YOUNG, AMERICAN AND DEPRESSED

12 OCTOBER 2002: YOUNG,
AMERICAN AND DEPRESSED


Cover
feature of Newsweek’s Oct 7 issue
:

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

Oct. 7 issue ˜  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 ŒEPIDEMIC‚?

      
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.

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.‰

 Gabrielle Cryan, now
19, got her first Prozac prescription when she was a high


school senior

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.

——————————————————————————–

With Brian Braiker in Boston,
Karen Springen in Chicago and Ellise Pierce in


Dallas