharma companies have made their clinical trial information accessible to the public. “Transparency” is the buzz. I don’t believe this increases “transparency” to patients. Maybe to physicians and scientists and of course, competing pharma companies. But I’ve seen these clinical trial portals and I can’t believe that most patients and consumers know what the information means or whether they should care.

Medication: Depakote ER for BP Acute Manic or Mixed Episodes

ABBOTT PARK, Ill., December 07, 2005 /PRNewswire-FirstCall/ — Abbott announced that the U.S. Food and Drug Administration (FDA) has approved a new indication for Depakote(R) ER (divalproex sodium extended-release tablets) for the treatment of acute manic or mixed episodes associated with bipolar disorder, with or without psychotic features. Depakote ER offers patients the convenience of taking this medication once a day. Compared with Depakote(R) (divalproex sodium delayed-release tablets), Depakote ER taken once a day helps provide more consistent levels of medication in the body. Search Google Web / Google News.

Important Product Safety Information for Depakote ER in Acute Mania

Valproate products should not be administered to patients with hepatic disease or significant hepatic dysfunction. Hepatic failure resulting in fatalities has occurred in patients receiving valproic acid and its derivatives, usually during the first six months of treatment.

Valproate may produce teratogenic effects in the offspring of women receiving the drug during pregnancy. Benefits of Depakote should be weighed against risk of injury to the fetus in women of childbearing potential.

Cases of life-threatening pancreatitis, some rapidly progressing to death, have been reported in both adults and children receiving valproate. Valproate is contraindicated in patients with known urea cycle disorders (UCD), a group of uncommon genetic abnormalities, due to reports of sometimes-fatal cases of hyperammonemic encephalopathy. Concomitant administration of valproic acid and topiramate has been associated with hyperammonemia with and without encephalopathy.

The frequency of adverse effects, particularly elevated liver enzymes and thrombocytopenia, may be dose-related. Multi-organ hypersensitivity reactions have been reported after the initiation of valproate therapy. In a clinical trial of valproate in elderly patients with dementia, some patients taking valproate experienced somnolence, sometimes requiring discontinuation.

Common adverse events (greater than 5 percent incidence) associated with Depakote ER or Depakote in clinical studies of acute mania patients were somnolence, dyspepsia, nausea, vomiting, diarrhea, dizziness, pain, abdominal pain, accidental injury, asthenia and pharyngitis

Medication: Risk of Birth Defects with Paxil

ROCKVILLE, Md., Dec. 8, 2005 – The Food and Drug Administration today is alerting health care professionals and patients about early results of new studies for Paxil (paroxetine) suggesting that the drug increases the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy. Paxil is approved for the treatment of depression and several other psychiatric disorders. FDA is currently gathering additional data and waiting for the final results of the recent studies in order to better understand the higher risk for birth defects that has been seen with Paxil. Search Google Web / Google News.

Seeking relief, yet finding despair

One drug was meant to give relief from respiratory trouble, but soon a whole new kind of trouble grabbed hold and nearly pulled her under.

By ALISA ULFERTS, Times Staff Writer

Published December 11, 2005

On April 2, 2004, I lit up my first cigarette in seven years. I considered its glowing tip for a moment, then pressed it into my inner arm. I took it away and pressed again. When I was done, a series of concentric burns blistered black on a surface that stays white even in summer.

I felt only the slightest needle prick with each circle. The smoke that drifted off my skin resembled the fog that had settled over me weeks before, anesthetizing me against pain. The next morning I was surprised to wake with seven weeping sores in the crook of my arm. READ THE ARTICLE

Prescription Drug Access

Well friends, we’re closing in on the winter holidays and the next thing you know, we’ll be welcoming 2006. I haven’t been updating this website much, and I feel badly about it, because web visitors generally like frequent updates and new information. As you would expect from a small business owner, I’ve been swamped with “work” and have never worked so hard in my life. The upside is that I enjoy my work very much. The downside is that I sometimes get sucked into the “busy-ness” and hardly have the mental energy for many other things I’d otherwise enjoy doing.

Here’s something that I wish I had time to investigate: Pharma companies’ patient assistant programs. Back in July of 2005 (right before this website went down from a server outage), I received an email from Ms. Carrie Maloney, a registered nurse, on behalf of a service called “Med Solutions“. Carrie wanted me to know that there is a service out there that helps patients get prescription drugs they need if they cannot afford to pay for the drugs. Med Solutions is a fee-for-service, which means you as a patient pay Med Solutions to help you get free drugs if you cannot afford to get the drugs for your medical condition.

