Response to Daniel Bergner’s article on SSRIs and sexual development in teens
How do we decide if SSRIs are worth their risks to teens' sexual selves?
For teens facing the question of whether to start taking SSRIs, it’s worth pausing to try to figure out what is causing the depression.
Dear Letters Editor:
Response to Daniel Bergner’s article on SSRIs and sexual development in teens.
When a teen presents to a health care professional with symptoms that meet clinical criteria for depression, the provider usually recommends that they “take medication and start psychotherapy.” But a critical step gets skipped: to do an evaluation to try to determine what factors are causing the disorder. If the underlying causes are identified first, that can and should inform the treatment plan. Depression is not single-cause determined, and there is no one treatment that is necessary and useful for every type of depression. Treating depression effectively to the point of returning the teen to the tasks of healthy development requires understanding what has gone off track and the reasons. Why do we so often rush to treatment without first determining causes?
Bergner’s essay highlights one essential reason for better evaluation before rushing to medication treatment: SSRIs can have serious repercussions for teens’ developing sexuality and sense of themselves more broadly. If there is even a remote chance that SSRIs can leave a lasting effect on sexual pleasure and desire, don’t we owe it to our teens to do greater diligence in setting a treatment plan that properly weighs the potential benefits of the medication against the potential risks?
For many teens I see, the most healing aspect of being prescribed SSRIs is the validation that comes with being taken seriously enough to say, “your struggles are more serious than just a bad mood.” This can be a powerful signal. But when parents and providers put too much stock in the medication’s capacity to do the job, the validation is short-lived and the teen never gets the help they need in figuring out what caused the depression, and what needs to be addressed for it to truly resolve. The medication may help them feel somewhat better, but does it get them well enough to go off it? Effective treatments in addition to medication are what make the difference between symptom abatement and return to health.
Determining underlying causes is a needed piece of the treatment puzzle and the possible sexual side effects of SSRIs are another reason we need to do a better job for teens in taking the search seriously.
Dr. Trysa Shulman
The author is a clinical psychologist in private practice