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Hear Me

When you go to see your doctor, he might suggest taking medication and he might suggest therapy. You can't just do one and not the other - you have to do both at the same time. Taking medication helps you decrease that depression, and when you get behind the depression you can deal with these issues like talk[ing] to your family to help you . . . it is good to try and conquer that depression.

The reason why medication was so terrible was because it was prescribed to me after a 10-minute meeting . . . [exclamations of dismay] like with the psychiatrist . . . this woman . . . she came under the highest regard and I went in there, and I talked to her for 10 minutes and she basically told me to . . . like, in not so many words: “Stop being a baby! Here, take this, you'll feel better.”

Holism. Holistic viewing of things, rather than the typical science of breaking it down and, like, . . . “Here's a pill!”

I was in there for, like, five minutes and they offered me medication

Always before prescribing drugs, they should try to find another solution through like, maybe, counselling - anything like that. Try to find the root of the problem first. Well, that's the biggest thing. You gotta find the root of the problem and then try to work [it] out . . . it may take more time, but it will have better results.

[It helps to] talk to a psychologist. . . . They make you aware that you're not the only person who goes through things like this, you know?

I think peer counselling is a good idea. They're the ones who maybe had the same experiences, so that they could have a lot of empathy toward the situation.

Some people feel more comfortable talking to somebody they don't know. . . . It's like I'm just a voice on the phone. . . . They can't see my face. They don't know who I am. They can't call me back. They can't go around and tell people about it.

I think it would be really useful to have counsellors who have already experienced depression and who have coped with it already . . . so that they know what it's like.

[With antidepressants] you're just attacking the person really. That's all you're doing - giving them all this stuff and the problem is still there. . . . You're not getting the problem.

I've known a few people who were taking antidepressants and I think they became too dependent on it. It was something that they had to take every morning in order to feel good and they felt this was their, sort of, addiction.

I was in art class one day and my teacher closes the door and she says, “I heard you're on antidepressants. . . . I think you're a really bright girl and I just want [your art] to be real and not fake and caused by medication.”

I wouldn't necessarily say you have to take medication for [depression]. There's other ways, like nutrition, vitamins, exercise. I prefer the natural route.

Understand Me

Overwhelmingly, the young women endorsed talk therapy as being a positive and an effective approach to managing depression. And while few young women felt that medication could be a helpful tool in addressing depression, the vast majority expressed deep concern about antidepressants. The quotes from the young women are telling, as they speak less about potential side-effects of medication and more about they ways in which doctors prescribed it - sometimes after only a few minutes of consultation. Young women want to be heard. Establishing a trusting relationship will allow you and a young woman to thoughtfully explore the risks and benefits of medication.

Some women prefer individual counselling, while others prefer group counselling; some want to see a “professional,” while others prefer to speak to young women like themselves dealing with the same problems. Ask a young woman what she might prefer before making a referral. There are two specific types of psychotherapy that have been shown to be effective in treating depression: cognitive-behavioural therapy and interpersonal therapy. However, there are situations where treatment with medication becomes a medical necessity, such as in cases where the young woman is at high risk of suicide or has severe depressive symptoms with or without psychosis.

We Want to Know

Young Women's Questions about Medication, and Clinicians' Answers

While the following answers are intended to clarify issues around medication, please consult with a health care professional for further information.

Q: Is medication always necessary when treating depression? If not, at what point in dealing with depression is medication necessary?
A: The general message is that medication is not always necessary. However, when depression is severe, persistent and affecting one's level of functioning, then medication is often required. Medication along with counselling or psychotherapy is an effective approach. Sometimes, someone may be too ill to be in psychotherapy and may need initial treatment with medication before being able to participate effectively in psychotherapy.

