Tips for Parents

About Jeremy	Warning Signs of Teen Depression	What Parents Can Do
Where To Turn	When A Teenager Is Sad... Pay Attention	*Helpful Links*
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Jeremy did not have to die!
On 29 April 2002 we lost Jeremy, our 18-year old son, to his own hand. He seemed to have everything going for him and his taking of his young life - the thing of greatest value and potential - came out of the blue for everyone. It wasn't because we, his parents, were unobservant or unresponsive. (There was some history of depression in the family and we are both in the medical profession.) We consistently watched both Jeremy and his brother for signs of emotional problems - even picking up ADD in his brother at an early age. However, Jeremy exhibited none of the then-current signs of teen-age mental instability or depression published by the American Association of Pediatrics - in fact even after his death those criteria still do not apply to Jeremy. His impressive athletic performance, outstanding academic achievements, and cordial interactions with both friends and family gave the appearance of a normal kid and young adult who had a solid grasp on his life. We had done the usual parent things...talking of alcohol, drugs, safe sex, compassion to others, rules of the game, survival - at sea, in the woods or mountains, and on the road. However, because it is perhaps a parent's greatest fear, we never discussed suicide nor the meaning and value of life in the big picture. Apparently, he was silently depressed (never a mention of his feelings) and likely not thinking rationally when in a fit of depression he made a flawed and fatal decision. *The following article (When a Teenager is Sad...Pay Attention) by Dianne Hales and Dr. Robert E. Hales appeared nationwide in* Parade on May 5, 2002 - the day following Jeremy's funeral. The two mentioned individuals fortunately survived; Jeremy did not. In retrospect, Jeremy met several of the listed Warning Signs of Teen Depression, too late to change a tragic sequence of events. For this reason, this outstanding article is reprinted here.

When A Teenager Is Sad... Pay Attention		By Dianne Hales and Dr. Robert E. Hales
Up to 8 percent if American adolescents are seriously depressed, but most parents don't recognize the signs.		Teenagers are notoriously moody but frequently hide feelings of sadness. Keep channels of communication open and listen closely to what your child is telling you.
Jeremy Ö Ö Ö Ö	Warning Signs of Teen Depression MOOD CHANGES, including feeling sad, irritable, becoming easily angered or having difficulty getting along with family members. LOSS OF INTEREST in hobbies, sports or social activities. LACK OF ENJOYMENT, even when involved in an activity previously enjoyed. CHANGES IN SLEEP PATTERNS, such as difficulty falling asleep or staying asleep. CHANGES IN APPETITE - gaining or losing weight. CHANGES IN ENERGY LEVELS, such as frequent fatigue, restlessness or agitation. SCHOOL DIFFICULTIES, including problems concentrating or a decline in grades. SELF-CRITICISM, even taking blame for things that are not really their fault.	What Parents Can Do TALK WITH YOUR CHILD and let him or her know you care and want to help. Don't assume that a teen's moodiness is "just a phase." HAVE YOUR TEEN SCREENED FOR DEPRESSION. You can get information from a school counselor or pediatrician. GET PROFESSIONAL HELP EARLY. The sooner teen depression is treated, the better. LOCK UP that may be deadly-or don't keep them around at all. REMOVE ALL GUNS, including hunting rifles, from the home. MAKE SURE YOUR CHILD'S TREATMENT IS UP-TO-DATE and that his or her therapist is aware of the most effective approaches. ADDRESS THE DANGERS OF ALCOHOL AND ILLEGAL DRUGS, explaining to teems that they are especially vulnerable.
