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Young and Depressed
Ten years ago this disease was for adults only. But as teen
depression comes out of the closet, it’s getting easier to
spot—and sufferers can hope for a brighter future.
by Pat Wingert and Barbara Kantrowitz, Newsweek,
October 7, 2002
For more articles on disabilities and special ed visit
www.bridges4kids.org.
Brianne Camilleri had it all: two involved parents, a caring
older brother and a comfortable home near Boston. But that
didn’t stop the overwhelming sense of hopelessness that
enveloped her in ninth grade. “It was like a cloud that
followed me everywhere,” she says. “I couldn’t get away from
it.”
BRIANNE STARTED DRINKING and experimenting with drugs. One
Sunday she was caught shoplifting at a local store and her
mother, Linda, drove her home in what Brianne describes as a
“piercing silence.” With the clouds in her head so dark she
believed she would never see light again, Brianne went
straight for the bathroom and swallowed every Tylenol and
Advil she could find—a total of 74 pills. She was only 14, and
she wanted to die.
A few hours later Linda Camilleri found her daughter vomiting
all over the floor. Brianne was rushed to the hospital, where
she convinced a psychiatrist (and even herself) that it had
been a one-time impulse. The psychiatrist urged her parents to
keep the episode a secret to avoid any stigma. Brianne’s
father, Alan, shudders when he remembers that advice. “Mental
illness is a closet problem in this country, and it’s got to
come out,” he says. With a schizophrenic brother and a cousin
who committed suicide, Alan thinks he should have known
better. Instead, Brianne’s cloud just got darker. After
another aborted suicide attempt a few months later, she
finally ended up at McLean Hospital in Belmont, Mass., one of
the best mental-health facilities in the country. Now, after
three years of therapy and antidepressant medication, Brianne,
19, thinks she’s on track. A sophomore at James Madison
University in Virginia, she’s on the dean’s list, has a
boyfriend and hopes to spend a semester in Australia—a plan
that makes her mother nervous, but also proud.
AN ‘EPIDEMIC’?
Brianne is one of the lucky ones. Most of the nearly 3
million adolescents struggling with depression never get the
help they need because of prejudice about mental illness,
inadequate mental-health resources and widespread ignorance
about how emotional problems can wreck young lives. The
National Institutes of Mental Health (NIMH) estimates that 8
percent of adolescents and 2 percent of children (some as
young as 4) have symptoms of depression. Scientists also say
that early onset of depression in children and teenagers has
become increasingly common; some even use the word “epidemic.”
No one knows whether there are actually more depressed kids
today or just greater awareness of the problem, but some
researchers think that the stress of a high divorce rate,
rising academic expectations and social pressure may be
pushing more kids over the edge.
This is a huge change from a decade ago, when many doctors
considered depression strictly an adult disease. Teenage
irritability and rebelliousness was “just a phase” kids would
outgrow. But scientists now believe that if this behavior is
chronic, it may signal serious problems. New brain research is
also beginning to explain why teenagers may be particularly
vulnerable to mood disorders. Psychiatrists who treat
adolescents say parents should seek help if they notice a
troubling change in eating, sleeping, grades or social life
that lasts more than a few weeks. And public awareness of the
need for help does seem to be increasing. One case in point:
HBO’s hit series “The Sopranos.” In a recent episode, college
student Meadow Soprano saw a therapist who recommended
antidepressants to help her work through her feelings after
the murder of her former boyfriend.
Without treatment, depressed adolescents are at high risk for
school failure, social isolation, promiscuity,
“self-medication” with drugs or alcohol, and suicide—now the
third leading cause of death among 10- to 24-year-olds. “The
earlier the onset, the more people tend to fall away
developmentally from their peers,” says Dr. David Brent,
professor of child psychiatry at the University of Pittsburgh.
“If you become depressed at 25, chances are you’ve already
completed your education and you have more resources and
coping skills. If it happens at 11, there’s still a lot you
need to learn, and you may never learn it.” Early untreated
depression also increases a youngster’s chance of developing
more severe depression as an adult as well as bipolar disease
and personality disorders.
NEW APPROACHES
For kids who do get help, like Brianne, the prognosis is
increasingly hopeful. Both antidepressant medication and
cognitive-behavior therapy (talk therapy that helps patients
identify and deal with sources of stress) have enabled many
teenagers to focus on school and resume their lives. And more
effective treatment may be available in the next few years.
The NIMH recently launched a major 12-city initiative called
the Treatment for Adolescents With Depression Study to help
determine which regimens—Prozac, talk therapy or some
combination—work best on 12- to 18-year-olds. Brent is
conducting another NIMH study looking at newer medications,
including Effexor and Paxil, that may help kids whose
depression is resistant to Prozac. He is trying to identify
genetic markers that indicate which patients are likely to
respond to particular drugs.