I emailed Carrie this response:

Thank you for bringing this to my attention. Have you considered bringing this up to PhRMA? Or if you did, what response did you get if any?

PhRMA is the pharma industry’s lobbying group – its association. Having worked within the pharma industry, I’ve been beaten over the head with all the patient assistance programs that drug companies offer patients. In fact, I had even heard a keynote speech by Billy Tauzin (used to be a politician, now president of the association) talk about the importance of increasing awareness of pharma’s patient assistance efforts so that the public will know drug companies are helping those who can’t afford to pay gain access to the drugs that they need. When I heard Billy’s speech I felt very encouraged by pharma companies’ actions. I thought perhaps this was a first step to mending some serious credibility bridges that various pharma scandals have burned over the past few years.

Carrie wrote me back thus:

Thank you for taking the time to email us. We are very aware of the program funded by the Pharmaceutical Companies (PPARx) and obviously we would love to have some funding, as all cost in supporting our organization is coming out of our own private funds. We feel that PPARx is somewhat self-serving to the Pharmaceutical companies. For example I could enter the brand name “Prozac” I would then do a search choose that medication and enter personal information, ie age,income,etc., What is generated as resources is not correct. Support systems come up that this medication is available either through “Hawaii RX” ( which is the cost that the state pays) or Hawaii AIDS program (which of course you have to have aids). The manufacture of this medication is Eli Lilly which is a participating program of PPARx and it is available through Eli Lilly free under their PAP . Based upon the information I put in to the system it should have came up as a free medication through Eli Lilly. This happens with many of the medications, and if I wasn’t familiar with these programs and was a patient trying to get a honest resource, then I would understand that It was not available free. This happens with alot of the medications and within different Pharmaceutical companies. So we do not feel comfortable with PPARx as we feel that they are misleading the public. If you have any other input please do not hesitate to contact us.

Carrie should be commended for her due diligence and checking the PPARx system. I was very disappointed to hear that PhRMA is falling short of its valiant efforts by not implementing the system well. Many companies and organizations have very good intentions, but if these intentions are not done well, it wouldn’t help anybody.

At the time I wanted to investigate this further, for example, by asking PhRMA whether it has dispatched testers for its system to see how “user-friendly” its patient assistance program is. However, it’s still on my “to do” list!

If you’ve tried pharma companies’ patient assistance program and experienced what nurse Carrie was describing, please let me know.

Additionally, January 2006 is when Medicare Part D becomes effective, and supposedly offer those on Medicaid better access to prescription medication. From what I’ve read so far, trying to understand how to enroll in Part D may be harder than walking a tight-rope backwards with a cinder block strapped around your waist.

Recovery or Remission?

Recently a visitor asked whether I had recovered from chronic depression. I’ve had very stressful periods, and would occasionally have low mood for a day or two. These do not come close to the type of depression I had experienced many years ago.

Cancer patients talk about remission more often than about cure. I think we can make a similar analogy with depression, at least I am very mindful of the low tides and how long I would be in a low state and how concerned I need to be. I have learned to tell the difference between response to a very stressful period or bad news – a “normal” state of depressed feelings – versus an abnormal state of depression. There seems to always be that depression “micrometastasis”, a dark seed of possibility waiting to come into full force if only it had the right combination.

For the time being, it looks like I am in remission.

The funny thing about depression is, because I have experienced how painful the depths of an abyss can be, I am thankful for ordinary things and boring days when nothing exciting happens. I am grateful I can connect with people without a wall around my heart (perhaps my mind). I am happy for being where I am today.

Topamax or Toprol?

Medication Confusion Alert Please make sure that when your doctor or pharmacist writes or fills your prescription for Topamax (topiramate) for epilepsy treatment or other unapproved use as prescribed by your doctor, that this is what you’re getting and not Toprol (metroprolol succinate). Toprol is used to treat high blood pressure, angina, and heart failure. It may be useful to also remember these drug’s chemical, or generic, names when you go to the pharmacy to get the prescription filled. Taking the wrong medication can hurt you, especially when you have other health conditions or take other medications that can interact with either one of these medications.

TOPAMAX (chemical name: topiramate)

Marketed by Ortho-McNeil Neurologics, Inc.

