Category Archives: Counseling and Psychotherapy Theory and Practice

Feeling Happy About (and a little jealous of) Craig Bryan’s New Book, “Rethinking Suicide”

While engaged in a little late-night Twitter scrolling, I came across a fascinating post and thread questioning the utility of suicide screening for low risk populations (e.g., schools). Having been mildly opposed (along with the UK and Canada), to general population suicide screenings, I felt validated, especially upon discovering that Craig Bryan was author of the Twitter thread. Dr. Bryan is one of the best and most authoritative resources on suicide in the world. As of two nights ago, I was only familiar with his professional book with David Rudd (Brief cognitive-behavior therapy for suicide prevention) and his excellent work with military veterans, suicide, and lethal means management. I also knew he had recently published a new book titled, “Rethinking Suicide.”

Then, today, I checked out Rethinking Suicide online. I was gob smacked. It’s fantastic.

This post is mostly to pitch Craig Bryan’s book.

Among other gems, Dr. Bryan frames suicide prevention as a “wicked problem” and tells us about the origin of the term, wicked problem. What’s not to love about that.

Here’s a quote from his introduction: “Consistent with the perspective of suicide as a wicked problem, I will argue in this book that we need to replace our solution-based approach to suicide prevention with a process-based approach focused on creating and building lives worth living” (p. 7). Wow. That’s like music to my ears.

Dr. Bryan also weaves in “confirmation bias” (more music) as part of his critique of using so-called “mental illness” as an explanatory mechanism in suicide (I know if you know me and this blog, you know I don’t even use the term mental illness unless I’m explaining why I don’t use the term mental illness, and so I’m destined to love Dr. Bryan’s deconstruction of that concept).

Anyway, you can find Rethinking Suicide through your favorite online bookseller. I recommend it highly. I’ve ordered my copy.  It’s about time we all started rethinking suicide.  

Promo and Discount for the Upcoming Psychotherapy Networker Symposium

Hi All,

I’d like to invite you to join me at this year’s Psychotherapy Networker Symposium, where I’ll be speaking alongside over 60 of the world’s leading therapists and experts.  

The Symposium is a special place where you not only learn with many of the best in the world and dive into what’s new in the field, but also where you can join a warm community of like-minded professionals to rest, rejuvenate, and be inspired for the year to come.  

And as a subscriber to my blog, you can save an extra $50 on registration when you use code SYM50 to attend in-person or online. Learn more here https://web.cvent.com/event/03998a0b-77a0-4ed6-a384-677316bf7d0d/websitePage:b2f73631-8191-4d29-9042-4dae64d267b1?RefId=jflanagan

This year’s keynote presenters include: 

  • Esther Perel, renowned couple therapist and author of Mating in Captivity and The State of Affairs 
  • Steven Hayes, developer of Acceptance & Commitment Therapy 
  • Resmaa Menakem, author of NYT Bestseller My Grandmother’s Hands 
  • Emily Nagoski, NYT Bestselling author of Come as You Are and Burnout 
  • Ramani Durvasula, author of Should I Stay or Should I Go: Surviving a Relationship with a Narcissist. 
  • Rev. angel Kyodo Williams, critically acclaimed author of Being Black: Zen and the Art of Living with Fearlessness and Grace hailed as “a classic” by Buddhist pioneer and psychologist Jack Kornfield. 

For those interested, there’s also a special evening appearance from comedian Gary Gulman, host of the acclaimed HBO comedy special and documentary, The Great Depresh

Check out the entire lineup and register for the in-person or online experience here: https://web.cvent.com/event/03998a0b-77a0-4ed6-a384-677316bf7d0d/websitePage:b2f73631-8191-4d29-9042-4dae64d267b1?RefId=jflanagan

The Symposium is a pretty cool event and I’m honored to be presenting (twice). Although I can’t figure out why they didn’t include me among the keynoters (hahaha, just joking), the keynote lineup is very impressive.

I hope to see you there either in-person or online! 

All my best,

John SF

Banned Books, Critical Race Theory, and My Cold, Dead Hands

Book banning and book burning is an old strategy designed to control information. Stephen King—the famous author and Twitter presence (https://twitter.com/StephenKing)—recommends (I’m paraphrasing here) that everyone rush out and buy and read banned books, because they contain important knowledge.