Doctors hope that the new research will ultimately result in
specific guidelines for adolescents, since there’s not much
evidence about the effects of the long-term use of these
medications on developing brains. Most antidepressants are not
approved by the FDA for children under 18, although doctors
routinely prescribe these medications to their young patients.
(This practice, called “off-label” use, is not uncommon for
many illnesses.) Many of the drugs being tested—like Prozac
and Paxil—are known as SSRIs, or selective serotonin reuptake
inhibitors. They regulate how the brain uses the
neurotransmitter serotonin, which has been connected to mood
disorders.
Outside the lab, the hardest task may be pinpointing kids at
risk. Depressed teens usually suffer for years before they are
identified, and fewer than one in five who needs treatment
gets it. “Parents often think their kid is just being a kid,
that all teens are moody, oppositional and irritable all the
time,” says Madelyne Gould, a professor of child psychiatry at
Columbia University. In fact, she says, the typical teenager
should be more like “Happy Days” than “Rebel Without a Cause.”
Even adults who make a career of working with kids—teachers,
coaches and pediatricians—can misread symptoms. On college
campuses, experts say, cases of depression are too often
misdiagnosed as mononucleosis or chronic-fatigue syndrome.
That’s why many kids still suffer unnoticed, even though more
schools are using screening tools that identify kids who
should be referred for a professional evaluation. Often it’s
only the overt troublemakers—disruptive or violent kids—who
get any attention. “In most cases, if a child is doing
adequately in school, is getting decent grades, but seems a
little depressed, there’s a great likelihood that the child
won’t come to the attention of the teacher, counselor
administrator or school psychologist,” says Phil Lazarus, who
runs the school-psychology training program at Florida
International University and is chairman of the National
Association of School Psychologists’ emergency-response team.
A Healthy Teen Brain
Brain development continues through adolescence, providing
the architecture for important reasoning skills.
Corpus Callosum: Involved in self- awareness and intelligence,
this cable of nerves keeps growing until the mid-20s.
Cerebellum: Coordinates learning and may fine-tune social
tasks; structural changes in this region peak at the age of
18.
Maturity Milestones
Teens must navigate a series of developmental hurdles as
they approach adulthood.
Self-Image: Learning to separate from parents and establishing
their own identity.
Relationships: Honing interpersonal skills and forming a
supportive social network.
Goals: Establishing educational and personal objectives for
family and career.
Sexuality: Adjusting to the changes of puberty.
Types of Depression
Major depression: Usually begins in the late teens, but
has been diagnosed in children as young as 4.
Dysthymic disorder: Chronic mild depression. Starts in early
childhood and can last for decades.
Bipolar disorder: Older teens cycle between mania and deep
depression. Young teens and children can experience both
symptoms at once.
Double depression: Victims alternate between major depression
and dysthymic disorder.
Warning Signs
If five or more of these symptoms persist for two or more
weeks, they may indicate teen depression:
Frequent absences from school or a drop in grades.
Bouts of shouting or crying.
Reckless behavior.
Extreme sensitivity to rejection or failure.
Loss of interest in friends.
Trouble Spots
Scientists aren’t sure if brain changes during adolescence
lead to depression, but they’ve identified possible sources
for the moodiness and rash behaviors that can become
pathological.
Frontal lobe: This region, which governs rationality, stays
underdeveloped throughout the teen years, possibly limiting
judgment skills.
Amygdala: Compared with adults, teens rely heavily on this
emotional center when making some decisions. This may lead to
impulsiveness.
Pituitary gland: Sex hormones released during puberty help
explain the intensity of teen emotions and may spark more
serious mood disorders.
FINDING HELP
And finding the right help can be as difficult as
identifying the kids who need help. There are currently only
about 7,000 child and adolescent psychiatrists around the
country, far fewer than most mental-health experts say is
required. The shortage is most acute in low-income areas and
there are severe consequences in communities with more than
enough traumatic circumstances to trigger a major depression.
At the age of 13, Jonathan Haynes of San Antonio was clearly
on a dangerous path. His parents, both crack addicts, were
homeless—a major risk factor for depression. Haynes did what
he says was necessary to survive: sold crack himself, and
broke into houses and cars. But his life began to improve in
the most unlikely place: jail. In 1999, his parents, by then
drug-free, encouraged him to get help. Still high from the
marijuana he had smoked that day, Haynes turned himself in to
police. At Southton, the county’s maximum-security facility
for juveniles, he was diagnosed and prescribed
antidepressants. Now 18, Haynes works as a cook and lives with
his family on San Antonio’s East Side. “I got my priorities
straight,” he says. “I gotta stay strong. I got strong
parents. That helps. Ever since I got out of Southton, I’ve
been off the streets.”