What Topamax can look like (click on each dosage form to see the image)

TOPROL (chemical name: metroprolol succinate)

Marketed by AstraZeneca LP.

What Toprol can look like

Medication: Eli Lilly Updates Strattera Label

Source: Eli Lilly “INDIANAPOLIS, September 29, 2005 /PRNewswire-FirstCall/ — Eli Lilly and Company today announced that it will update the product label globally for its attention-deficit/hyperactivity disorder (ADHD) medication, Strattera, to communicate new information regarding uncommon reports of suicidal thoughts among children and adolescents. In conjunction with a request from the U.S. Food and Drug Administration (FDA), Lilly submitted to regulatory agencies an analysis of adverse event data from its Strattera clinical trials database that identified a small but statistically significant increased risk of suicidal thoughts among Strattera-treated children and adolescents (5 cases out of 1357 patients or 0.4 percent vs. 0 cases out of 851 patients taking placebo). There also was one case of a suicide attempt in a patient taking the medication (out of 1357 patients). There were no suicides among children, adolescents or adults on the medication during any Strattera clinical trials, and there was no indication of an increased risk of suicidal thinking in the adult population. As part of the FDA’s continuing focus on patient safety, the agency and its Pediatric Advisory Committee plan to complete an ongoing review of adverse event data for all ADHD medications by early 2006.”

Read This Book and Call Me in a Week

Doctors in England are prescribing self-help books for mild depression instead of medication. This practice, bibliotherapy, provides patients with non-medication option. For patients with severe depression symptoms, medications are warranted. I’m sure the U.S. is watching and waiting to see how well this model works, and as a nation we already love self-help books and tapes and gurus. However, U.K.’s adoption of bibliotherapy may stem from a practical fact:

In Britain, the National Heath Service covers everyone’s medicines and doctor visits, free of charge.

Bibliotherapy also helps free up physicians to treat seriously depressed or mentally ill patients. Bibliotherapy also allows patients who has a long wait to see a physician (what you get for “free” you often pay with time) to have an alternative “prescription.”

Source: Wall Street Journal, August 9, 2005. “For Mild Depression, Some U.K. Doctors Prescribe Reading”

Is anger its own disorder?

Anger problems now has its own name: Intermittent Explosive Disorder. Many treatment regimens in depression and bipolar disorder address anger and rage that patients often experience during an episode or during the course of the illness.

I don’t dispute anger being a critical issue to address, but I am not sure that our continual splitting off symptoms into its own “disorder” is a good idea. It takes us farther away from addressing the person as a whole, and closer to treating the individual disorders almost as if these are unrelated to each other and therefore warranting its own medication. I think this brings us even closer to overmedicating.

SOURCE: Out of control anger

By Carey Goldberg, Globe Staff | August 8, 2005

They used to just call it a bad temper and tell you to count to 10. Then came bunches of guys sitting around in circles and learning ”anger management.” Now, increasingly, the catchphrase is ”Intermittent Explosive Disorder.” Researchers delving into pathological anger report that it is more widespread than anyone had suspected. And that their understanding of its biological roots is deepening, raising prospects of better treatment. A national study found that at some point in their lives, about 5 percent of people have such frequent, serious blow-ups that they qualify as suffering from Intermittent Explosive Disorder, a full-fledged psychiatric diagnosis. It is twice as common in men as in women and tends to begin before age 20.

Symptoms of Depression

What are the symptoms of depression?

• * continuous feeling of sadness and emptiness

• * feeling worthless (“if I were to die in an accident, no one would notice.”), hopeless (“there’s no future for me.”)

• * sleeping too much or too little

• * eating too much or too little

• * no longer enjoying activities you used to enjoy (“everything seems dull and I can’t feel joy in doing things I used to enjoy doing.”)

• * persistent tiredness and loss of energy

• * suicidal thoughts (“living is not worth the pain.”)

Information source: U.S. National Institutes of Mental Health or NIHM at http://www.nimh.nih.gov/publicat/bipolar.cfm.

Symptoms of Bipolar Disorder

What are the symptoms of manic depression (bipolar disorder)?

