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, its getting easier to spotand 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 didnt stop the
overwhelming sense of hopelessness
that enveloped her in ninth grade. It was
like a cloud that followed
me everywhere, she says. I couldnt 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 finda 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.
Briannes father, Alan,
shudders when he remembers that advice. Mental illness
is a closet problem in this
country, and its got to come out, he says. With a
schizophrenic brother and
a cousin who committed suicide, Alan thinks he should
have known better. Instead,
Briannes 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 shes
on track. A sophomore at James Madison University in
Virginia, shes on the deans
list, has a boyfriend and hopes to spend a
semester in Australiaa
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: HBOs 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 suicidenow 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 youve already completed
your education and you have
more resources and coping skills. If it happens at
11, theres still a lot
you need to learn, and you may never learn it. Early
untreated depression also
increases a youngsters 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 regimensProzac, talk therapy or some
combinationwork 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 theres 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 testedlike
Prozac and Paxilare 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 kidsteachers, coaches
and pediatricianscan misread symptoms. On college
campuses, experts say, cases
of depression are too often misdiagnosed as
mononucleosis or chronic-fatigue
syndrome. Thats 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 its only the overt
troublemakersdisruptive
or violent kidswho get any attention. In most cases,
if a child is doing adequately
in school, is getting decent grades, but seems a
little depressed, theres
a great likelihood that the child wont 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 homelessa
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 countys
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
Antonios 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, Ive
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
brains 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 isnt 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 theres a genetic predisposition to
depression. The closer
your connection to a depressed family membera depressed
father rather than a depressed
uncle, for examplethe greater an individuals
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 years terrorist attacks, although its
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. Its 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 thats
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, didnt
work. Then Willenbring spent six years on Wellbutrin,
which was effective but
problematical because he needed to take it three times a
day. Its 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 hes 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. Were 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
Id 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 processand I
know this sounds cornywas
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 couldnt 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. Were all a work in progress,
Cryan says. But Ive 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
Arthur Magazine 