But does a diagnosis of depression in a child require medication? Consider Nancy Allee's 10-month journey with SSRIs and other drugs. At 12, she was as bubbly as Megan Kellar is now. She soon developed "a five-month-long headache" and started having nightmares. After about a year in counseling, things seemed to be going better and, her mother Judith says, "we terminated it so as not to make it a way of life." A few months later, Nancy became hostile and rebellious but nothing that Judith considered "out of the bounds for a normal teenager." Then, "without any warning, she [took an] overdose" of her migraine medication, was hospitalized and depression was diagnosed. While Judith thought the overdose was out of the blue, Nancy says, "I'd had depression for a long time. If I'd had bad thoughts, I'd always had them and kind of grew up with them. I was always very bubbly, even when I was depressed. A lot of people didn't notice it. To me, suicide had always been an option."

Nancy was put on Zoloft. When that didn't work, the doctor added Paxil and then several other drugs. But there was a panoply of side effects: her hands would shake, she would bang her head against the wall. A voracious reader, she became too withdrawn and listless to pick up a book. There were times she couldn't sleep, but on one occasion she slept 72 hours straight.

"I was seeing five different doctors, and it was overkill," says Nancy. "At one point, I was taking 15 pills in the morning and 15 in the evening. I wound up burying my medication in the backyard. I didn't want to take it anymore." Then Nancy was tested for allergies, a process that required her to be medication free. "It was like the sky was blue again," says Nancy, who at 18 is still off drugs but sees a counselor occasionally. "The colors came back. It was a total change from the medication stupor. Everything wasn't peachy, but I was able to appreciate doing things again."

Most psychiatrists, despite their enthusiasm for the new antidepressants, write prescriptions for only six months to a year and taper the dosage toward the end. Even Fassler admits, "We try to use medication for the minimum amount of time possible. And with a younger child, we're more cautious about using medication because we have less research concerning both the effectiveness and the long-term consequences and side effects." Says Michael Faenza, president of the National Mental Health Association: "I feel very strongly that no child should be receiving medication without counseling. Medication is just one spoke in the wheel."

The lack of science about the effects of these drugs on childhood development is the reason the FDA has required all manufacturers of SSRIs that treat depression to conduct studies on the subject. Says Dr. Peter Kramer, professor of psychiatry at Brown University and author of Listening to Prozac: "Anyone who thinks about this problem is worried about what it means to substantially change neurotransmission in a developing brain. We don't know if these kids would compensate on their own over time and if by giving them these medicines we are interfering with that compensatory mechanism."

Until we know more, some argue, the risks of such medication are just too great, if only because of the message it sends to children. Says Dr. Sidney Wolfe, director of Public Citizen's Health Research Group: "We are moving into an era where any quirk of a personality is fair game for a drug. On one hand, we are telling kids to just say no to drugs, but on the other hand, their pediatricians are saying, 'Take this. You'll feel good.'"

Teen rebellion can put a twist on even that, however. One New York couple, becalmed by antidepressants themselves and openly concerned about the depression of their 18-year-old, were castigated by their son for their "weakness" and dependence on Prozac. His argument: your drugs change who you really are. In place of their drugs, the young man argued for his "natural" remedy: marijuana.

Indeed, pot and alcohol are common forms of self-medication among depressed teens. Weller estimates that about 30% of her teen patients have used pot or alcohol after a depressive episode, most of them at the urging of friends who said smoking and drinking would make them feel better. A high school social worker in Minnesota decided to look into the case of a troubled girl who was still a freshman at 17. The girl admitted she smoked pot as a constant habit but did not understand why she craved it so much. A psychological evaluation found the girl was suffering from clinical depression as well as ADHD. She was prescribed an antidepressant, which had striking results. It not only elevated her mood and helped her focus but also reduced her desire for pot and tobacco.

"It used to be said that adolescence is the most common form of psychosis," says Kramer, the man who helped make Prozac famous. Then he turns serious. "But if a child has a prolonged period of depressive moods, he needs to be evaluated for depression." Even if little is known about the long-term effects of SSRIs on young bodies, most doctors in the field argue that the drugs are a blessing to kids in pain. Says Duke's March, who is doing a comparative study of the benefits of Prozac and cognitive-behavior therapy: "My clinical experience is that it's worse to risk a major mental illness as a child than to be on medication. If you weigh the risks against the benefits, the benefits are probably going to win."

Susan Dubuque of Richmond, Va., is convinced of the benefits. Her son Nick went through "seven years of testing hell." At seven, ADHD was diagnosed and he was put on Ritalin. "When he was 10 years old, he didn't want a birthday party because he just couldn't deal with it," she recalls. Then, his mother says, Nick "bottomed out and became suicidal, and one day I found him in a closet with a toy gun pointed at his head, and he said, 'If this was real, I'd use it.'" The next day she saw a psychologist who had recently evaluated Nick and was told, "If you don't get him help, next time he'll be successful." Nick was found to be suffering from clinical depression and took a series of antidepressants. "I was worried about my son's killing himself," says Susan, who was called by clinicians a "histrionic mother" and a "therapy junkie," as she spent $4,000 on drugs and therapy for her son. "I would have sold my house if that was what it would have taken."

Nick is better now, and has co-authored a book with his mom: Kid Power Tactics for Dealing with Depression. Susan is happy to have her son back safe—even though there is some stress. "It's so much fun to have an obnoxious 15-year-old," she says, "and I mean normal obnoxious."

— Reported by Jodie Morse/New York, Alice Park/Washington and James Willwerth/Los Angeles

From the May 31, 1999 issue of TIME Magazine

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