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Down Time: Teens and Depression

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Hopeless but Not Helpless

In fact, because there are so many kids with untreated mental illness, many experts suggest all teens should undergo a mental health screening, either at school or during yearly physicals. The current method favored by professionals, TeenScreen, was developed by David Shaffer, professor of psychiatry at Columbia University in New York. The simple questionnaire, which takes kids about five minutes to fill out, doesn't result in a diagnosis but does identify teens who require further evaluation. (Go to teenscreen.org for more information.)

For children who need help, the most effective treatment is a combination of talk therapy and medication. A major study by the NIMH found that teens given a combination of Prozac and cognitive behavior therapy (CBT) recovered faster than those receiving therapy alone. "The idea is to teach kids they can change their moods by changing their thoughts," says Dr. Koplewicz. "They learn to give more positive interpretations of situations and relationships." He gives an example: A depressed tween or teen who sees someone frowning, immediately concludes, "He's angry at me," and she feels bad. CBT helps her explain the situation to herself differently, to think instead, "He's probably just having a bad day," and not take the scowl personally.

The use of antidepressants in teens does raise concerns. The NIMH study found that 15% of the teens taking Prozac alone had suicidal thoughts, versus 6% of the teens not on medication. But the use of CBT with antidepressants provides safeguards against the risk of suicide, the study suggests. The research has unfortunately been misinterpreted, with some concluding that antidepressants shouldn't be used at all for kids, says Lia Gaggino, M.D., mental health chair of the Michigan chapter of the American Academy of Pediatrics. "You have to realize the study didn't measure what would have happened with no treatment at all," she says. "When doctors and parents got scared and stopped using the medication, suicide rates actually went up slightly." The NIMH research also found that continuing treatment is the linchpin of long-term recovery from depression, though it remains unclear exactly how long active intervention should go on.

My daughter's teen years were marked by more ups and downs, including a period when she decided to go off her medication. She had been forewarned by her doctors that this could cause serious withdrawal symptoms and should be done only under medical supervision, but she went ahead anyway, without anyone's knowledge. Six months later she came to me feeling emotionally rocky and asked to start taking antidepressants again.

Now a college student, Marie hasn't had an episode of depression for several years. She seemed to grow stronger as she got older, which is fairly common. I've been told by other parents that their children also improved as they made the transition from adolescence to adulthood. Families should not assume kids will automatically outgrow depression, however. "You have to catch mental illness early and treat it correctly," says Dr. Hirsch. "The point is to address the current symptoms and give kids the skills they need to better handle their lives going forward."

Marie will always be at risk, yet she is doing so much better now that I no longer wake in a panic about where she is and what she's doing. People sometimes want to know what her mother and I did to pull her through. I tell them Marie deserves all the credit. She's the one who bravely hung in there, facing her demons and making the good choices that give us all hope of a bright future for her.

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