Dear Dr. SerVaas: What do you think of using Prozac for depressed teenagers? What about young people who have bipolar illness and don't know it? Are they apt to be made worse by Prozac or Zoloft?
Sherri Miller
Raleigh, North Carolina
Dear Reader: Bipolar expert and researcher Dr. John Nurnberger of the Indiana University School of Medicine responds:
"These medicines should be prescribed carefully to adolescents. Some teenagers may have bipolar illness, and it may have been considered a conduct problem (e.g., experimentation with drugs, trouble with the police, or risky sexual behavior). We know that half of the cases of bipolar illness have onset in the teens or early 20s, sometimes with depression, sometimes with a manic episode. Family history can be an important warning sign. If someone has bipolar illness, a mood stabilizer like lithium should be prescribed first, and then an antidepressant only if necessary.
"However, we know that many teenagers get depressed and only a minority of them will have bipolar illness. Fluoxetine (Prozac) appears to be effective in this group on the basis of controlled clinical trials, whereas the data are still being gathered with the other antidepressants. Side effects to watch for include problems with agitation or insomnia, particularly early in treatment. We sometimes use a low dose of olanzapine or quetiapine to help with this. Suicidal ideas and actions can occur in patients receiving medication or not receiving medication. It is important to be alert to this."
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