Do Different Children Respond the Same Way to the Same Antidepressant?

A question I see coming up a lot on Mom forums is regarding new antidepressants that have been prescribed for their children. The conversation usually goes something like this;

“My MD just put my daughter on Prozac. Is anyone else taking it? What's been your experience with it?’ 

There are an equal number of comments from mothers saying 'It's the best thing ever, worked so well’ to ‘We had the worst experience, DO NOT RECOMMEND’ to ‘It did nothing for my kid’.

For the mom whose child is using these medications for the first time, this can be very confusing. It certainly does not alleviate any concerns about the medication in question. 

This is because, with traditional medications, for the most part, they do what they say on the bottle. If you take an antihypertensive, blood vessels open up, the heart beats with less force, you pee out extra water and your blood pressure decreases. With an inhaler, the lungs open up and you stop wheezing. With a diabetic medication, over time blood sugar becomes controlled.

This is not the case for antidepressants. Let's say we have 100 people on a specific antidepressant.  Maybe only 30 respond well, 25 do not respond at all and 50 will respond a little.  They either work, kind of work, or don't work at all. In some cases they may do the opposite of what they are supposed to do.  

As a mom, that's the uneasiness of using these medications for your children.  You are throwing darts in the dark, or spaghetti at the wall.

I'd like to talk about a study on antidepressants that took place just under 20 years ago. It is called the STAR*D study.

In this study, just under 3000 people with depression were given Celexa, a type of antidepressant, for 3 months. Of the 3000 people, 28% of them went into remission which means the depression completely went away.  Of the people left over, just under 50% had some improvements in their depression, while 25% did not improve at all over the 3 months.

So in this instance, one third of people got better, half got a little better, and a quarter had no change on the same first antidepressant medication.

But Why?

This is an example of how on the same medication, people are going to have different experiences; some will do well, others won't. That's why when you see posts online where a mother is asking about people’s experiences with a specific medication, the jury is out. Some families will swear by the medication in question, whereas others will describe it as the worst decision they ever made.

The differences in experiences come down to genetics. It is one of the factors that plays a big role in how people respond to medication.  Genetics impacts what the body does to the drug, and what the drug does to the body.  It determines whether or not your body plays well with the medication and is able, or not able, to process it.  This determines whether or not you feel the benefits or side effects. That’s why if you, or a family member, have done well with Zoloft, for example, more than likely your child will also respond well to Zoloft.  The genetics are similar and ‘play well’ with this medication. Conversely if you didn't do well on Zoloft, your child might have the same bad experience.

So what is a Mom to do?

If you or a family member has a good experience on a certain antidepressant, suggest it to your MD.  The genetic lottery is in your child’s favor. For people who don't have a family history of antidepressant use and therefore are not able to refer back to personal experience, pharmacogenomic testing can be helpful. It determines how your genes affect the way that you respond to medications.  This is a great tool to help save time as you are not spending 3 months at a time trying out antidepressants, all the while unsure about whether or not they are going to work for your unique child.

Tips for your child's appointment

Make sure that either you or your child’s healthcare provider are using rating scales and scoring your child at regular intervals so see whether they are getting better or getting worse over time.  Typical treatment periods are 2-3 months long per medication to see whether they are working.  Scoring with rating scales is more accurate than just trying to remember how they were last month compared to today. Regular check-ins with your child’s provider allows them to react quickly and adjust the medication dose if needed.  

It truly is a comprehensive and collaborative effort between parents and their child’s healthcare providers when trying out new antidepressants. Your child will fall into one of three buckets: their symptoms go away, their symptoms get a little better, or their there will be no change in their symptoms. The way other children respond to a medication may not be the way your child responds to that same medication.

I have provided an Antidepressant Quick Guide with a list of items to remember and discuss at your child's next healthcare appointment. Click here to grab it.