I’ve been disappointed at efforts by state legislatures, governors, school superintendents, parents, and others who have been involved in book banning, as well as any or all of the above who have suggested that critical race theory (CRT) shouldn’t be taught in colleges and universities (it’s not really taught in any formal or in-depth way in K-12 schools, but even if it were, why not?).

CRT, books, and other sources of knowledge offer perspectives. A couple days ago, I received an email from a professor and student offering me feedback on a paragraph in our counseling theories text. From the student’s perspective, the paragraph felt anti-Semitic. I pulled up the paragraph on my computer, read it, and although I didn’t see it exactly the same way as the student, she had an important point—the passage could be taken in a negative way. I emailed the student and her professor and thanked them for the feedback, noting we’ll change that paragraph in the next edition.

One goal that Rita and I have in writing textbooks is to be inclusive, accessible, and non-racist/non-sexist. Although I’m sure we always fall short of our ultimate goal, in isolation and without feedback from others, we could never even come close to or make progress in accomplishing our inclusiveness goal. We were grateful to receive the feedback. Another goal we have is to keep learning. This experience, and many others, leads me to think that there may be no better way to learn, than to listen to the perspectives of others. Why not? Where’s the benefit in closing our ears and being defensive.

Just to be clear, I’m opposed to banning books; I’m opposed to limiting the teaching of CRT; and I’m opposed to other people trying to control information available to me and others. My best guess is that when other people try to control information, they probably fear the information. Why? I don’t know, but IMHO, putting our collective heads in the sand (this brings to mind the movie, “Don’t Look Up”) is NOT a particularly useful strategy for dealing with fears. 

I teach theories all the time. At the University of Montana, I’ve taught Theories of Counseling and Psychotherapy nearly every fall semester for many years. Rita and I have a textbook on theories of counseling and psychotherapy published by John Wiley & Sons. All the hubbub over CRT has convinced me that I need to commit myself to teaching more CRT concepts in my theories course. Like all theories, I’ll treat it like a theory we can learn from.

Last week we had a visit from a university faculty person from a state where professors are being coerced into not teaching CRT. Hearing him talk about this experience made me wonder how I’d handle it if I was told I shouldn’t teach CRT at UM. Obviously, I don’t know my exact response to that scenario, and I hope it never develops, but my best hypothesis, based on a little personal theorizing, is that I’d get fired or go to jail before I agreed to NOT teach CRT, because it’s a theory, a perspective (and not the only one), from which we should all strive to learn.

I know I’m being overly dramatic, but I strongly believe that learning from the perspectives of others is a good thing. I don’t plan on stopping. To steal (and modify) an old line from the NRA: I’ll give you my banned books and theories when you pry them from my cold, dead hands.

Just saying.

How on Earth Could Suicide Rates Go Down Along with the Onset of the Pandemic in 2020?

Last week I got to be part of an amazing conversation with Paula Fontenelle and Stacey Freedenthal. Paula and Stacey are experts in suicide prevention, postvention, and treatment. You can easily find them and some of their great work online using your favorite search engine. They both have books out. Paula’s is: Understanding Suicide and Stacey’s is: Helping the Suicidal Person.

Paula invited Stacey and I onto her podcast (which is also a video production). We all sat in separate rooms in three different states (Oregon, Colorado, and Montana) and talked about, “How on earth” it could be that pandemic-related mental health stress and distress is up (the research says so), and yet suicide rates in 2020 dipped, for the first time in two decades? What a great question!

Between the three of us, we had many answers. That’s good, because death by suicide is always influenced by many factors (in the scientific world, we like to say that suicide is multi-determined). Our answers are speculative, but I think it’s good to be speculative, as long as you admit to the fact that you’re being speculative.

The most fascinating of many fascinating explanations for the recent reduction in suicide rates was our “in real time” discovery that the pandemic relief checks went out in April of 2020. That was important because, year-after-year, the CDC reports that April is nearly ALWAYS the month with the highest suicide rates and in 2020, it was the LOWEST. Why is April always linked to high suicide rates? No one knows for sure, but Paula, Stacey, and I talk about potential explanations for that too. As T. S. Eliot wrote:

“April is the cruelest month, breeding lilacs out of the dead land, mixing memory and desire, stirring dull roots with spring rain.”

If you’re interested in suicide-related phenomena—not everyone is—you should listen or watch Paula’s “Understand Suicide” podcast. You can watch any of the episodes for great info, but for our episode, here are the links.

