Jeremy had been seeing another child psychiatrist for the last year before he visited my office. He initially started treatment after his family noted increased irritability in the home, falling grades, withdrawal from his friends, worrisome posts on social media, and a decision to quit the school swim team (a sport that he was particularly good at and was potentially going to pay his way through college). His treating child psychiatrist had appropriately diagnosed Jeremy with depression (in children irritability is often seen as the primary symptom rather than depressed mood)—and had started him on Prozac (Fluoxetine), an SSRI antidepressant that is the most studied antidepressant in children and FDA approved for this indication. According to the textbooks, this was the correct choice. For the subsequent six months, the dose was slowly increased, yet Jeremy’s symptoms got worse. Anger outbursts emerged and he had internalized that he was a bad child, often commenting that he wished he was never born. Ultimately, after he relayed to a friend that he was thinking about hurting himself, the school counselor was informed, and Jeremy was sent to a partial hospital program. While there, he was switched to an alternative SSRI antidepressant, Zoloft (Sertraline), and its dosage was slowly increased for the subsequent three months until
Child/Adolescent Concerns: Jeremy’s Story
The blood of your parents is not lost in you.
- Menelaus, The Odyssey, 8th century BC
Adolescent Anxiety and Depression: Jeremy’s Story
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his nausea was so great that they could not increase further. Eventually Abilify, an atypical antipsychotic medication that is often used for adjunct depression in adults, was added to his treatment. He started to gain weight on this medication, so Topamax, an antianxiety medication that potentially causes weight loss, was added. After a year of no improvement, and recent cognitive decline, he presented to my office in search of another opinion about how to help him. Understandably, the family was skeptical of the efficacy of medications altogether—and had never heard about genetic testing, but at that point was willing to try almost anything to bring back the old Jeremy.
One week later, Genomind’s genetic test yielded a crucial finding in Jeremy’s genetic makeup: variant alleles of SLC6A4. This is the gene that codes the presynaptic transmembrane protein involved in serotonin uptake in the serotonin receptor. In plain English, a backup at the serotonin receptor will result in less serotonin getting to the end target. Less serotonin can result in depression and anxiety. The concern in this case is that the two antidepressants he was prescribed, Prozac (Fluoxetine) and Zoloft (Sertraline) work by blocking the serotonin uptake. Therefore, given his variant of two SLC6A4 short alleles, there is a higher likelihood that he would not respond to SSRI antidepressants – and moreover, that they would cause unwanted side effects. Results of Genomind Genetic Testing suggested to avoid SSRIs and recommended several alternative options. With some skepticism, he and his parents agreed to try a third medication option, (one from a different class of antidepressants), in fear that they would “waste another year” of Jeremy’s life.
Since then, Jeremy’s condition has been so stable we only see one another for the infrequent medication check. The last time we met, he caught me up to speed with his latest swimming accomplishments and a copy of his straight A report card. He’s referred a family member and several friends battling mental health concerns for genetic testing at Potomac Psychiatry, now that he’s a true believer. Seeing may be believing, but feeling better is even more impactful.
Dr. Mark A. Novitsky Jr.
Mark A. Novitsky Jr., MD is a Dual Board Certified Child and Adolescent/Adult Psychiatrist with experience in clinical and forensic practice. Dr. Novitsky uses a variety of psychotherapy techniques, as well as medication management when necessary, in the treatment of children and adolescents. He highly values an ongoing collaborative relationship with parents. His psychotherapy techniques include cognitive behavioral therapy (CBT), play therapy, and parent management training. Following his training in child psychiatry, he sought out formal Cognitive Therapy training with children and adolescents through “The Beck Initiative”, sponsored by The Aaron T. Beck Center at the University of Pennsylvania, where Dr. Aaron Beck first created CBT.
Dr. Novitsky has served for several years as corporate medical director for Philadelphia’s fastest growing non-profit by serving children experiencing emotional, behavioral, and academic challenges. His extensive clinical experience includes, but is not limited to:
- Childhood trauma/Post-traumatic stress disorder (PTSD)
- Attention Deficit Hyperactivity Disorder (ADHD)
- Depressive disorders, Bipolar disorder and other mood disorders
- Anxiety Disorders and Obsessive Compulsive Disorder (OCD)
- Oppositional Defiant Disorder and Conduct Disorder
- Autism Spectrum Disorder
- Learning Disorders
- Substance Use Disorders
- Intellectual Disability
Dr. Novitsky is an adjunct clinical faculty member at Temple University Hospital’s Department of Psychiatry and Behavioral Science and is the clinical preceptor for 2nd year residents Child and Adolescent rotation. He educates psychiatry residents and 4th year medical students about the intricacies of the mental health world and how it interfaces with other inter-agency supports that comprise a court-involved youth’s comprehensive treatment. He has been the recipient of a grant for his research, has been published in peer-reviewed journals, and has presented at national conferences.
- Diagnosis and Prognosis
- Child and Parental Assessments in Custody and Divorce Cases
- Treatment Recommendations
- Pharmaceutical Claims