Parents can't see that their son is depressed

Dear Reader,

This is tough. It's hard to witness loved ones struggle with mental health issues. Your brother is lucky to have you in his life. It’s possible that he's having an adverse side effect to his medication, such as symptoms of depression. However, depression can only be diagnosed by a mental health professional. It might be helpful to talk to your brother first about how he’s feeling before taking any further steps. There may be many reasons for his behavior change.

As a place to start, it might be helpful to learn more about the different types of medication typically used for treatment for attention-deficit/hyperactivity disorder (ADHD) and their associated side effects. One of the most commonly prescribed medications for ADHD is methylphenidate. While it’s often effective in improving school performance and behavior in children with ADHD, there are some side effects, most notably difficulty with sleep and lack of appetite. Another common prescription for those with ADHD is dextroamphetamine. Dextroamphetamine is a type of amphetamine that blocks the reuptake of norepinephrine and dopamine, two neurotransmitters that assist with concentration. When taken with antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors (MAOIs), dextroamphetamine has the potential to further slow the reuptake of norepinephrine and dopamine, exacerbating symptoms of depression. These medications also may exacerbate mental illnesses that existed before the ADHD diagnosis, including depression or bipolar disorder. If you know what type of medication your brother is on, you may have a better idea of how his medications are impacting his behavior change.

You may want to evaluate the attention your brother is receiving from health care professionals: Is your brother's mental health consistently monitored by the professional who prescribed him his medicine? Does he see a mental health professional on a regular basis? Counseling, along with drug therapy, is often more beneficial than medication alone. Although you’re the person closest to your brother emotionally, a professional will likely be able to more accurately assess the situation from a diagnostic and therapeutic perspective and provide recommendations for treatment according to what your brother needs.

Here are some other questions and issues to consider:

• Have you talked privately with your brother about how he feels? Has he noticed a difference — positive or negative — since he began taking the new medications? Thirteen can be a time of transition; excessive moodiness and crying, however, generally isn’t typical. Has anything in your brother's life changed that may contribute to these emotional changes? Has your brother said anything about it?
• What else could be contributing to what you perceive to be your brother's depression? You say you've practically raised him. How much quality time and attention has your brother received from your parents in the past? Now? Would your other family members be open to exploring the family dynamic and your brother's experience together with a professional?
• What makes you believe that your brother is experiencing depression? Has he been in treatment for depression previously? Is he exhibiting other symptoms of depression (e.g., lack of interest in activities, difficulties with sleep, suicidal ideation)? How long has he been exhibiting symptoms?
• What do you believe your role to be in getting help for your brother? Does your brother turn to you for support? Is there someone else closer to him who would have a better idea of what he’s feeling? Does he feel comfortable coming to you for help?

It's understandable why you’re concerned about your brother’s mental health. However, there may still be a lot of unknowns that are making next steps unclear. Once you've asked yourself some of the questions about the situation and your role, you may want to try talking with your parents again. If you haven't in the past, you can tell them you'd like the three of you to set aside some time for a conversation and let them know why you're so concerned.

You may feel alone in your concern about your brother, but it seems that there are others out there who care, too. Sometimes, they just need to know what's happening. It’s also helpful to remember that you may not always know the full story about someone else’s health condition, as that it between them and their health care provider. It’s also wise to be sure to make time to take care of yourself in the process. To help your brother through this time, it’s wise to ensure that you’re healthy, too.

Wishing you and your family all the best,