To watch: https://youtu.be/fPrDdQg7G_E

To listen: https://bit.ly/3KrJILO

Have a great weekend.

Two New Theories Homework Assignments and Links to Old Theories Resources

My apologies for some bad links when I posted this yesterday. I tried a different linking strategy and it seemed to work on my computer, but not so much for anyone else. Sorry for your inconvenience! And embarrassed for myself.

John Sommers-Flanagan

For the past two years I’ve been using some new theories course assignments and am sharing them here.

New Assignments

The first new homework assignment is called: Multicultural Competence, Multicultural Humility, and Me.  I use this as an early (about week 3) writing assignment for first-year, first-semester M.A. students. I like using it because it gives me a taste of their writing skills, while also introducing them to foundational multicultural content. I have been consistently impressed with the students’ sensitivity to culture and desires to be humble, lifelong learners when it comes to cultural diversity.

The second new homework assignment is for students to take the long form of my Theoretical Orientation test during week 1 and then to retake it during week 15. I have them compare their scores and declare up to three “favorite” theoretical perspectives. Like the multicultural paper, this assignment has produced very interesting…

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Two New Theories Homework Assignments and Links to Old Theories Resources

For the past two years I’ve been using some new theories course assignments and am sharing them here.

New Assignments

The first new homework assignment is called: Multicultural Competence, Multicultural Humility, and Me.  I use this as an early (about week 3) writing assignment for first-year, first-semester M.A. students. I like using it because it gives me a taste of their writing skills, while also introducing them to foundational multicultural content. I have been consistently impressed with the students’ sensitivity to culture and desires to be humble, lifelong learners when it comes to cultural diversity.

The second new homework assignment is for students to take the long form of my Theoretical Orientation test during week 1 and then to retake it during week 15. I have them compare their scores and declare up to three “favorite” theoretical perspectives. Like the multicultural paper, this assignment has produced very interesting (and relatively fun to read) reflections from our students.

Old Resources

If you’re new to teaching or haven’t caught my previous postings for Theories resources, below are some links to materials I’ve found useful. As I’ve said before, although it’s great if you use our Theories text (woohoo), you can also use all these materials in combination with whatever text you’re using. I’m aware of many other strong textbooks—although my bet is that ours is the leader in theories jokes and humor and is probably the most well-liked by students (but I might be biased!).

Theories Course Syllabus

Here’s a link to my most recent syllabus:

Videos

I have a previous blog with links to free videos on my Youtube site. That link is below:

Although we have an excellent theories-specific video series, you need to adopt our text to access them.

Lab Activities

If you want these, email me at john.sf@mso.umt.edu and I’ll email them to you at my earliest convenience.

Good luck in your teaching this semester. I know the challenges are big, but the process of witnessing and participating in student learning is a big positive reinforcement.

Paradoxical Intention, Part II: Transformative Epiphanies

Often, I have the honor of getting a personal preview of Rita S-F’s Godblogs. I sit in a cushy chair, shut my eyes, and let her words create images in my brain. It’s not unusual for her readings to stimulate unusual thoughts. But, last week, while listening, I was taken with a particular epiphany.

She was reading about how easy (and destructive) it is to be judgmental; I can’t recall the details. In response, a voice in my head spoke gently,

“I wonder if it might help if you could try, just a little, to be even more judgmental. . .” followed by an additional internal commentary “. . . said no one ever.”

The thought—of trying to be even more judgmental—made my lips curl upward into a smile. I felt an urge to laugh. Then, naturally, I thought of Viktor Frankl.

As I wrote in my last blog (https://johnsommersflanagan.com/2021/12/06/paradoxical-intention-dont-try-this-at-home-or-maybe-dont-try-it-anywhere/), Frankl was the first person I know of who explicitly discussed paradoxical intention as working like a joke to the psyche. I’ve written about that, but I’d never felt it in my gut. This time I did actually feel it. Then, and in response to the thought of intending to be “even more judgmental,” along with the urge to laugh, I also felt a small internal push back toward acceptance.  

