Depression with FMS and CFS

Depression can be viewed as both a symptom of fibro and a co-morbid condition. Often when a teenager is finally referred to me for fibro he will report a long-standing depression. Childhood onset depression is slippery and often overlooked. Interestingly enough, symptoms of depression in children and teenagers can include vague aches and pains,[1] particularly headaches and back pain often associated with fibro. As a co-morbid condition, depression is virtually indistinguishable from fibro. Chronic pain and illness are depressing. The question may be whether fibro is a symptom of depression or depression a symptom of fibro, or whether they are simply partners. In either case, it is important to note:

-       Fibro symptoms are known to be alleviated in many cases by SSRIs (like Prozac), SNRIs (like Cymbalta) and other anti-depressant groups[2]

-       SSRIs can cause detrimental side effects and suicidal ideation

-       While psychodynamic therapy might help adults with depression, it is not a good therapeutic choice for an adolescent. Go with CBT.

-       Ritalin can cause or exacerbate depression in teens[3]

-       A severe depression may require hospitalization

 In every case, depression should be taken seriously; it's a serious matter.

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[1] http://www.mayoclinic.com/health/teendepression/DS01188/DSECTION=symptoms Your adolescent - depressive disorders. American Academy of Child and Adolescent Psychiatry. 

[2] http://www.scientificamerican.com/article.cfm?id=new-study-antidepressants-fibromyalgia

[3] Talking Back to Ritalin, Revised : 
What Doctors Aren't Telling You About Stimulants and ADHD
by Peter Breggin, M.D.  Perseus Books, 2001

Diagnosis: Sick of It

Boundary issues

There are a few common themes with young fibro patients, and this is one: Weak boundaries. They tend to be very caring, very empathic with their friends, siblings, parents. They are the family peacemakers, the one the other family members count on to be solidly supportive at all times. Parents see them as very intelligent, caring, hard working, intense. This is the child who cannot let it go. Often the phenomenon of adolescent onset illness can be attributed to a specific stressor; SATs, death of a loved one, illness or absence of a parent; the teen is unable to stop the stressor at the surface and allows it to penetrate her actual physical being. It can also be triggered by an upcoming event; adulthood. This sounds oversimplified. More often than not, however, I see a young woman, 17 years old, in the prime of her life, bright, talented, friendly, pretty, now lying in bed for months at a time. This is simply not a coincidence. The responsibilities of adulthood are daunting enough; for the particularly sensitive adolescent, the competition and drive required to succeed can be so emotionally overwhelming that they manifest physical symptoms. A child will not achieve his developmental task of individuation while lying in bed, needing his parents’ care and attention! This is a complex psychological and medical picture. If your teenager is so stressed out that she is making herself sick, CBT is a good place to start.

Building Trust With Practitioners

I recently treated a teenager who had learned to mistrust her doctors. Though she clearly was suffering from a severely debilitating case of Fibro, many of the physicians she had consulted had been derailed by her obesity. Instead of viewing her weight as a symptom (one of many) of Fibro, the doctors had decided the presenting pathology was obesity. Not only was this unhelpful to the diagnostic process, it delayed treatment and was humiliating and harmful to the already suffering child; somewhere between insensitive and negligent, at the very least it was not good medicine.

As with all things adolescent, trust is imperative in the treatment of Fibro/CFS. The more information the doctors have, the more effective the treatment process will be. The key to gleaning pertinent information from the adolescent patient is good listening. If she feels heard and taken seriously, she will tell you what you need to know. If he feels stupid or judged, he will shut down. In the famous words of Sean Covey (adult son of "7 Habits" author Stephen Covey): Listen more than you talk. You have two ears and one mouth. Duh!