Question. After having exhausted many other avenues of treatment for my 6-year-old son, I feel confident that Prozac could change his life for the better. My son has endured a lot in his short life, from the domestic abuse and alcoholism of my husband to moving twice. He was evaluated by two different psychiatrists, who found him to be a mad/sad child and they also said he was genetically loaded for depression. Both my husband and I have experienced depression. I feel like our lives are becoming more out of control each day. I am afraid for him and his future. Can you suggest what my next step should be?
Answer. I appreciate that this is a painful situation for you, but I am a bit unclear as to what, precisely, is causing your lives to become more out of control each day . First of all, I would be interested to know what the psychiatrists said about your son, besides that he is a mad or sad child. Did they feel that he is clinically depressed or in need of an antidepressant? If not, what did they recommend? Did they feel that your son was reacting normally to a very difficult situation?
Clinical depression is certainly a different condition from being angry and upset over the very difficult issues in your lives. I do not believe it would be warranted to expose your son to the side effects and risks of an antidepressant medication simply on the basis of his genetic loading, though that, indeed, is a risk factor for clinical depression. It would really depend on the symptomatic picture your son is presenting, which is not provided in your question. Symptoms such as marked irritability, aggressive behaviors, deterioration in school performance; or more classically depressive symptoms, such as poor sleep, poor appetite, expressions of hopelessness, guilt, low self-esteem or suicidal statements, might persuade me that a trial on Prozac is appropriate.
If you and your son are now involved in counseling/psychotherapy, I think you are already taking the right step. If not, it certainly sounds like both of you could benefit from therapy. You might also look into support groups for both you and (separately or together) your son. I think such groups can often be more helpful than individual therapy. If you believe strongly that your son merits a trial on an antidepressant, I would suggest an evaluation through the child psychiatry department of a teaching hospital or medical school. You may also wish to contact to the American Academy of Child and Adolescent Psychiatry at 3615 Wisconsin Ave. NW, Washington DC 20016 or call (202) 966-7300 for resources, booklets and referral sources in your area. Good luck.