151
increase in non-fatal suicide behavior). The risk is three-fold higher during
days 10 to 29. What if they were not taking anti-depressants? Another high
risk time for children and adults is when anti-depressants are suddenly
stopped. It is important that the doctor and the patient know the high risk
times so both can be especially vigilant.
In summary, moderate or serious depression carries with it a threat of self-
injury. This risk requires special precautions. Taking anti-depressants must be
considered carefully because the drugs may slightly increase the risk of
agitation and suicide in some young people while the drug may effectively
relieve depression in other people. The prescribing doctor, the collaborating
psychotherapist, the patient, and the parents of a child or teen should be
involved in making the treatment plans. The prescriber and/or the
psychotherapist must see the patient frequently, probably weekly for an hour,
especially during high risk or high stress or high agitation times. The FDA’s
concern is high enough that the drug manufacturers and the FDA are now
considering adding a suicide warning on every package for children or teens.
For unexplained reasons, the news reports describe the manufacturers as
being more eager to have a blunt, rather scary label placed on their
medications than is the FDA. On Oct 15, 2004, FDA required black box
warnings of suicide risks for children and teens to be printed on every
box of anti-depressants.
A recent study at the University of Colorado by Valuck, Libby, Giese & Sills
(2004) illustrates the crucial need for more research into the risks of self-
harm for adolescents taking antidepressants. These researchers followed
24,000 depressed adolescents for six years. The risk of a suicide attempt, in
their sample, was not greater for young people given antidepressants than
for those not getting antidepressants. Of possible additional significance, the
adolescents given antidepressants for at least 180 days made fewer suicide
attempts than adolescents taking the drug for less than 55 days. Standing
alone, these results are difficult to integrate with the above studies: Do
different outcome measures (suicide attempts, near-lethal acts, and actual
suicide rates) yield different results? What factors correlate with being
prescribed antidepressants? Why did some subjects take medication much
longer than others? Were they more compliant patients? The authors suggest
that the quality of health insurance may influence what medication one gets,
who administers the antidepressant, who gets antidepressants alone, who
gets only psychotherapy, and who gets both? Many, many studies are needed
to answer these vital questions.
Level I: Behavior (see chapter 11)
Lynn Rehm (1981) has developed a self-control treatment program
for depression based on Kanfer's model of self-monitoring, self-
evaluation, and self-reinforcement. The first five steps summarize
Rehm's methods:
Self-observation