In his case, it seems clear that traumatic family events
contributed to his illness. But more often the trigger for
adolescent depression is not so obvious. Scientists are
studying a combination of factors, both internal and external.
The hormonal surges of puberty have long been shown to affect
moods, but now new research says that changes in brain
structure may also play a role. During adolescence, the
brain’s gray matter is gradually “pruned,” and unused
brain-cell connections are cleared out, creating superhighways
that allow us as adults to focus and learn things more deeply,
says Dr. Harold Koplewicz, author of “More Than Moody:
Recognizing and Treating Adolescent Depression.” The link
between this brain activity and depression isn’t clear, but
Koplewicz says the pruning happens between the ages of 14 and
17, when rates of psychiatric disorders increase
significantly.
Scientists also believe that there’s a genetic predisposition
to depression. “The closer your connection to a depressed
family member—a depressed father rather than a depressed
uncle, for example—the greater an individual’s likelihood of
suffering depression,” says John Mann, chief of the department
of neuroscience at Columbia University. Negative experiences,
such as growing up in an abusive home or witnessing violence,
increases the probability of a depressive episode in kids who
are at risk. Doctors around the country reported an influx of
young patients after last year’s terrorist attacks, although
it’s too soon to tell whether this will translate into
significantly higher numbers of youngsters diagnosed with
major depression. Lisa Meier, a clinical psychologist in
Rockville, Md., a Washington, D.C., suburb, says the attacks
made many kids’ worst fears seem all too real. “Prior to
September 11, if a child said they were afraid a bomb would
drop on their house, that was very clinically significant,
because it was an atypical fear,” Meier says. “It’s not
atypical anymore.”
TRIAL-AND-ERROR THERAPY
Many depressed adolescents have a long history of trouble,
which often includes misdiagnosis and a lot of trial-and-error
therapy that can aggravate the social and emotional problems
caused by the depression. Morgan Willenbring, 17, of St. Paul,
Minn., has suffered from depression since he was 8, but school
officials first thought he had attention-deficit disorder. “I
think that’s because they see that a lot,” says his mother,
Kate Meyers. “They tend to lump together what they see as
acting-out behavior.” It took more than two years to figure
out a good treatment regimen. Desipramine, one of the older
antidepressants, didn’t work. Then Willenbring spent six years
on Wellbutrin, which was effective but problematical because
he needed to take it three times a day. “It’s very easy to
forget, which was not helping,” he says. When he missed too
many doses, he had trouble concentrating and got into fights
at home. But a month ago he switched to a once-a-day drug
called Celexa and says he’s doing better. He even managed to
get through breaking up with his longtime girlfriend without
missing a day of school.
The results of the NIMH study may help make life easier for
youngsters like Willenbring. The lead researcher, Dr. John
March, a professor of child psychiatry at Duke University,
says there is already evidence from other studies supporting
short-term behavioral therapy and drugs like Prozac and Paxil.
But that regimen works only in about 60 percent of cases, and
almost half of those patients relapse within a year of
stopping treatment. “We’re hoping [the study] will tell us
which treatment is best for each set of symptoms,” March says,
“and whether the severity of symptoms biases you toward one
treatment or another.”
Until the results of that study and others are in, parents and
teenagers have to weigh the risk of medication against the
very real dangers of ignoring the illness. A recent report
from the Centers for Disease Control found that 19 percent of
high-school students had suicidal thoughts and more than 2
million of them actually began planning to take their own
lives. One of them was Gabrielle Cryan. In 1999, during her
junior year at a New York City high school, “I obsessed about
death,” she says. “I talked about it with everyone.” With her
parents’ help, she found a therapist just before the start of
her senior year who “put a name to what I’d been feeling,”
says Cryan. “My therapist made me realize it, face it and get
over it.” She also received a prescription for Prozac.
Although she had some hesitations about Prozac, “it really did
help me,” she says. So did the talk therapy. “The first part
of the healing process—and I know this sounds corny—was
becoming more self-aware,” she says.
The therapy helped her see that “everything was not a
black-and-white situation.” Before therapy, little things
would throw her into a funk. “I couldn’t find my shoe and the
whole week was ruined,” she says now with a laugh. “They
taught me to get some perspective.” And while her depression
now is “nonexistent,” she knows that she may have to face it
again in the future. “We’re all a work in progress,” Cryan
says. “But I’ve picked up a lot of tools. When I feel symptoms
coming on, I can reach out and help myself now.” Stories like
hers are the successes that lead others out of the darkness.
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