| p>As a psychiatrist that specializes in alcoholism and | | | | put a college student on medication, I explain to him/her |
| addiction, I treat a number of depressed college | | | | that it is tough for me to make positive biochemical |
| students with antidepressants. This age group tends to | | | | changes in the brain with the medications I prescribe |
| experiment with drugs and alcohol. I have observed | | | | when the substances he/she is using counteract the |
| over the years of my practice, that the | | | | positive effects of the medications. |
| antidepressants I prescribe do not seem to be as | | | | Research on teenage depression with substance |
| effective in someone who is using marijuana and/or | | | | abuse, has tended to focus on teen drug abuse or |
| alcohol even if the use is infrequent. Here are 2 cases I | | | | teenage drinking at the level of abuse or dependence. |
| have treated that illustrate this point. | | | | There has not been much focus on recreational use |
| Case 1: I treated a 19 year old college boy for anxiety | | | | of marijuana or alcohol in this population. What are the |
| and depression. He said he occasionally used | | | | dangers of marijuana and the dangers of alcohol use |
| marijuana to calm himself before a social event | | | | when used at a low level? |
| (weekly or every other week) because he felt more | | | | Reduced antidepressant response. |
| comfortable around people when he was high. He did | | | | The findings of a very recent study, conducted by Dr. |
| not respond to two different antidepressants I | | | | Benjamin Goldstein et al at the University Of Pittsburgh |
| prescribed over the course of 12 weeks. I told him that | | | | dealing with depressed adolescents who were using |
| his marijuana and alcohol use on the week-ends might | | | | marijuana and alcohol at a recreational level support |
| be interfering with the medications effectiveness. He | | | | this. The study was presented on October 26th, 2009 |
| agreed to go without marijuana or alcohol for a month. | | | | at the American Academy of Child and Adolescent |
| Sure enough, his social anxiety started to diminish even | | | | Psychiatry and was summarized in the Medscape |
| though I had not changed the dose of his | | | | medical news. The study showed that the |
| antidepressant or added any new medications. He | | | | antidepressant response was significantly reduced in |
| experienced significantly reduced anxiety and | | | | depressed teenagers using marijuana or alcohol on a |
| depression and has not returned to marijuana or | | | | recreational basis. They studied 334 adolescents with |
| alcohol. He reported going to social functions, having a | | | | major depressive disorder of which 28.1% used |
| great time, and feeling more self confident than when | | | | marijuana or alcohol on a recreational basis. The |
| he first came to see me. | | | | researchers also found that those that quit marijuana |
| Case 2: I treated a 21 year old college girl for | | | | alcohol during the study showed a good response to |
| depression that would go out with her friends drinking | | | | antidepressants and those that started using marijuana |
| on week-ends. She said she used drinking to | | | | alcohol during the study had a reduced response to |
| anesthetize herself and escape her feelings of | | | | antidepressants. |
| depression. She did not drink at all during the week. I | | | | I would not be surprised if the findings outlined in |
| prescribed the same antidepressant she had done well | | | | Dr.Goldstein's study regarding teenage marijuana and |
| on when she was 14 years old. However, after 6 | | | | alcohol use apply to college kids and even older adults. |
| weeks on a therapeutic dose she remained | | | | Here is the take home message for depressed |
| depressed. At 14, she was not drinking alcohol. I | | | | teenagers on antidepressants: |
| explained to her that alcohol was a central nervous | | | | You Use, You Lose |
| system depressant and was probably counteracting | | | | In other words, you lose antidepressant response. |
| the effects of the antidepressant. I asked her to quit | | | | Remember, recreational use of alcohol and marijuana |
| drinking and let the medication do its job. She agreed | | | | interferes wIth the antidepressant response. |
| to this because her depression had gotten | | | | If you want to feel better, let the antidepressants do |
| progressively worse over several weeks and she felt | | | | their job in your brain without mixing its effects with |
| miserable. Four weeks later, she felt much less | | | | other drugs you may want to experiment with. |
| depressed. She reported looking forward to the day, | | | | According to this study, antidepressants are most |
| finding it easier to keep up with her work, and | | | | effective for your age group if you are not using drugs |
| participating in more activities with her friends. | | | | or alcohol. |
| Both these cases provide anecdotal evidence that the | | | | Reference: |
| antidepressants I prescribe for depression or anxiety | | | | 2 case studies from the practice of Dr. Sarita Uhr and |
| do not appear to be as effective when my college | | | | author of this article. She is a psychiatrist in private |
| patients are actively using alcohol or marijuana. When I | | | | practice in Dallas, Texas. |