Depression: Medication Adjustments and Dream Analysis in Teens - Psychiatry

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Understanding the complexities of depression, especially in adolescents, requires a nuanced approach that encompasses medication management, psychological support, and an understanding of the emotional landscape that young individuals navigate. In your case, the adjustments made by your daughter's psychiatrist regarding her medication—specifically, maintaining the dosage of Lexapro (樂復得) while reducing the dosage of Seroquel (思樂康)—can be understood through several key considerations.

Firstly, the decision to reduce Seroquel rather than Lexapro likely stems from the side effects your daughter is experiencing. Seroquel, an atypical antipsychotic often used for mood stabilization and sleep aid, can cause sedation and may contribute to difficulties in waking up in the morning. By lowering the dose of Seroquel, the physician aims to mitigate these side effects while still providing some level of support for her mood and sleep. Lexapro, on the other hand, is a selective serotonin reuptake inhibitor (SSRI) that primarily targets depressive symptoms and anxiety. The decision to maintain its dosage suggests that the psychiatrist believes it is effectively managing her depressive symptoms without significant adverse effects.

Regarding your daughter's recurrent dreams about her late classmate, this phenomenon can be quite common in individuals dealing with grief and unresolved trauma. Dreams often serve as a mechanism for processing emotions and experiences, particularly those that are distressing or significant. The fact that she is dreaming about a traumatic event from two years ago may indicate that she is still grappling with the emotional impact of that loss. In the context of depression, such dreams can be intensified, as individuals may be more sensitive to negative emotions and memories.
To address the impact of these dreams on her sleep, several strategies can be employed:
1. Sleep Hygiene: Encourage a consistent sleep schedule, where she goes to bed and wakes up at the same time every day. Creating a calming bedtime routine can also help signal to her body that it’s time to wind down.

2. Cognitive Behavioral Therapy (CBT): Engaging in therapy, particularly CBT, can help her process her feelings about the loss and develop coping strategies for her dreams. A therapist can work with her to reframe her thoughts and reduce anxiety related to sleep.

3. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, deep breathing exercises, or progressive muscle relaxation can help reduce anxiety and promote a sense of calm before bed.

4. Journaling: Encouraging her to write about her feelings and experiences before bedtime can provide an outlet for her emotions and may help reduce the intensity of her dreams.

5. Medication Review: Continue to work closely with her psychiatrist to monitor her medication's effectiveness and side effects. If the dreams persist and significantly impact her sleep, discussing potential adjustments or additional therapies may be beneficial.

6. Supportive Environment: Create a supportive atmosphere where she feels comfortable expressing her feelings about her dreams and the loss of her friend. Open communication can help her feel less isolated in her experiences.

In conclusion, the interplay between medication adjustments and emotional processing through dreams is a delicate balance in treating depression, especially in adolescents. By addressing both the pharmacological and psychological aspects of her treatment, you can help your daughter navigate her feelings and improve her overall well-being. It’s essential to maintain an open dialogue with her healthcare providers and ensure she has access to the support she needs during this challenging time.