Q: How do you assess someone's need for medication?
A: Often several sessions are required to be sure that the depression is not getting better on its own and to assess the severity and persistence of the depression. If the young woman agrees, then family members can have input on what they have observed related to the depression. Remember, it is important to find out what else is happening in a young woman's world. This takes time

Q: Why are more young women prescribed antidepressants than men?
A: There are increased rates of depression in young women compared to young men, and young women are more likely to seek referral for depression. The higher rates of depression in young women start at puberty and are probably related to genetic, biological and psychological factors as well as societal pressures faced by women.

Q: Please give a detailed description of how antidepressants function in the body.

A: Antidepressants have their effects by influencing neurotransmitters (chemical messengers) in the brain. The main neurotransmitters that are involved are serotonin, norepinephrine and dopamine. Some medications work selectively on just one of these substances, while others affect more than one. However, the therapeutic effect is complex and involves the secondary effect of these neurotransmitters on other chemicals in neurons (nerve cells) that are essential to healthy brain function. Medications sometimes cause unwanted effects on the body, including increased heart rate, agitation, anxiety, poor appetite, increased appetite, weight gain and decreased sex drive. Not everyone experiences side-effects, and different medications have different side-effects, so check with your doctor or pharmacist if you are not sure whether a symptom is due to medication.

Q: There has been a lot in the media about dangers in prescribing to young people. What should service providers working with young women know about this?
A: It is important for service providers to be aware of the benefits and risks of these medications and to discuss these with the young woman and, if she agrees, her family. In addition, they should discuss the benefits and risks of not taking medication. In most cases of moderate to severe depression, there is a greater benefit and lower risk in taking medication than choosing not to take it and thus continuing to suffer the adverse effects of depression. Improved mood, success at school and the ability to connect with people socially are potential medication benefits that many young people value.

Medications have been useful in alleviating depressive symptoms. We know that these symptoms can cause suicidal ideas and that completed suicide in young people has been attributed to these symptoms. There is some evidence that in rare cases some selective serotonin reuptake inhibitors (SSRIs) may lead people to have more suicidal thoughts and attempts. In clinical trials there have been no actual suicides clearly attributable to these medications. Researchers are trying to find out if suicide is a true side-effect and, if so, how the medications might contribute. The long-term effects of these medications on the developing brain are also unknown, although so far there have been no permanent brain changes linked to these medications in young people. Both the doctor and the young woman need to monitor her closely for side-effects.

Please note: There is no age at which taking antidepressants is inherently risky. SSRIs have been used successfully and safely in three-year-olds (for autism, not depression) and they have been used successfully and safely in 93-year-olds. The Compendium of Pharmaceuticals and Specialties provides a warning about age, but merely to say that “safety and efficacy has not been established in individuals under 18.” This does not mean the drugs are dangerous in kids and teens, but merely that they need to be studied more thoroughly in this age group.

Support Me

Be open to discussing options including medication, talk therapy and other cultural practices that may be important to young women in their healing process. Acknowledge the stigma and fears related to medication; take the time to openly discuss any questions or concerns the young woman may have.

Seek out young women-friendly techniques and case studies. Two helpful resources are listed below. Both authors focus on using respectful approaches to help young women:

• make contact with their strengths and resiliencies
• explore their internal and external experiences
• discuss how parents and families can be included in this type of approach.

Pipher, M. (1994). Reviving Ophelia: Saving the Selves of Adolescent Girls. New York: Ballantine.

See especially Chapter 13, entitled “What I've learned from listening.” The author provides concrete suggestions for speaking with girls, including a list of questions she asks girls to ask themselves.

Johnson, N.G. (2003). On treating adolescent girls: Focus on strengths and resiliency in psychotherapy. Journal of Clinical Psychology, 59 (11), 1193-1203.

In this case study, the author also offers examples of questions for young women.

Hear me, Understand me, Support me: What young women want you to know about depression

• Acknowledgements
• Letter to Service Providers
• About the Guide
• Challenges
• Unspoken Challenges
• Girl-Centred Health
• A Healthy Helping Relationship
• The Last Word
• A Critical Link - Referrals and Additional Resources
• In Their Words: Young Women's Stories, Advice and Wisdom