Paradoxical intention has two parts. First, there’s the intention. I’ve tried the intention part of paradoxical intention with myself (and used it with clients) in specific situations when physical behaviors or responses feel outside of voluntary control. One example is the twitching eye syndrome. If you have an eye that’s prone to twitching, you can try to make it twitch more or try to make it twitch when it hasn’t been twitching. That’s the intention part. The other part is for the intention to be aimed toward the opposite of your goal. In the case of listening to Rita’s blog, the thought of intending to be more judgmental was received and then produced psychological push-back. What was different than any other response I’ve ever felt about paradoxical intention was my urge to smile and laugh. I’d never felt like laughing when I tried to make a bothersome eye twitch . . . twitch more.

Later—while driving I-90 west—a place where I’m prone to feeling intermittent anger toward drivers I label in my mind as “stupid,” I did another experiment.

“I wonder,” I thought to myself, “if maybe I could try to start feeling just a little angrier toward those other drivers. Being alone in the car, I tried it out with a brief litany of profanity. In response, I felt increased anger. That wasn’t good. But within seconds, my brain started the natural push-back. I took note of my greater anger and quickly judged it as unpleasant. Then, I noticed an internal psychological push-back toward the center. I suddenly wanted the anger—which usually feels so justified in the moment—to go away. And so, I let it go.

Paradoxical intention isn’t a magic trick. Nothing in the world of human psychology is magical. Paradoxical intention operates on natural psychological dynamics. Laura and Fritz Perls would have called it an internal polarity. Behaviorists like to call it a form of overcorrection. The popular press tends to reduce it to a term I can’t help but find offensive: reverse psychology.

Although you might try paradoxical intention on your children or your friends, because of one central underlying principle, that’s not a great idea. The underlying principle is best expressed by an old (and bad) joke.

“How many mental health professionals does it take to change a light bulb?”

“Only one. But the light bulb has to want to change.”

You could try a little paradoxical intention . . . on yourself . . . but only if you want to experience a new transformative epiphany.

Paradoxical Intention: Don’t Try This at Home (or maybe don’t try it anywhere)

People want change.

People don’t want change.

As W. R. Miller noted in his treatise on motivational interviewing (MI), ambivalence is nearly always the order of the day. Most people, most of the time, would like to be better and healthier versions of themselves. And, most people, most of the time, resist becoming better and healthier versions of themselves.  Who knew?

Alfred Adler may have been the first modern psychotherapist to write from a non-psychoanalytic perspective about how to work with individuals not interested in changing. What follows is a complex quote from Adler. He’s writing about how to work with a patient who is depressed, but not motivated or willing to change. You may need to read this excerpt several times to track it and appreciate Adler’s method. You may see all those words below and not want to put in the effort. That’s okay. You can stop reading now if you don’t want to gather in the nuance sprinkled into Adler’s indirect suggestion.

After establishing a sympathetic relation, I give suggestions for a change of conduct in two stages. In the first stage my suggestion is “Only do what is agreeable to you.” The patient usually answers, “Nothing is agreeable.” “Then at least,” I respond, “do not exert yourself to do what is disagreeable.” The patient, who has usually been exhorted to do various uncongenial things to remedy this condition, finds a rather flattering novelty in my advice, and may improve in behavior. Later I insinuate the second rule of conduct, saying that “It is much more difficult and I do not know if you can follow it.” After saying this I am silent, and look doubtfully at the patient. In this way I excite his [her/their] curiosity and ensure his attention, and then proceed, “If you could follow this second rule you would be cured in fourteen days. It is—to consider from time to time how you can give another person pleasure. It would very soon enable you to sleep and would chase away all your sad thoughts. You would feel yourself to be useful and worthwhile.”

I receive various replies to my suggestion, but every patient thinks it is too difficult to act upon. If the answer is, “How can I give pleasure to others when I have none myself?” I relieve the prospect by saying, “Then you will need four weeks.” The more transparent response, “Who gives me pleasure?” I counter with what is probably the strongest move in the game, by saying, “Perhaps you had better train yourself a little thus: do not actually do anything to please anyone else, but just think about how you could do it!” (Adler, 1964a, pp. 25–26)

Similar to Adler, Viktor Frankl also wrote about using “anti-suggestion” or paradox. Frankl was keen on this method as a means for treating anxiety, compulsions, and physical symptoms. An excerpt from our theories textbook describing Frankl’s paradoxical intention follows.

