Customer Reviews

More Than Moody : Recognizing and Treating Adolescent Depression

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*More Than Moody* is an interesting and very readable book that should be very helpful to parents who want to understand the warning signs of depression in their teen or college-age kids. Depression is discouragingly common today among young people, and all too often parents--especially those with with ambitious, successful kids--refuse to admit their child might have a problem. This denial is understandable, but it often has disasterous consequences. Dr. Kopelwicz does a good job of showing that severe depression can strike any young person, often for no apparent reason, and that avoiding the problem is not an option.

This book's major failing is that it grossly oversimplifies the complexity of depression, and makes treating it look much easier than it often is. Dr. Koplewicz seems to believe--almost as an article of faith--that making a depressed teen well is simply a matter of getting them to take their Prozac, or possibly some other SSRI. This was his approach to Jesse, a high achieving college student disabled by persistent depression.

Jesse's case study was extremely interesting--particularly in showing the ways his successful parents dealt with their gifted son's increasingly severe decline. Jesse's story also revealed a number of problems with Dr. Koplewicz treatment philosophy.

Jesse apparently did better when he was on Prozac, but quit taking it repeatedly. Dr. Koplewicz blames the length and severity of Jesse's depressive episodes on his noncompliance, and his failure to see himself as having a diseased brain that needed drugs to function effectively. Koplewicz laments that it took Jesse six years to graduate from Duke because he wouldn't accept reality and take his pills, and takes some pleasure in reporting that at 30 and on Paxil, Jesse understands that he will need to be take his pills for life. At this point Jesse was supporting himself in the computer industry, but was having trouble with his girlfriend because of his difficulty connecting with her emotionally. (Incidently, emotional flatness [and male sexual dysfunction] is a common side effect of SSRI's like Prozac and Paxil, but Koplewicz declines to share this with the reader.)

Koplewicz doesn't seem to realize that for an adolescent attempting to find his or her own identity, taking a drug that alters personality could cause a frightening confusion over who he or she really was. By effectively forcing Jesse to take Prozac (under threat of hospitalization or expulsion), Koplewicz turned a simple treatment option into a terrifying assault on an immature young man's still-uncertain sense of self. A wiser psychiatrist would have ensured that Jesse had regular psychotherapy to help him with his developmental issues, and would have emphasized that medication was a tool for relieving symptoms, and that if Jesse had problems with one drug, they could try another, or see how therapy alone would work. Koplewicz's overconfidence in the SSRI's and denial of their side effects repeatedly turns his interventions with teenagers into power struggles, in which he becomes [in his young patients' minds] a hostile force determined to brand them defective and drug them into obedience.

Koplewicz simply doesn't seem to know much about how teenagers think. If adolescents feel that their feelings and concerns are being taken seriously, and that they have a choice of treatment options, they are much more likely to be compliant. Therapy is pretty much essential for teen depression--not only can it resolve many cases without medication--it can give a teen a way to work out their feelings and conflicts about using medication, making compliance much more likely.

In general, the reader should know that the SSRI's like Prozac do not work for some people and may have intolerable side effects, like feelings of unreality, emotional numbness, and for males, impotence. Many other drugs are available, though, and a good doctor will be aggressive in finding one (or a combination) that is effective and has an acceptable side-effect profile. If your teen is seriously depressed make sure (in addition to therapy) he or she is seeing a doctor who is comfortable prescribing the older antidepressants (TCA's and MAOI's). They remain the most effective antidepressants known, and can be lifesavers for those who don't respond to the modern drugs.

As a mother who has two children that have suffered from teenage depression, this book is a true breath of fresh air. Koplewicz sheds light to the distiction between regular behavior and clinical depression in an entertaining and informative way that I have not experienced after personally researching the topic for five years.

Thank you Dr. Koplewicz.

"More Than Moody" is an outstanding resource for parents and others who are concerned about the emotional and psychological health of adolescents. The narrative provides lucid insights into the clinical presentation of depression and bipolar disorder in youth -- enabling parents to recognize the appropriate "red flags" and best interpret their child's symptoms. The book also provides readers with a clear and thorough understanding of the different approaches to effective treatment and resources that are available to them. The book includes many clinical case studies which serve to not only lend a personal perspective and add poignancy to the narrative, but further illustrate and reinforce the many key points of the author. As with Dr. Koplewicz's other excellent book (It's Nobody's Fault), this book is written in a style that is as easy to read as it is informative. "More Than Moody" is a "must read" for all concerned parents of middle school and high school students.

This is a terrific book with tons of great information.
It's not a silly pop psychology book that advocates medicating all teens...

