On February 7, 2004, a complete disaster occurred in the laboratory of a pharmaceutical company: the lifeless body of 19-year-old Traci Johnson was found in the bathroom, where she had taken her own life by hanging herself from the shower head. . However, Traci Johnson had never shown any signs of depression during her voluntary admission to the relevant clinic for a study on antidepressants and children… Millions of people worldwide die from suicide every year . In addition, there are still a huge number of people who make a failed suicide attempt. These are mainly people who work in psychiatry.
Things are completely different for 19-year-old Traci Johnson. She had never shown symptoms of depression before in her life. It was therefore a great mystery why she had taken her own life . What sets Traci apart from other suicide cases is that she was a test subject in a clinical trial by the pharmaceutical company Eli Lilly of a new type of medication for depression called cymbalta . This is a brother of Prozac .
However, Tracy Johnson turned out not to be the only one who died under these bizarre circumstances as a result of a suicide attempt. During previous studies with the same drug, four other young people also appear to have taken their own lives…
The unfortunate death of Traci Johnson has prompted the world of psychology and psychiatry to conduct a large-scale investigation into the effectiveness and safety of the treatment of young people and children with an antidepressant. The conclusion of the research? Very, very caution is required when using antidepressants in children and young people .
Following the death of Traci Johnson, the FDA , the Food and Drug Administration, issued a general warning against the use of antidepressants in children and adolescents. It is now virtually mandatory that every package leaflet of an antidepressant separately points out the specific danger of the use of antidepressants in children and young people.
Children’s brain development
Children’s brains undergo enormous development during development. This development begins during pregnancy . This starts with neurogenesis , which is the rapid multiplication of neurons through cell division. Subsequently, the periods of migration (where the neurons move to their final location), differentiation and enlargement begin.
The brain gradually develops into its final shape. The last area to be fully developed is the dorso-lateral prefrontal cortex, which is associated with regulating attention, controlling impulses, setting priorities, and other higher functions. This process is not completed until after the age of 20 .
Synaptic extinction follows a kind of neural Darwinism: the synapses that are often used survive. Experience and expectation also partly determine which synapses survive and which do not. This results in a number of critical sensitive periods when, for example, it is easiest to learn a language.
What is depression?
Depression is a type of depression that a person experiences. This depression should not be confused with a ‘normal dip’. Unlike a slump, depression does not go away on its own and the despondency is many times more intense. In addition, depression affects daily functioning.
Symptoms
According to the DSMIV (diagnosis manual), a person has depression if he or she meets the following criteria:
To diagnose a major depressive episode, one or two of the following symptoms must be present:
- Depressed mood
- Loss of interest or pleasure
These two criteria must exclude the possibility that they are caused by a physical condition or mood-incongruent delusions or hallucinations.
A diagnosis is also possible when one has 1 of the 2 above symptoms and at least 4 of the following symptoms:
- Depressed mood most of the day.
- Marked decrease in interest in pleasurable activities.
- Changing appetite and marked weight gain or weight loss.
- Disrupted sleep patterns or insomnia or sleeping more than normal.
- Changes in activity levels, restlessness, or moving significantly slower than normal.
- Fatigue or loss of energy almost every day.
- Feelings of guilt, helplessness, anxiety, and/or fear.
- Reduced ability to concentrate or make decisions.
- Thinking about death or suicide.
Finally, the following ‘requirements’ must be met:
- The symptoms cause clinically significant distress or impairment in social, occupational or other important circumstances.
- The symptoms are not the result of direct physiological effects of substance use (for example, drugs or medication) or a physical condition.
- The symptoms cannot be explained better than by grief, for example after the loss of a loved one.
- The symptoms last longer than two months or suicidal thoughts are strongly present.
The brain and depression
The brain consists largely of two cell types . You have the neurons (nerve cells; these cover 15% of the brain tissue) and the glial cells (these are supporting cells; cover 85% of the brain tissue). The neurons communicate with each other by sending chemical substances back and forth, these are called neurotransmitters. The neurotransmitters are transmitted using the synapses , a kind of gates on the neuron. In some cases, something goes wrong in this communication process. It may be that the transmitter is not strong enough, or that the receiver does not send a message back. It may also be the case that there is too much or too little communication.
In people with depression, there is too little of the neurotransmitter serotonin in the brain. This may be because the synapses produce too little of this substance, or because the substance is broken down, recycled and reabsorbed too quickly after the message has been passed on.
What does an antidepressant do?
An antidepressant works on the production and breakdown of the neurotransmitter. Most antidepressants prevent the neurotransmitter from being broken down and reabsorbed too quickly, making the chemical available in the synapse for longer. However, the MAOIs only inhibit the breakdown of neurotransmitters.
Antidepressants and their development
During development, our brains go through major changes. At certain times, certain parts of the brain are more sensitive to harmful external factors than at other times. However, relatively little is known about the influence of antidepressants on the brain and brain development.
Grow
The neurotransmitter serotonin is particularly associated with positive emotions and mood. However, serotonin also acts as a growth factor. During the first years of our lives, serotonin promotes the growth of connections (synapses) between neurons. It is also important in developing normal responses to stressful events later in life. Serotonin is not only active in the brain, but also in other places in the body. If the serotonin concentration is tampered with, changes may also occur in these other places in the body.
Developing anxiety disorders
Various studies with young mice have shown that mice react extremely anxiously to fear and pain stimuli when they are given Prozac, an antidepressant, every day. These mice appear to freeze when exposed to relatively harmless emotional situations. These young mice often developed an anxiety disorder . Mice are obviously not people. But the genetic makeup is largely similar to that of humans. However, these results with young mice do provide a possible indication of how the brains of young people deal with an antidepressant.
So why not treat depression in young people?
The alternative to treating is not treating. But this does not seem to be a pleasant option either. Studies have shown that untreated depression in young people ,eats away, chunks of gray matter in the brain, particularly in the amygdala, hippocampus and temporal lobe. These parts of the brain play a major role in thinking and learning.
When someone has had depression, the chance of a subsequent, new depression increases by 60%. The more often one develops depression without treating it, the more difficult it becomes to prevent or ultimately treat subsequent depressions.
In addition, the risk of a suicide attempt among young people is still unacceptably high if depression is not treated.