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Paradoxical Intention

. . . In a case example, Frankl discussed using paradox with a bookkeeper who was suffering from chronic writer’s cramp. The man had seen many physicians without improvement; he was in danger of losing his job. Frankl’s approach was to instruct the man to:

Do just the opposite from what he usually had done; namely, instead of trying to write as neatly and legibly as possible, to write with the worst possible scrawl. He was advised to say to himself, “now I will show people what a good scribbler I am!” And at that moment in which he deliberately tried to scribble, he was unable to do so. “I tried to scrawl but simply could not do it,” he said the next day. Within forty-eight hours the patient was in this way freed from his writer’s cramp, and remained free for the observation period after he had been treated. He is a happy man again and fully able to work. (Frankl, 1967, p. 4)

Frankl attributed the success of paradox, in part, to humor. He claimed that paradox allows individuals to place distance between themselves and their situation. New (humorous) perspectives allow clients to let go of symptoms. Frankl considered paradoxically facilitated attitude changes to represent deep and not superficial change.

Given that Frankl emphasized humor as the therapeutic mechanism underlying paradoxical intention, it fits that he would use a joke to explain how paradoxical intention works,

The basic mechanism underlying the technique…perhaps can best be illustrated by a joke which was told to me some years ago: A boy who came to school late excused himself to the teacher on the grounds that the icy streets were so slippery that whenever he moved one step forward he slipped two steps back again. Thereupon the teacher retorted, “Now I have caught you in a lie—if this were true, how did you ever get to school?” Whereupon the boy calmly replied, “I finally turned around and went home!” (Frankl, 1967, pp. 4–5)

Frankl believed paradoxical intention was especially effective for anxiety, compulsions, and physical symptoms. He reported on numerous cases, similar to the man with writer’s cramp, in which a nearly instantaneous cure resulted from the intervention. In addition to ascribing the cure to humor and distancing from the symptom, Frankl emphasized that paradox teaches clients to intentionally exaggerate, rather than avoid, their existential realities.

********************************

I’m writing about paradoxical intention today because of an inspiration from Rita’s blog yesterday. There’s so much ostensible hate, judgment, and certainty in contemporary discourse. That got me thinking about whether a paradoxical approach might be timely and effective. Yesterday, I tried it on myself. Stay tuned, in my next post, I’ll write about how a little paradox worked out for me, and how it might help shift some of the lamentable, polarized arguments happening all around us.  

The Feminist Lab in Counseling and Psychotherapy Theories

Sometimes when I’m talking about feminism in my theories class, I refer to it as the F-word. I feel like I have to do more “selling” of feminist therapy than any other approach. Maybe I’m just imagining it, but I hear rumors like, “I hope we get to skip feminist therapy in the lab” and “How do you practice feminist therapy?”

The answers are: “No, you don’t get to skip feminist therapy” and “Because feminist therapy is technically eclectic, you can practice it nearly any which way you like.” Freedom is another F-word, and there’s plenty of that when you’re being afeminist.

Yesterday, while facilitating a grad lab where the practicing happens, it was fascinating to observe feminist therapy in 10 minute snippets. I heard a beautiful self-disclosure. I heard talk of clothes and bodies and of the wish to be taken seriously. No one mentioned the patriarchy . . . but everyone . . . hopefully . . . got to taste and talk about oppression and hierarchy and the wish to be a free and expansive self.

Someone even talked about farting. Someone else about dancing. Others about uninhibited delight.

Should you be interested in what prompted these interactions, I’m attaching my feminist lab instructions here:

The Efficacy of Antidepressant Medications with Youth: Part II

After posting (last Thursday) our 1996 article on the efficacy of antidepressant medications for treating depression in youth, several people have asked if I have updated information. Well, yes, but because I’m old, even my updated research review is old. However, IMHO, it’s still VERY informative.

In 2008, the editor of the Journal of Contemporary Psychotherapy, invited Rita and I to publish an updated review on medication efficacy. Rita opted out, and so I recruited Duncan Campbell, a professor of psychology at the University of Montana, to join me.

Duncan and I discovered some parallels and some differences from our 1996 article. The parallels included the tendency for researchers to do whatever they could to demonstrate medication efficacy. That’s not surprising, because much of the antidepressant medication research is funded by pharmaceutical companies. Another parallel was the tendency for researchers to overstate or misstate or twist some of their conclusions in favor of antidepressants. Here’s the abstract:

Abstract

This article reviews existing research pertaining to antidepressant medications, psychotherapy, and their combined efficacy in the treatment of clinical depression in youth. Based on this review, we recommend that youth depression and its treatment can be readily understood from a social-psycho-bio model. We maintain that this model presents an alternative conceptualization to the dominant biopsychosocial model, which implies the primacy of biological contributors. Further, our review indicates that psychotherapy should be the frontline treatment for youth with depression and that little scientific evidence suggests that combined psychotherapy and medication treatment is more effective than psychotherapy alone. Due primarily to safety issues, selective serotonin reuptake inhibitors should be initiated only in conjunction with psychotherapy and/or supportive monitoring.

