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Editor's Note: Because of the sensitive nature of this report and the
age of the youth, the names of the three profiled families have been
changed to protect their privacy. "Approximately 3.5 million children and teenagers have depression, according to a report by the U.S. Surgeon General. Other recent surveys estimate that as many as one in five teens suffer to some degree." For most teens, the 241 Toll Road serves as a shortcut to a desired location. For Wendy Roberts, though, it was seen as a way to end her life - particularly as she traveled across a bridge near the Santa Margarita Parkway exit. Dozens and dozens of feet separate the raised structure and the wilderness area below. But it wasn't the lengthy drop that prevented Wendy from acting on her plan. Nor was it the sentiment of leaving behind family and friends. Rather, it was the fear of failing yet a second time at ending her life. "I felt so angry and hopeless," says the South County teen, "that I had my mind made up that dying was the best solution." The 17-year-old, who attempted suicide nearly two years ago through an overdose of prescribed medications, suffers from depression. And though she may at times feel different from other kids her age, she's far from being alone. Approximately 3.5 million children and teenagers have depression, according to a report by the U.S. Surgeon General. Other recent surveys estimate that as many as one in five teens suffer to some degree. As one of the most common mental illnesses, depression left untreated can take such a hold that death at times seemingly offers the only avenue of escape. Others often turn to less drastic but equally disturbing ways, such as cutting, burning and plucking out their hair, to temporarily mask their pain. "It's got pretty severe consequences," says Dr. Gail Fernandez, medical director of the inpatient adolescent unit at UCI Medical Center in Orange. "I'm not talking about somebody who's got the blues for a couple days or a week, or somebody who has what we call dysthymia, which is a mild depression you can kind of live with. "Once you've been diagnosed with major depression, even though you might be able to function, life is pretty unrewarding and it's a struggle...It makes everything that you would normally do much more difficult." Difficulty in simplicity For Wendy, mastered tasks and routines, such as going to school and doing homework, become a challenge. Once enjoyed after-school activities became a source of dread. And she became so anxious in social settings that she began avoiding longtime friends. As difficult as her two-year journey has been, Wendy is among the fortunate. Through lots of courage and strength on her part and professional treatment, she's learning to understand and manage her disease. Numerous other depressed teens, 80 percent according to The Centers for Disease Control, receive no treatment. Many are never diagnosed; sometimes a parent says, "Snap out of it;" often, the teen just trudges along. "Those are the ones typically that can kill themselves, because they never made it to a psychiatrist or even their family doctor," says Fernandez. An average of more than 1,000 high school age children attempt suicide each day. It has become the third-leading cause of death among teenagers. In most of these cases, depression is a factor. Depression vs. the 'blues' Part of the reason for the large number of youngsters who go undiagnosed is that the symptoms often are written off as normal teenage behavior. It's not uncommon, for instance, for grades to sometimes drop or that kids experience "the blues" as they adjust to the physical, emotional, psychological and social changes that accompany this stage of life. "Originally, I thought it was a lack of motivation," says Karen Conley, whose 17-year-old son was diagnosed with depression and ADD when he was in the eighth grade. "I was told by friends and teachers, 'It's a typical teenage hormonal problem.'" Often associated with extreme sadness and crying spells, an absence of these symptoms can be misleading. Anger, hostility and irritability are among other symptoms that typically accompany depression, particularly with boys. Explaining depression Depression, which involves an imbalance of brain chemicals called neurotransmitters, is defined as an illness when the feelings of depression persist and interfere with one's ability to function. "It has all the signs and symptoms of being a medical disorder," says Fernandez. "You can be struck by it just like you can be struck by diabetes. And just like diabetes, you may not choose the illness, but you can do things to improve it." Numerous criteria are used in diagnosis, the main one being that several continuous symptoms must be present for two weeks or more. Sad or irritable moods, loss of interest in activities, change in appetite or weight, change in sleep patterns, loss of energy and difficulty in concentrating provide clues. By the time a teen sees a psychiatrist, these symptoms often have been present for several months and sometimes years. More often than not, another disorder is involved as well, making an already tough situation even more treacherous. Karen's son, Mark, turned to drugs to help relieve his pain. Instead of easing his suffering, the occasional pot he smoked brought paranoia, anxiety and drug-induced schizophrenia. His depression worsened. According to the U.S. Surgeon General, approximately two-thirds of adolescents with major depressive disorder also have another mental disorder. The most common ones include dysthymic disorder (a mood disorder similar to major depression, but it has fewer symptoms and is more chronic), an anxiety disorder, a disruptive or antisocial disorder, or a substance abuse disorder. Like Wendy, 20-40 percent of these teens have or eventually develop bipolar, a mood disorder in which episodes of mania alternate with episodes of depression. While the precise causes of depression