Bipolar Disorder includes the depression symptoms during the depression cycle, plus these symptoms during the mania cycle:

• * Increased energy, activity, and restlessness

• * Excessively “high,” overly good, euphoric mood

• * Extreme irritability

• * Racing thoughts and talking very fast, jumping from one idea to another

• * Distractibility, can’t concentrate well

• * Little sleep needed

• * Unrealistic beliefs in one’s abilities and powers

• * Poor judgment

• * Spending sprees

• * A lasting period of behavior that is different from usual

• * Increased sexual drive

• * Abuse of drugs, particularly cocaine, alcohol, and sleeping medications

• * Provocative, intrusive, or aggressive behavior

• * Denial that anything is wrong

Information source: U.S. National Institutes of Mental Health or NIHM at http://www.nimh.nih.gov/publicat/bipolar.cfm.

Bipolar Disorder – Loved Ones

Since I founded the Mental Health Source Page, I have received many emails from family members and loved ones of people who suffer from bipolar disorder. These emails are heartbreaking because by the time family members write, they are often very desperate and at their wits end. Often, I’m asked for advice about what they can do, whom they can call or reach out to, and when they should give up.

These are personal questions that outsiders often cannot answer appropriately or adequately. Especially in cases where children or individuals can face violence – where physical or emotional harm may be involved – family members may want to consider formal intervention. Bipolar Significant Others (www.bpso.org) is a website that is dedicated to supporting family members and significant others of those who suffer from bipolar disorder. I’d recommend any family members who face this tough dilemma to visit the BPSO website.

Medication websites

2005 Update Every day, a plethora of health websites dot the internet landscape. Pharmaceutical companies also get in on the action by offering information about their products. What’s in it for you? Without a question, the single most important thing to download from a product website is the Package Insert, often abbreviated as “PI” and referred to as such by physicians. Whatever your doctor can tell you about a drug is a combination of the doctor’s clinical experiences with the drug as well as what s/he reads in the PI.

[R] means “Redirect”: What bugs me is how companies remove patient-friendly information from a product website once that product has gone generic. Since I created this section in 2002, I’ve seen this trend of redirecting the now-generic product page to the new formulation (extended release or an isomeric form of the drug). If companies want to demonstrate that they really do care about these conditions, they should leave the patient-friendly information on those websites and give people a choice to click to the new product page.

Abilify Psychotropic, Bristol-Myers Squibb. Abilify is the brand name for aripiprazole, the newest antipsychotic launched late last year. Abilify is indicated for the treatment of schizophrenia, with notable differences in side effect profiles when compared with current atypical psychotropics on market today. Weight change is minimal (many patients stop taking their meds when they gain a lot of weight, and this has a negative effect on their treatment), muscle movement disorders are not too different from those seen with placebo, and sedation is minimal. We’ll wait for some market experience to see how the positive observations seen in clinical trials stack in “real life”, when patients are not as tightly monitored as when they are in a clinical trial setting.

Buspar Anxiolytic/Generalized Anxiety Disorder, Bristol-Myers Squibb. Year 2002 Update: Since Buspar has gone generic, I’m not sure how long this web site will stay, but I don’t expect there to be any patient programs ongoing (it would be nice if generic companies, who are now are raking in the cash, to provide for patient programs the way pharmaceutical companies do, but that would be an anomaly…) Year 2003 Update: Looks like BMS is geared to pay a hefty fine for intellectual property disputes, but the web site is still running. Year 2005 Update: Website’s now just one page with link to PI.

Celexa SSRI-Class Antidepressant/Depression, Forest Pharmaceuticals. Now that citalopram’s gone generic, the website is redirecting you to the “next generation” of celexa while providing no helpful patient information.

Cymbalta SSNRI Depression and Diabetic Peripheral Neuropathic Pain, Eli Lilly. The patient related information mirrors those provided for Lilly’s other depression drugs.

Depakote Anticonvulsant and Antimanic agent/Partial Seizures, Bipolar Disorder, Migraines Prophylaxis, Abbott. Website includes: three categories of usage of this product, including Prophylaxis of Migraine Headaches, Absence and Complex Partial Seizures, and Mania Associated with Bipolar Disorder.

[R] Effexor SNRI-Class Antidepressant and Anxiolytic/Depression, Generalized Anxiety Disorder, Wyeth. Website redirects you to the “XR” formulation (still branded) website, which has some patient friendly information.

Geodon Antipsychotic, Bipolar Mania and Schizophrenia, Pfizer. Patient-friendly information is sparse, the website looks like a web brochure. I’d like to see more patient-related information than what is available, especially given this drug is still relatively “new”.

Lamictal Anticonvulsant/Adjunct Therapy for Partial Seizures, GlaxoSmithKline. This medication is now approved for the maintenance treatment of adults with bipolar I disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapy. There is also a resource center called Bipolar.com.