Why are so many people against diagnosing and medicating adolescent depression. Only a parent with a child suffering from depression could understand the horror of watching your teen self-destruct before your eyes and not know what is happening.

The book helped me understand how important diagnosis and medication is for a depressed teen. The book also validates what a parent experiences when you live with an adolescent who has unrecognized, unmediated depression. To withhold treatment and medication for a Depressed teenager would be irresponsible parenting.

More Than Moody is the best book I have read on adolescent depression. It is clear, comprehensive and easy to read. The stories about the teenagers and their families are fascinating and very informative. Even though my own children are still very young, I experienced chronic depression when I was a teenager and this book caught my eye. I am glad it did because it gave me new insights in what we now know about teen depression , new treatments that work and what happens to these kids when they get older. The story about Jesse, who is 15 when he is first seen and is now 30 hit home. I felt like I was watching as an observer in this young man's therapy and life over the years. This is a great book.

This book is a real page turner! I could not put it down. As a teenager I suffered from severe bouts of depression and I wish a book like this was available for my parents to read. Now as a parent of an adolescent who suffers from depression I can empathize with the teenagers, their parents and the stories in this book. More than Moody is not filled with a lot of psycho babble, but rather with easy to read and comprehend stories and situations we can all relate to and the various treatments available. Thank you Dr. Koplewicz for giving my family the thing we've been searching for - Thank you for giving us hope.

More Than Moody is a real page turner and I could not put it down. As a teenager I experienced depression and I wish a this book was available for my parents to read. Now as a mother of a depressed teenager I can empathize with the teenagers, their parents and their stories. This book really hits home! Thank you Dr. Koplewicz for giving my family the very thing we've been searching for - Thank you for giving us hope.

Koplewics has long been a leading advocate of psychiatric drugs for kids. In a June 17, 1999 story for Salon.com he said, "I actually think we're not medicating kids enough." This book is his attempt to get more kids on mind-altering drugs.

It is simply astonishing how Koplewics ignores the mountains of evidence in his own book that childhood problems have non-biological causes (relationships, life events, cultural factors) and real physical causes (e.g., hormones) and instead pushes pills - without offering a shred of evidence that these kids have bad brains. Of course, in this regard he displays a common trait of psychiatrists - the dismissal of the obvious in favor of the hypothetical and untestable.

Just so no kid misses his or her pharmocological treat, there are the multitude of different types of depression followed by the all encompassing caveat: "none of this is etched in stone." In other words, don't be discouraged if your kid doesn't meet all the criteria. We've got a diagnosis for everyone. (One is reminded of the statement in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)(xxii): "In DSM-IV, there is not assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder." Imagine a real doctor saying diabetes is not a distinct entity with boundaries dividing it from cancer, an infection or complete health.)

There are the unquestioned and unexamined platitudes: "adolesence is demoralizing almost by definition." Understandable feelings are redefined as "symptoms" of illness. A fear of the future (we're all so confident of the future, aren't we?) becomes "Generalized Anxiety Disorder." Fears of the family well-being (imagine a kid being concerned about that!) become "Separation Anxiety Disorder."

Koplewics writes, "It's the duration of the symptoms that tell if a teenager has crossed the line into depression." Says who? Psychiatrist Nancy Andreasen, editor-in-chief of the American Journal of Psychiatry, has written (Science, vol. 275,14 March 97), "thresholds based upon duration ... are boundaries of convenience ... not boundaries with any inherent biological meaning."

Koplewics attitude towards children is often patronizing. One girl's description of a horrible childhood is described by Koplewics as "the product of the drama of adolescence."

Questionable "facts" and outright untruth abound in the book. According to Koplewics, the newer antidepressants (SSRIs) "have fewer side-effects" and "have always been found to be more effective than placebos." Not so. In his 1999 textbook, The Fundamentals of Clinical Neuropsychiatry, Dr. Michael Alan Taylor writes, "It is a mistake to think that one class of drug is `safer' or has `fewer' side effects .... Taylor specifically cites claims about the SSRIs

A July, 2002 analysis by George Washington University's Thomas Moore of 47 studies used by the FDA in approving six antidepressants found that in over half the studies, the drugs were no better than placebo. The overall slight benefit antidepressants had over placebo were found to be "not meaningful for people in clinical settings."

Koplewics ignores the side-effects of drugs and the withdrawal effects. Failed treatment is excused because, of course, one never recovers from psychiatric "illness." Typical is this statement: "That Jesse [treated with drugs as an adolescent] has depression as an adult is not a surprise."

Ho-hum. Failed treatment is all part of a days work.