The main difference from our 1996 review was that in the late 1990s and early 2000s, there were several SSRI studies where SSRIs were reported as more efficacious than placebo. Overall, we found 6 of 10 reporting efficacy. An excerpt follows:

Our PsychInfo and PubMed database searches and cross- referencing strategies identified 10 published RCTs of SSRI efficacy. In total, these studies compared 1,223 SSRI treated patients to a similar number of placebo controls. Using the researchers’ own efficacy criteria, six studies returned significant results favoring SSRIs over placebo. These included 3 of 4 fluoxetine studies (Emslie et al. 1997, 2002; Simeon et al. 1990; The TADS Team 2004), 1 of 3 paroxetine studies (Berard et al. 2006; Emslie et al. 2006; Keller 2001), 1 of 1 sertraline study (Wagner et al. 2003), and 1 of 1 citalopram study (Wagner et al. 2004).

Despite these pharmaceutical-funded positive outcomes, medication-related side-effects were startling, and the methodological chicanery discouraging. Here’s an excerpt where we take a deep dive into the medication-related side effects and adverse events (N.B., the researchers should be lauded for their honest reporting of these numbers, but not for their “safe and effective” conclusions).

SSRI-related medication safety issues for young patients, in particular, deserve special scrutiny and articulation. For example, Emslie et al. (1997) published the first RCT to claim that fluoxetine is safe and efficacious for treating youth depression. Further inspection, however, uncovers not only methodological problems (such as the fact that psychiatrist ratings provided the sole outcome variable and the possibility that intent-to-treat analyses conferred an advantage for fluoxetine due to a 46% discontinuation rate in the placebo condition), but also, three (6.25%) fluoxetine patients developed manic symptoms, a finding that, when extrapolated, suggests the possibility of 6,250 mania conversions for every 100,000 treated youth.

Similarly, in the much-heralded Treatment of Adolescents with Depression Study (TADS), self-harming and suicidal adverse events occurred among 12% of fluoxetine treated youth and only 5% of Cognitive Behavioral Therapy (CBT) patients. Additionally, psychiatric adverse events were reported for 21% of fluoxetine patients and 1% of CBT patients (March et al. 2006; The TADS Team 2004, 2007). Keller et al. (2001), authors of the only positive paroxetine study, reported similar data regarding SSRI safety. In Keller et al.’s sample, 12% of paroxetine-treated adolescents experienced at least one adverse event, and 6% manifested increased suicidal ideation or behavior. Interestingly, in the TCA and placebo comparison groups, no participants evinced increased suicidality. Nonetheless, Keller et al. claimed paroxetine was safe and effective.

When it came to combination treatment, we found only two studies, one of which made a final recommendation that was nearly the opposite of their findings:

Other than TADS, only one other RCT has evaluated combination SSRI and psychotherapy treatment for youth with depression. Specifically, Melvin et al. (2006) directly compared sertraline, CBT, and their combination. They observed partial remission among 71% of CBT patients, 33% of sertraline patients, and 47% of patients receiving combined treatment. Consistent with previously reviewed research, Sertraline patients evidenced significantly more adverse events and side effects. Surprisingly and in contradiction with their own data, Melvin et al. recommended CBT and sertraline with equal strength.

As I summarize the content from our article, I’m aware that you might conclude that I’m completely against antidepressant medication use. That’s not the case. For me, the take-home points include, (a) SSRI antidepressants appear to be effective for some young people with depression, and (b) at the same time, as a general treatment, the risk of side effects, adverse effects, and minimal treatment effects make SSRIs a bad bet for uniformly positive outcomes, but that doesn’t mean there won’t be any positive outcomes. In the end, for my money—and for the safety of children and adolescents—I’d go with counseling/psychotherapy or exercise as primary treatments for depressive symptoms in youth, both of which have comparable outcomes to SSRIs, with much less risk.

And here’s a link to the whole article: