Oct. 12--Yet the view persists that adolescents are somehow immune to the debilitating clinical depression that afflicts many adults. And such carefree-days-of-youth thinking on the part of some parents and caregivers can yield tragic results.
Teen suicides, which had been on a downward trajectory for the previous two decades, showed an 18 percent rise in 2004 over the previous year, according to a recent report by Journal of the American Medical Association. Although the rate dipped slightly in 2005, the most recent year charted, the number remains well above predicted levels.
As for depression, the World Health Organization reports that one in 33 children and, among them, one in eight teens, is clinically depressed. The organization predicts those numbers could double by 2020.
Those are sobering figures. But they are hardly surprising to child psychiatrists, loved ones of teen suicide victims and teens themselves. To wit:
--Dr. James Margolis, a pediatric psychiatrist and medical director of the Sutter Counseling Center in Sacramento: "Parents tend not to take kids' problems seriously. Breaking up with a girlfriend, doing poorly in school -- these mean the world to teens. They are what I call developmentally nearsighted and have a myopic view of reality. Parents need to validate those feelings."
--Chris Bunnell of Auburn, a suicide crisis hotline organizer whose son, Tracy, took his life in 1991: "Ever since I lost my son, I tell people that even if (a teen) mentions just once that 'I'm going kill myself,' don't take it lightly. You need to listen to them and address it more openly."
--Karrie Beeman, 19, whose brother Christopher committed suicide in Auburn in 2004: "I think everyone feels that way sometimes, when you're in the moment and have no options, no way out. You need someone to talk to. But I don't think guys, especially, feel comfortable doing that. You need to know this is normal. You're not alone."
Indeed, for depressed adolescents, those halcyon days of youth can be a cruel promise unfulfilled. Teen years, to them, represent a time of anguish and despair.
Just last month, a student at Sacramento's Mira Loma High School excused himself from class about 10:15 a.m., walked into a restroom and shot himself. It was his 17th birthday. He died the next day. The suicide garnered local media attention because the school was put on lockdown. (Normally, media outlets do not report suicides, fearing that doing so may spawn more attempts.)
Nevada County has reported 24 suicides in the past 12 months. Not all involved adolescents, but enough did to spur Gail Beeman, Christopher's mother, to push for awareness programs in schools. Nevada Union High School was the first to hold one, in late September.
"It's going to continue to get worse unless we deal with it in an open environment," Gail Beeman says. "Let's get rid of that stigma about therapy and antidepressants. And let's teach these kids coping skills."
Experts, for their part, continue to debate the reasons for the spike in suicides.
Some medical professionals, including the National Mental Health Association, blame the effect of the "black box" warning that the U.S. Food and Drug Administration put on antidepressants in 2004, the year before suicide rates rose precipitously. The warning stemmed from several reported cases in which antidepressants were said to have brought on teen suicides.
"It's tough to say that conclusively," says Dr. Robert Hendren, executive director of the University of California, Davis, M.I.N.D. Institute and chief of child psychiatry for the UC Davis School of Medicine. "Sometimes (teen suicide) can fluctuate along with substance abuse. And that JAMA report shows there was an increase in substance abuse. But some might wonder if kids are using substances to self-medicate if they are depressed."
But Hendren and Sutter's Margolis are unequivocal about the benefits of antidepressants.
"Since those warnings came out, we've seen almost a 50 percent decline in primary physicians (prescribing) the drugs," Margolis says. "We're trying to educate physicians that many studies show that antidepressants are overwhelmingly effective for teens.
"They work in seven in 10 cases. They might not work for bipolar patients and those with anger and personality disorders. And maybe, for one depressed (teen), it might not show positive results. But that leaves seven of 10 helped significantly by these drugs."
Hendren says it's not necessarily a bad thing that primary-care physicians think twice before prescribing Prozac and other antidepressants.
"No doubt, (drugs) make a big difference in adolescent depression and prevent suicides," he says. "But a patient needs to be adequately monitored. Perhaps the advantage of the black-box warning was it gave people pause to say, 'This isn't to say it's like telling someone to take two aspirin and call me in the morning.' "
Karrie Beeman was 15 and grieving over her brother's death when she went on antidepressants. She said it made a huge difference in her state of mind and coping skills.
"The best way I can describe being depressed is that you don't feel like you're on earth," she says. "You're floating above, watching everything. When I went on antidepressants, I could actually participate in class discussions and didn't feel like I was just sitting there watching my life go by. I was back in my life."
Medication alone, however, is not sufficient in helping troubled teens.
Traditional talk therapy or even informal peer or parental communication helps, experts say. Parents and even therapists can often miss signs of oncoming depression, especially with adolescents who tend not to share their feelings.
"Sometimes people say (that) to be depressed, you have to look depressed and say you feel depressed," Hendren says. "Most children and adolescents don't say that. They're more likely to be irritable or withdrawn. Parents can begin to get concerned for those reasons.
"But many times, you ask a teen: 'Are you feeling down?' They'll say 'Not really' -- either because they don't know how to label it or because they don't want to admit that, whereas a depressed adult would be more likely to mention it."
For instance, sleep patterns among depressed teens differ from those of depressed adults, Hendren says. "They have more trouble falling asleep or staying asleep rather than sleeping too much," Hendren says. "Other times, they might have physical symptoms and come in with their first complaint being a headache or stomachache. Then one has to look beneath the surface."
Parental awareness is a first step. Gail and Steve Beeman said they felt guilty after their son Christopher -- by all accounts a happy, successful freshman at Sierra College -- jumped off the Foresthill Bridge following a series of events that included losing his driver's license for an alcohol-related offense and breaking up with his girlfriend.
"I was an old-school, 'just walk it off, get over it' type of guy," Steve Beeman says. "I realized I wasn't as sympathetic or knowledgable to see some of these things. To parents, suicide is a bad thing. You don't want to talk about it, so we parents need education to talk about it with kids and talk to other parents about it."
The Beemans' daughter, Karrie, now a sophomore at UC Santa Barbara, said her six months of antidepressants and talk therapy helped. She says her peers need to get over the stigma of depression.
"Kids need to know you're not a weaker person to stand up and seek help," she says.
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