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Wednesday, October 29th, 2008

| CWK Producer

Fifteen-year-old Sarah McMenamin suffers from depression. It started a year ago with the death of her father.

“I was just like, ‘I just want to die,’” she says, describing her feeling before seeing a therapist. “I would never kill myself, but I just wish I was dead, I just wish I was never going to wake up.”
 
For depressed teens, experts at the American Academy of Child and Adolescent Psychiatry say what can help is medicine – combined with talk therapy.

“I think the therapist helped me,” explains Sarah, “’cause it was talking, you know, I got it out. I didn’t bottle everything up.”

“The advantage to getting some therapy along with medication is that you get to the root of the problem,” explains Dr. David Gore, clinical psychologist. “You get to see why you’re feeling that way. And if you start understanding why you’re feeling that way, chances are pretty good you’ll stop feeling that way.”

But according to a new study from Thomson-Reuters, more teens than ever are getting medication without psychotherapy.  Why?  Gore has an answer.

“Basically, psychiatrists are pretty busy,” Dr. Gore says. “They don’t want to spend a lot of time with people. They want to get people in and out, maybe two or three an hour. … It pays better to do that than spending an hour doing psychotherapy.”

Three months ago, Sarah started seeing a new doctor.

“Right away he put me on Zoloft,” she says. “He didn’t even know me for an hour and he put me on it.”

But psychologists say medicine alone just won’t work as well.

“You take your pill, you’ll get some immediate relief,” explains Dr. Gore, “but the problem’s going to crop up again in two months or four months or six months. You’ve got to get to the root of the problem.”

Sarah will resume talk therapy again in a few months. She says she is looking forward to it.

“You get it out on the table and you know your feelings’” she says, “and you go in thinking it’s one thing and you come out finding out it’s like 10 different things and you’re like, ‘Wow.’”

Tips for Parents

All teens experience ups and downs.  Every day poses a new test of their emotional stability – fighting with a friend, feeling peer pressure to “fit in” with a particular crowd or experiencing anxiety over a failed quiz – all of which can lead to normal feelings of sadness or grief.  These feelings are usually brief and subside with time, unlike depression, which is more than feeling blue, sad or down in the dumps once in a while. 

According to the Nemours Foundation, depression is a strong mood involving sadness, discouragement, despair or hopelessness that lasts for weeks, months or even longer.  It also interferes with a person’s ability to participate in normal activities.  Often, depression in teens is overlooked because parents and teachers feel that unhappiness or “moodiness” is typical in young people.  They blame hormones or other factors for teens’ feelings of sadness or grief, which leaves many teens undiagnosed and untreated for their illness.

The Mayo Clinic reports that sometimes a stressful life event triggers depression.  Other times, it seems to occur spontaneously, with no identifiable specific cause.  However, certain risk factors may be associated with developing the disorder.  Johns Hopkins University cites the following risk factors for becoming depressed:

• Children under stress who have experienced loss or who suffer attention, learning or conduct disorders are more susceptible to depression.
• Girls are more likely than boys to develop depression.
• Youth, particularly younger children, who develop depression are likely to have a family history of the disorder.

If you suspect that your teen is clinically depressed, it is important to evaluate his or her symptoms and signs as soon as possible.  The National Depressive and Manic-Depressive Association cites the following warning signs indicating that your teen may suffer from depression:

• Prolonged sadness or unexplained crying spells
• Significant changes in appetite and sleep patterns
• Irritability, anger, worry, agitation or anxiety
• Pessimism or indifference
• Loss of energy or persistent lethargy
• Feelings of guilt and worthlessness
• Inability to concentrate and indecisiveness
• Inability to take pleasure in former interests or social withdrawal
• Unexplained aches and pains
• Recurring thoughts of death or suicide

It is important to acknowledge that teens may experiment with drugs or alcohol or become sexually promiscuous to avoid feelings of depression.  According to the National Mental Health Association, teens may also express their depression through other hostile, aggressive, risk-taking behaviors.  These behaviors will only lead to new problems, deeper levels of depression and destroyed relationships with friends and family, as well as difficulties with law enforcement or school officials.

The development of newer antidepressant medications and mood-stabilizing drugs in the last 20 years has revolutionized the treatment of depression.  According to the Mayo Clinic, medication can relieve the symptoms of depression, and it has become the first line of treatment for most types of the disorder.  Psychotherapy may also help teens cope with ongoing problems that trigger or contribute to their depression.  A combination of medications and a brief course of psychotherapy are usually effective if a teen suffers from mild to moderate depression.  For severely depressed teens, initial treatment usually includes medications.  Once they improve, psychotherapy can be more effective.

Immediate treatment of your teen’s depression is crucial.  Adolescents and children suffering from depression may turn to suicide if they do not receive proper treatment.  Suicide is the third leading cause of death for Americans aged 10-24.  The National Association of School Psychologists suggests looking for the following warning signs that may indicate your depressed teen if contemplating suicide:

• Suicide notes:  Notes or journal entries are a very real sign of danger and should be taken seriously.
• Threats:  Threats may be direct statements (“I want to die.”  “I am going to kill myself”) or, unfortunately, indirect comments (“The world would be better without me.”  “Nobody will miss me anyway”).  Among teens, indirect clues could be offered through joking or through comments in school assignments, particularly creative writing or artwork.
• Previous attempts:  If your child or teen has attempted suicide in the past, a greater likelihood that he or she will try again exists.  Be very observant of any friends who have tried suicide before.
• Depression (helplessness/hopelessness):  When symptoms of depression include strong thoughts of helplessness and hopelessness, your teen is possibly at greater risk for suicide.  Watch out for behaviors or comments that indicate your teen is feeling overwhelmed by sadness or pessimistic views of his or her future.
• “Masked” depression:  Sometimes risk-taking behaviors can include acts of aggression, gunplay and alcohol or substance abuse.  While your teen does not act “depressed,” his or her behavior suggests that he or she is not concerned about his or her own safety.
• Final arrangements:  This behavior may take many forms.  In adolescents, it might be giving away prized possessions, such as jewelry, clothing, journals or pictures.
• Efforts to hurt himself or herself:  Self-injury behaviors are warning signs for young children as well as teens.  Common self-destructive behaviors include running into traffic, jumping from heights and scratching, cutting or marking his or her body.
• Changes in physical habits and appearance:  Changes include inability to sleep or sleeping all the time, sudden weight gain or loss and disinterest in appearance or hygiene.
• Sudden changes in personality, friends or behaviors:  Changes can include withdrawing from friends and family, skipping school or classes, loss of involvement in activities that were once important and avoiding friends.
• Plan/method/access:  A suicidal child or adolescent may show an increased interest in guns and other weapons, may seem to have increased access to guns, pills, etc., and/or may talk about or hint at a suicide plan.  The greater the planning, the greater the potential for suicide.
• Death and suicidal themes:  These themes might appear in classroom drawings, work samples, journals or homework.

If you suspect suicide, it is important to contact a medical professional immediately.  A counselor or psychologist can also help offer additional support.

References

• American Academy of Child and Adolescent Psychiatry
• American Foundation for Suicidal Prevention
• Johns Hopkins University
• Mayo Clinic   
• National Association of School Psychologists
• National Depressive and Manic-Depressive Association
• National Institute of Mental Health
• National Mental Health Association
• Nemours Foundation
• Thomson-Reuters

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