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My son attended a rehab center for substance abuse at the age of 14. He is now 16 and is involved with AA and is seeing a therapist. He has been sober for over 2 years. He is on celexa and wellbutrin. Although he has made progress, he is very unmotivated, not curious and flat in expression. His IQ is above normal. What can be done to help him live a more positive and active life ?



Answered by: David Kahn

His flatness could certainly indicate that he has depression. Is he on adequate doses of medication? If there are no side effects, Wellbutrin can be given up to 450 mg per day, and Celexa up to 60-80 mg per day. If he has adequate treatment with these medications, consideration should be given to change to another medication with a different mechanism, such as Effexor or Cymbalta. Does he have bipolar disorder? If that is in the background of his depression, he may do better with a medication called Lamictal. Depression is also sometimes more effectively treated with specifi forms of psycotherapy such as cognitive therapy. But all of his symptoms could also represent other issues that are not necessary from depressive illness, for example, adolescent mood changes, conflicts within your family, or other issues he would need to deal with by really talking these out, or possible in family therapy.

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David Kahn, M.D.
 

David A. Kahn, M.D.

Dr. Kahn is the Diane Goldman Kemper Family Clinical Professor of Pyschiatry Emeritus, Columbia University Medical Center; and attending psychiatrist, New York Presbyterian Hospital.

He received his B.A. from Haverford College in 1975, completed medical school and internship in medicine at Columbia, and was resident and chief resident in psychiatry at Columbia Presbyterian Medical Center and the New York State Psychiatric Institute. He then received an NIMH extramural research fellowship at the Psychiatric Institute, where he worked in the area of mood disord...
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