When A Teenager Is Sad...Pay Attention By Dianne Hales and Dr. Robert E. Hales
Zoe Maldonado's world started to fall apart in 1996, when she was 13. Growing up in Manhattan, Zoe was constantly teased by classmates, but she was always able to turn to her grandmother. Then her beloved grandmother died of cancer a few weeks before Zoe began high school. "It destroyed me," recalls Zoe. More traumas followed: A boy she considered a friend raped her, she says, and two of her uncles died within a short time. "I wanted to crawl under a rock," she says. "I went from a B student to an F student. I lost weight. I kept trying to hurt myself. I didn't see any point in living anymore." In Zoe's junior year, a teacher at her school committed suicide. "I broke down," she says. "I went to the dean of students, who is a psychiatrist, and she talked to me about how I felt." Zoe began treatment with antidepressant medication, individual therapy and family counseling at Columbia-Presbyterian Medical Center. Now 19 and a college sophomore who wants to teach the deaf, she looks back on her high school years as "milestones." "Without those experiences, I might not be the person I am today," Zoe says. "In therapy, I learned to express my feelings, to set goals, to communicate better. My grades improved. So did my social life. I could talk with my mother without fighting. I was able to save myself. Now I want to save others from feeling like I did---all alone in the world." The National Institute of Mental Health estimates that up to 8% of American teenagers suffer from major depression; girls are twice as susceptible as boys. According to a 1999 survey, about 20% of high school students have seriously considered suicide. And every year, about eight to 11 in every 100,000 teens do take their own lives---as many as those who die from all other natural causes combined. "Depression is the most common emotional problem in adolescence and the single greatest risk factor for teen suicide," says Dr. Peter Jensen, a child psychiatrist and director of the Center for the Advancement of Children's Mental Health at Columbia University in New York. Depression is a treatable biological disease characterized by changes in brain chemistry. The greatest challenges for parents are recognizing depression in young people notorious for their moodiness and admitting that their child has a mental disorder. "The knee-jerk reaction is a sense of failure," says Dr. Jensen. "Many people still believe that home and family problems cause depression, but the opposite is true: Depression causes home and family problems." Spotting Depression When he was in high school in the mid-1990s, Ross Szabo of Nazareth, Pa., put on his "happy face" every morning. "I was president of my junior class," says Ross. "I played varsity basketball. I was involved in all sorts of activities. But whenever I was alone, I was crying. I'd wake up crying, and I'd cry myself to sleep at night. And nothing was on my mind more than wanting to die." On a January day in his senior year, Ross played in a basketball game and celebrated his team's victory at an ice cream parlor. That night he tried to kill himself with an overdose of pills. His parents rushed him to a hospital. Like Ross, many depressed teens don't look or act sad. They may hide their tears, snap at parents or burst into angry tirades. Some turn to alcohol or drugs in hopes of feeling better, or become depressed after they start abusing these substances. Many depressed teens drop out of activities and pull away from friends. Their schoolwork suffers; many are labeled as underachievers. One overlooked risk factor is cigarette smoking. According to psychologists at the University of Alabama, depressed teens may smoke to feel better, but nicotine alters brain chemistry and actually can make them feel worse. "I tell parents that if a teenager has problems at school, home or play, the problem may be depression," says Dr. Graham Emslie, professor of psychiatry at the University of Texas Southwestern Medical Center at Dallas. "If there are problems in two of these areas, the youngster probably has depression. With problems in all three, it's almost a certainty." Getting Treatment *Many parents are afraid to ask teens if they've thought about killing themselves*. "They're scared of the answers," says Dr. Miriam Kaufman, author of Overcoming Teen Depression: A Guide for Parents. She advises parents not to panic if teens say they've thought about suicide. "Let them know you understand that they must be in a great deal of emotional pain and assure them that they won't always feel this way." She suggests asking troubled teens to promise they will talk to a parent "in person" before attempting suicide. "This is a promise that teens usually keep," she adds. Most important of all is seeking treatment from a qualified professional. In the last decade, mental-health researchers have learned that 60% to 75% of teens respond to treatment with the medications called SSRIs (antidepressants such as Prozac and Paxil). Studies also have shown that cognitive-behavioral therapy---which focuses on teaching new ways to deal with stress and sadness, such as changing unrealistic or highly negative ways of thinking---can be as effective as medication. "Lots of kids feel empty or lonely or sad every day but don't know why," says Ross Szabo, who recovered with medication and psychotherapy. Now 24, a senior at American University and youth spokesperson for the National Mental Health Awareness Campaign, Ross often speaks to high school students about his experience. "I tell them that depression can happen to anyone---regardless of gender, intelligence or socioeconomic status---and that, with help, they can get through it. I know, because I did."
Where To Turn A NEW TEST is now available nationwide through the Youth Depression Screening Initiative. The test allows kids to hear questions over headphones and respond in complete privacy on laptop computers. The *Center for the Advancement of Children's Mental Health at Columbia University* is working with schools and communities to administer the test and provide treatment, if necessary. For information, contact www.kidsmentalhealth.org. THE NATIONAL MENTAL HEALTH AWARENESS CAMPAIGN provides resources for various mental illnesses at www.nostigma.org. For local referrals, and crisis intervention, call 1-877-495- 0009. THE NATIONAL INSTITUTE OF MENTAL HEALTH has launched the Treatment for Adolescents with Depression Study (TADS) to compare the effectiveness of Prozac, cognitive-behavioral therapy and a combination of both. Visit www.nimh.nih.gov/studies/tads.cfm or call 1-866-458-7425. The consent of one parent is required.
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