are unknown, extensive research on adults with depression generally points to both biological and psychosocial factors. According to the National Mental Health Association, many things contribute to clinical depression. For some people, a number of factors may be involved. For others, a single incident prompts the illness. Other times, people become depressed for no apparent reason. Besides often having too little or too much of certain brain chemicals, teens with negative thinking patterns and low self-esteem seem more likely to develop clinical depression. Girls are at a greater risk than boys, as are individuals with a family history of depression. Side effects from some medications, along with difficult life events such as divorce, the death of a loved one and bullying also can contribute to depression. "Until you actually live it and see it, (you do not understand) the ravages of a chemically imbalanced kid," says Karen. "He'd been loving and positive. If there was an obstacle, he'd find a way around it. And then somewhere along the way...he wasn't the kid that I or the family knew him to be." Treatment While depression can indeed wreak havoc on one's life, the upside is that it is highly treatable. Mark, for example, is graduating early from high school with a 3.5 gpa. He has been drug-free for a little more than a year; he works as a supervisor at a popular retail spot. Today, rather than slamming his fist into the wall, cutting on himself or taking his frustration out verbally on his mom, the South County resident can identify the onset of symptoms and take steps to ward them off. Listening to music, journaling, exercising or talking with a friend represent some of the positive outlets depressed teens have come to rely on. While homes rock with emotion at times, good is met along the away. Family bonds firm up, characters build up. A sense of pride and admiration emerge as the adolescent makes his or her way through the raised hurdles blocking a path. And sometimes, one is blessed with more than he or she ever expected. "Not only do I feel like I have my son back," says Karen, "I feel that he's become a better person than he ever thought he could be." Like most teens with depression, Mark's treatment consists of therapy and medication. According to the National Mental Health Association, therapy can help teens understand why they are depressed and teach them ways on how to cope with stressful situations. Medication, on the other hand, relieves some of the symptoms of the disease. Karen, who "wasn't going to be the kind of parent who just throws their kids onto medication for a quick fix," first changed her son's diet and added more exercise. She also learned new behavior modification techniques, helped her son form new study habits and sought counseling. And, she began praying more often. Tactics such as these oftentimes heal. Other times, additional intervention is needed. When Mark was in the eighth grade, Karen reluctantly started him on the difficult journey of meds - which one(s) to take, how often and when. It's a difficult decision for parents to make, but one they typically go with because the alternative is sometimes simply too great. For many, an antidepressant may be all that is prescribed. If other conditions exist, however, additional medication may be advised. Mark, for example, currently takes four medications: one for ADD, an antidepressant, a mood stabilizer and one that helps him sleep. His doctor's goal, says Karen, is to have him stabilized for one year then begin reducing and then eliminating the meds. "We try to emphasize that medication can help the symptoms, but then you're going to have to change some of the patterns of your thinking and the way you react to stress or you're going to be more susceptible in the future," says Fernandez. "That doesn't mean you'll need to be on medication forever. It means be careful and identify the symptoms early in the future if they reoccur." According to Fernandez, teens who have had one episode of depression have a 50 percent chance of getting a second event. And for those who have a second episode, 90 percent are likely to experience a third occurrence. On average, an episode lasts between seven and nine months. If medication is started, says Fernandez, the individual must be monitored for the first six to eight weeks. Not only should parents keep a watchful eye, their teen should be making frequent visits to a therapist for additional monitoring. "There's a lot of talk about becoming suicidal on antidepressants," she says. (A study on Paxil from Great Britain recently caused great alarm.) "It's very well known in our field that when you're severely depressed that your thought processes are kind of impaired, they're slower and you don't plan things out very well. When you start getting treated for depression, there's a period of time where you're mood is improving, but you're still extremely depressed. That time becomes dangerous for some people because you start being able to think better, but yet you're still very depressed." Both Wendy and Mark, for example, did not inflict harm on themselves when they were sad or feeling hopeless. Instead, it was during times of anger and frustration. Other options Susan Jacobs' daughter had been taking the antidepressant Zoloft for 18 months. Concerned about both the side- and long-term effects of the drug, Susan sought the services of an Irvine practitioner who uses natural medicine. The microbiologist prescribed therapeutic doses of herbs to the 17-year-old to enhance and build up her body so it could recover on its own. "Instead of regulating a chemical in the brain," says Aleks Strande, founder of Irvine-based Simply Healing, "basically, I provide food to nourish the nerve system, which is weak." In addition to therapeutic doses of herbs, Strande also recommends exercise and offers dietary advice. The treatment, coupled with communication and coping techniques, has brought favorable results to the San