Lexapro SSRI-Class Antidepressant, Forest Pharmaceuticals. Nice feature of physicians locator (from the American Medical Assocation) and depression screening tool under “Resources and Tools” as well as suggested resource including links and reading references. I especially like the Patient Literature section, which addresses different patient populations (general guide, guide for “you”, guide for men, guide for women, etc.).

Neurontin Anticonvulsant/Adjunct Therapy for Partial Seizures, Pfizer. This medication is approved for neuralgia and epilepsy. While this medication has not been approved for treating bipolar disorder, some physicians prescribe it “off-label” as an alternative agent. Neurontin off-label use sparked a whistleblower lawsuit.

Paxil SSRI-Class Antidepressant/Depression, Panic Disorder, OCD, GlaxoSmithKline. Website includes a self test and helpful information for friends and family members.

Prozac SSRI-Class Antidepressant/Depression, OCD, Bulimia Nervosa, Eli Lilly. Website has basic information about depression and about fluoxetine.

Remeron Atypical Antidepressant/Depression, Organon. Remeron is now available in rapid-dissolving tablet form. At least the site is back up with some information for visitors – the site is divided into US visitors, consumers (Organon company info, not Remeron-specific), and non-US visitors/healthcare professionals.

Seroquel Bipolar disorder, Antipsychotic/Schizophrenia, Astra-Zeneca. Website has a wealth of information about both conditions for patients.

[R] Wellbutrin Atypical Antidepressant/Depression, GlaxoSmithKline. Redirects to the extended release formation. Has a self-assessment.

Zoloft SSRI-Class Antidepressant/Depression, OCD, Panic, PTSD, Pfizer. Website includes: Your choice of disease conditions that Zoloft is FDA-approved to treat, Personal stories (reads more like testimonials for Zoloft’s efficacy), About Zoloft (how it works, side effects), Request materials (product brochures and disease state brochures), Prescribing information. Also presented in en Espanol. Year 2003 Update: The Zoloft “egg” mascot is one of the more frequently recalled ads when consumers were surveyed. For some reason I really like the semi-smile on the egg-shaped character (I guess the ad agency succeeded in one of its goals.)

Zyprexa Antipsychotic, Antimanic agent, Eli Lilly. Website has a nice section on “Managing day by day”, which I have not seen on other product websites.

What is “first line” therapy?

You’ll often hear physicians discuss therapies as either “first-line”, “second-line” or “third-line”. There are terms referring to the preference of medication to treat a medical condition based on the clinical data available regarding medication efficacy (effectiveness) and safety, and now in the managed health-care system – cost.

First line medications are those that have a proven track record to work (often by being on market the longest), are safe in majority of patients, and cost the least.

Second line medications are often used only after first-line medications fail.

Third line medications are used when second line medications fail.

Only if the doctor believes there are unique circumstances to the patient profile will he or she choose a second line drug or third line drug. However, in the case of psychotropic medications, this trend seems to be fading as doctors are choosing second- and third-line drugs as first line drugs.

Exercise: 30 Minutes/Day, 6 Days/Week

“A study in the January issue of the Journal of Preventive Medicine suggested that a half-hour a day of exercise six days a week – which is the amount the federal government recommends for all Americans – might be ideal. Comparing two groups of depressed patients, the study found that the group that performed only 80 minutes of exercise a week received little to no mental-health benefit. But the three-hour-a-week group had a substantial reduction in symptoms. The study concluded “the response and remission rates in the (three-hours-per-week) group are comparable to other depression treatments, such as medication or cognitive behavioral therapy.”"

I agree that exercise confers excellent benefits for managing depression. Exercise has been helpful in my long-term mood management. However, depressed patients may consider exercise as adjunct (add-on) therapy instead of looking only to exercise as treatment. A good point that a physician has brought up was that depressed patients could barely get out of bed, let alone get out to exercise 6 days a week.

Depression in Teens and Children

Ms. Nejman’s article, Experts call teen depression a challenge highlights the challenges of balancing the need to treat depression in teens and children against the safety risks of treating depression with antidepressants. Talk therapy may be an excellent option, and a required one when medication is involved, but adolescence is not the period when trust in adults is particularly strong. I had severe depression as a teenager and to this day, I continue to feel tremendous gratitude to high school counselors and teachers who must have found me a terror to work with, but never gave up trying to “reach” me.