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

Eric Suarez, 17, who suffers from bipolar disorder, takes nine medications daily to treat his depression-some for the symptoms and others to combat the side effects of those drugs.

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 ‘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.

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.

Jonathan Haynes was diagnosed with depression while in jail for dealing drugs. Now 18, he works as a cook and lives with his family on San Antonio’s East Side

       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.

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
       
       © 2002 Newsweek, Inc.