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Down Time: Teens and Depression

Thousands of tweens and teens suffer from undiagnosed depression. But as one family learned, facing the problem openly and squarely can change everyone's outlook.
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It was early spring. Alone in the upstairs bathroom, my 12-year-old daughter, Marie*, carefully counted out 15 tablets of acetaminophen. She swallowed the pills, a few at a time, then crept back to her room and slipped under the covers, expecting to fall asleep and not wake up. My wife and I knew her mood had been low, but it never occurred to us that anything this serious could be happening.

Marie had been spotted kissing the boyfriend of one of the "popular" girls. They retaliated by spreading stories that she'd slept with every boy in sixth grade, that she was a slut and that anyone seen with her would come under similar attack. Even her closest friends began to desert her. She didn't confide in her mother or me or anyone else who might have been able to help her.

Luckily, all that happened was she spent the night throwing up. Since she seemed better the next day, we remained unaware, assuming she'd had a minor stomach flu. It wasn't until two weeks later, when my wife stumbled on Marie's diary open in her room, that the full story began to reveal itself.

Not Just a Case of Teen Blues

Marie's suicide attempt, I learned, was not an unusual event. According to the Centers for Disease Control and Prevention (CDC), 15% of high schoolers have seriously considered killing themselves, and 7% say they've tried. Suicide is the third leading cause of death for children 11 to 18.

In most cases, the underlying cause is depression. While all teens will occasionally be sad, angry and gloomy, most survive adolescence without serious harm. But about 11% of kids 13 to 18 grapple with clinical depression, reports the National Institute of Mental Health (NIMH). Boys and girls are at equal risk until puberty, when the rate for girls doubles, for reasons that are not clear.

According to the CDC, only 21% of kids who need mental health evaluations receive them, often because their families don't have health insurance or access to providers, they fear being stigmatized or adults—like Marie's mother and me—fail to recognize the warning signs.

And today's teens are grappling with more worries than ever. UCLA's Higher Education Research Institute recently surveyed kids entering college and discovered that their emotional health level had dropped to record lows, triggered by recession-related money worries and the increased pressure to excel in school.

For vulnerable kids, the normal social complexities of adolescence can provoke a serious episode. That's what happened with Marie. Being bullied was bad enough, but it was depression (diagnosed after she took the acetaminophen) that caused the urge to self-destruct. "At its worst," says Harold Koplewicz, M.D., an adolescent psychiatrist and president of the Child Mind Institute in New York City, "teen depression can seem like adolescent moodiness on steroids."

That makes it hard for parents to distinguish between ordinary angst and a true disorder. Among the symptoms to watch out for, says Judy Garber, Ph.D., a clinical psychologist and researcher at Vanderbilt University in Nashville, are talk of suicide, inability to concentrate, excessive fatigue, slowed movement and a decrease or increase in appetite. The difference between a passing phase and a serious disease is severity and longevity: Exhaustion during exam week isn't cause for concern. Being terribly tired for two weeks or longer might be.

If you suspect depression, schedule an evaluation with a psychologist or psychiatrist specializing in adolescents right away, says Glenn Hirsch, M.D., medical director of the Child Study Center at New York University. "You wouldn't wait for a tiny infection to become raging pneumonia," he says. "Mental illness is no different." Untreated kids are at risk for academic failure and substance abuse—with consequences that may follow them, along with the depression, into adulthood. And put aside any fears that the assessment itself could put suicidal thoughts into a tween's or teen's mind. "There's nothing dangerous about getting your child checked out," says Dr. Hirsch.

The day my wife found Marie's diary we rushed her to a psychiatrist. He recommended hospitalization (the insurance company would authorize only a one-week stay), regular talk therapy sessions and medication. But in one way, at least, I did exactly what Dr. Hirsch warns against. Desperate to keep Marie's disorder private, I closed up, telling no one what our family was going through. What would happen, I worried, if neighbors, friends at school and other parents began to think of Marie as a kid with emotional problems? Would she lose all her friends? Would teachers somehow treat her differently?

In the end, there was no keeping my daughter's situation secret—Marie was missing school and was clearly not herself. But I shouldn't have worried, because openness turned out to be the best possible thing for her and our family. Other parents didn't tell their kids to stay away from Marie, as I feared they would. On the contrary, many were understanding—and a surprising number admitted that their children were grappling with similar problems.

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