Fernando Valley teen. "It was very effective," says Susan. "Her depression is a lot better. She's in good communication with me about when certain things are starting to happen and we can kind of talk it though. She can usually work it out now before it gets to the next level." The effects on the family Such favorable results are not only welcomed by the depressed teen but by family members whose lives also appear shaken by the disease. As with other difficult and unexpected life turns, emotions run high and change continually. They grieve over the loss of the child or the sibling they once knew. They ache for the pain that they go through. They worry about their future or that they may try to harm themselves. They blame themselves for things gone wrong and feel powerless when their attempts to help fail. With each setback, the hope they've gained turns to despair. And they're angered by the upset the disease brings to their home. "I could feel the control of my home slipping and it all revolved around what mood he was going to be in," says Karen. "I felt like I had to micro-manage and control everything because he wasn't able to." When her pep talks and love proved fruitless, Karen - unsatisfied with where she was headed - stopped taking care of things and making excuses for her son's behavior. She also learned how not to react to his moods, gave fewer speeches and followed through with established consequences. She learned this new parenting approach through a family group at BreakAway Health Corp. The Costa Mesa-based facility offers treatment programs for adolescents, adults and families needing help with problems resulting from psychological issues or substance abuse. The Conleys attended the outpatient program for two hours, four nights a week for approximately six months. Family members met in one room, the kids in another. And on Thursday nights, they all met together. In addition to new learned techniques, programs such as these offer a safe haven for families to openly share what they usually keep as a well-guarded secret. "There's certain family members and certain friends you don't feel comfortable talking to about it because you know they are not going to accept anything you have to say or believe it," says Karen. "Or, they'll look and you and think, 'it must be your parenting skills.'" Besides putting the views of others aside, parents also have to put away - or at least put on hold - the ideals they hold for their children. Karen, for example, had to give up her own image of what she thought her son's high school experience should be. The prom, the sports and graduating with his class. Instead, she put him in an environment where she believed he would accelerate academically and grow as a person. All three of the profiled teens are in alternative schooling. Wendy is in an independent study program. Mark attended one as well before enrolling in a "sober" public high school in Costa Mesa when he was a junior. And Susan Jacobs' daughter is homeschooled. Previously, all three had been in a mainstream schooling setting. Fernandez, however, cautions against such long-term changes at school. Instead, she recommends parents work with school administrators to make adjustments, such as attending school half-day or eliminating homework for a short time. "You still have to achieve all the things that kids have to achieve," she says. "If they can't handle the pressure of school, let's say, then we're not preparing them very well for the pressure of a job. "Once you give into the school issue, I think in a way you're supporting that kid's withdrawal from normal life. Once in a while there is an adolescent that just doesn't fit the normal school environment, but that's very rare." Indeed, decisions remain part of the fabric, from meds to schooling to how to parent a mentally ill child. Add in the fragile state of many of these kids, and the pressure and responsibility intensifies. As statistics show, a wrong decision or misread cue could prove catastrophic. Love, caring and attention provide the opening. Sandy Bennett is an associate editor. Signs of depression The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters. If one or more of these signs of depression persists, parents should seek help. • Decreased interest in activities, or inability to enjoy favorite activities • Frequent absences from school or poor performance in school • Frequent sadness, tearfulness, crying • Persistent boredom; low energy • Low self-esteem and guilt • Hopelessness • Poor concentration • Difficulty with relationships • Social isolation, poor communication • Increased irritability, anger, or hostility • Talk of or efforts to run away from home • Extreme sensitivity to rejection or failure • A major change in eating and/or sleeping patterns • Thoughts or expressions of suicide or self-destructive behavior • Frequent complaints of physical illnesses such as headaches and stomachaches – Source: American Academy of Child and Adolescent Psychiatry A Teen Speaks Out depression is like stumbling into quicksand. i could feel life being sucked out of me as i was unwillingly pulled down. i felt so alone, like i was different. and i didn't know why. it felt as if a spell had been cast over me and i was cursed with an evil personality. a different, strange, horrid personality that was pushing the real me out, taking over and living inside my body. my everyday routine became a chore. i started fibbing to the people i love to try to avoid the things i suddenly began to dread. at the time it seemed harmless. it wasn't, though. it ended up feeding into my depression and shoving me into the black hole i had grown to fear. it seemed useless trying to explain my emotions and moods. people already seem to have their minds made up about what depression is. for the most part, their perceptions are incorrect. i've heard and read what ignorant people say about depression and the people suffering from it - hurtful and untrue statements such as, "oh, they just need to snap out of it." or, they misinterpret behaviors as laziness and self-pity. i feared that they might be thinking the same of me. the little beast somehow mixes all of the emotions you never wish to feel in one big ball of pain. fighting this fiend drained my energy and left me feeling hopeless. i felt so powerless over myself. i was confused and couldn't understand why everything that i tried, to lift myself, failed. it came to a point that nothing mattered. i was desperate and willing to try anything to escape this horrific place, including suicide. it was sad knowing that i was willing to leave behind everything that once mattered to me. everything that i loved, looked forward to doing and that had once made me happy. i later felt like a coward and that i was running away. i look back at the things i was running away from and wonder why. i can't run in the opposite direction every time i come across a problem. things are tough, but there is so much good mixed in between the rough times. if i would have succeeded, i would have missed out on life. my family, friends, passions - everything. depression defiantly has been my toughest battle. i still have setbacks. but through each new battle, i know if i hang in there long enough, i can do it again! – by 17-year-old south county female Fast facts for the family • One of the most common mental illnesses, depression involves an imbalance of brain chemicals called neurotransmitters. • The condition is hereditary and highly treatment. • Approximately 3.5 million children and teenagers have depression, according to a report by the U.S. Surgeon General. Other recent surveys estimate that as many as one in five teens suffer from the disease. • Approximately two-thirds of adolescents with a major depressive disorder also have another mental disorder. • According to The Centers for Disease Control, 80 percent of the teens who suffer from depression receive no treatment. • An average of more than 1,000 high school age children attempt suicide each day, making it the third leading cause of death among teenagers. In most of these cases, depression is a factor. Dealing with adolescent pressures When teens feel down, there are ways they can cope with these feelings to avoid serious depression. All of these suggestions help develop a sense of acceptance and belonging that is so important to adolescents. • Try to make new friends. Healthy relationships with peers are central to teens' self-esteem and provide an important social outlet. • Participate in sports, job, school activities or hobbies. Staying busy helps teens focus on positive activities rather than negative feelings or behaviors. • Join organizations that offer programs for young people. Special programs geared to the needs of adolescents help develop additional interests. • Ask a trusted adult for help. When problems are too much to handle alone, teens should not be afraid to ask for help. - Source: National Mental Health Association Support for family and friends If Diane Bagby's son had been diagnosed with cancer or had been involved in a debilitating car accident, she would have received an outpouring of support from neighbors and friends. Instead, his condition often brought whispers and stares. Her 24-year-old son, who has endured several episodes of major depression, was diagnosed with schizophrenia when he was 18 years old. "My son was always really hyper and I always got the stares, mothers looking at me like, 'Why can't you control your kid.' I can't say that I ever, ever got used to that," she says. "You know in the back of your mind people are thinking, 'What's going on in their house that caused that? What trauma happened to that child that caused him to develop schizophrenia?'" In addition to overwhelming emotions, such as grief, guilt and anger, relatives of the mentally ill must also deal with the stigma attached to the disease. This includes ones not only held by outsiders, but ones they hold themselves. Diane, for example, couldn't even say the word schizophrenia aloud for months. Instead, she whispered the word for about a year. Today, she openly shares her experience with other family members and friends who have a loved one with mental illness. The San Juan Capistrano resident is among a number of volunteers who lead the Family-to-Family Education Program, sponsored by the National Alliance for the Mentally Ill (NAMI). Diane, who heard about the workshop through her best friend, attended the program last fall. Initially skeptical, she finally made a call after four urgings. "The program relieved a lot of guilt," she says. "And it put me in contact with other families that were completely normal, but they had ill children." To many who attend, this connection with other families in the same situation is perhaps the most powerful component of the free program. In addition, the 12-week workshop also includes a wealth of information. Among the many topics addressed are basics about brain biology (including physical evidence linked to mental illness), problem- solving, medications, empathy, communication skills, self-care, rehabilitation and advocacy. The Santa Ana-based, nonprofit organization also offers several ongoing support programs. The groups, which are led by a professional and volunteer facilitator, meet once a week at several locations throughout Orange County. Similar to the Family-to-Family workshop, a nine-week program called Peer-to-Peer is available as well for those who have a mental illness. For additional information on these programs, call 714.544.8488. - By Sandy Bennett Resources • National Mental Health Association: www.nmha.org • National Alliance for the Mentally Ill (NAMI): www.nami.org • American Academy of Child and Adolescent Psychiatry: www.aacap.org • Mental Health Association of Orange County: www.mhaoc.org or call 714.547.7559 • Orange County Psychiatric Society: www.ocps.org • NAMI Orange County: 714.544.8488 |
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