By Joyce Heid
Becoming a teenager is a big turning point in a child’s life. The door to adulthood has opened. New emotions, social pressures and physical changes are happening so fast, life may seem a blur.
The vast majority of teens handle these changes and pressures extremely well. However, the teen years are also when serious mental illnesses first present themselves. Depression is uncommon in childhood, but during adolescence the prevalence rises to that of adult levels. While rare, suicide—the most severe complication for depression—is the third-leading cause of death for 15- to 24-year-olds in the United States. It is also the sixth-leading cause of death among 5 to 14-year olds.
Suicide attempts are 1000 times more common that suicide and are a significant public health problem. Teens with depression and a previous suicide attempt are at highest risk for completed suicide.
According to the American Foundation for Suicide Prevention, psychiatric illnesses are present in 90 percent of suicide victims. In fact, the number-one cause for suicide is untreated depression. Depressive symptoms such as hopelessness, loneliness and anxiety are key warning signs for depression that need to be taken seriously.
There is good news. Mental illness is treatable, and effective treatment of depression can prevent suicide. Most people with severe depression have some part of themselves that desperately wants to live.
However, depression can make it difficult for them to summon their positive resources and get the help they need. They may feel so boxed in by the pain of their depression that they may be unable to see all the alternatives to solving their problems. For parents, being aware of the signs of depression, keying into the teen’s emotions and seeking professional help are essential to helping him or her reach a path of healing.
Treatment for depression is readily available. The best approaches for teens combine psychotherapy with medication. Controversy specifically has surrounded the use of antidepressants in teens, specifically that the drugs may increase suicidal thoughts.
Dr. John Walkup, of the Johns Hopkins Children’s Center, supports the use of antidepressants to treat teens diagnosed with depression.
“When used in conjunction with talk therapy, antidepressants actually provide teens with the best chance to alleviate their depression and decrease their risk for suicidal thoughts or behavior,” he says.
Until the person with depression and suicidal thoughts is on track in treatment and clearly better, safety must be the number-one concern. Create a safety net, such as relatives, teachers, counselors, clergy, coaches or other adults important in your teen’s life. While many people are afraid of the stigma of depression, mental illness and the word “suicide,” it is best to err on the side of safety. The more support a person considering suicide has, the less isolated he or she will feel.
A Family History
Depression is often hereditary. Many people who have attempted or committed suicide have also had another relative do the same. If your family has a history of depression or mental illness, it is a good idea to develop a solid relationship with a mental health professional even before symptoms develop. If you educate children at a young age that it is okay to reach out for help if they feel isolated, anxious or depressed, they will not feel intimidated or ashamed to reach out for help as they grow older.
Lisa Hurka Covington, founder and president of the locally based group SPEAK (Suicide Prevention Education Awareness for Kids), implores, “It is essential to plant the seed as early as elementary age so children learn coping skills, feel good about themselves and have respect for others.”
In other words, the earlier children learn coping mechanisms and know where to go for support, the better chances they have of breaking the depression chain.
There has been some debate as to whether the Internet is a good tool for finding the support and information needed to prevent suicide.
Covington states, “The Internet has its pros and cons when it comes to suicide. There are websites that can guide young people in a positive direction to seek help if they are in crises by directing them to a suicide or crises hotline that can save their life. But there are also websites that are detrimental, encouraging people of all ages to complete suicide by giving them the methods in detail.”
“Chat rooms are another part of the problem if they are not used in the correct fashion,” she continues. “One suicidal person can talk to another encouraging each other to end their lives. A step further, it can and does lead to suicide pacts of two or more killing themselves at the same time.”
Therefore, Covington strongly encourages parents to be vigilant about their child’s computer use: “Parental guidance is essential when it comes to the Internet. Monitoring children and keeping open communication with them could save their life.”
Teenage girls make more suicide attempts than boys. However, boys are more likely to die by suicide, as they tend to choose more violent methods. If your child or any family member in your home is depressed, go get treatment and, in the meantime while your loved one is getting better, make sure that the home environment is safe—remove or secure all firearms, ropes, pills, kitchen utensils and any other weapons. Keeping the home safe is essential while recovering from depression.
In 2004, Maryland lost 86 young people by suicide. The exact cause of the increase in suicides is unknown. Some have argued that modern life with rapid changes in society, culture and the media (including the Internet) may have undermined the structure of life, leading to increased rates of depression. While none of us would turn back the clock, we have to be sensitive to how some people may not tolerate the rapid changes in how we live.
In the mid-1990s, the rates of completed suicide began to decrease among high-risk teens. It is possible that increased awareness of teen depression, decreased stigma and better prevention methods, including the increased use of antidepressants during that same time period, may account for this good news.
The bottom line is: If someone in your family is struggling with depression, don’t wait until it is too late. Families do not need to feel alone in the struggle against mental illness and the tragedy of suicide. There is no shame in reaching out for help. BC
Hotlines for Help
If you or someone you care about are thinking about suicide, call for help. The National Hopeline Network is available 24 hours a day, seven days a week—call 800-SUICIDE (or 800-784-2433).
The Maryland Crisis Hotline is also available 24 hours a day, seven days a week to offer help with suicide, drug abuse, domestic violence, sex abuse—essentially any crisis that can affect a family or individual. Anyone of any age can call 800-422-0009 for help.
Warning Signs of Suicide
-Threats, direct such as “I want to kill myself,” or indirect such as “Everyone would be better off without me, I won’t be a problem for you much longer…”
-Obsession with death, including poems, drawings or stories about death, or reading about death.
-Dramatic personality changes.
-Decline in school performance, lack of interest and difficulty concentrating.
-Withdrawal from friends and family.
-Change in eating and sleeping habits.
-Irrational, bizarre behavior.
-Drug and alcohol abuse.
-Giving away favorite possessions, throwing away important belongings, cleaning his or her room.
-Becoming suddenly cheerful after a history of depression (often this means he or she has reached a decision).
-Complaining of worthlessness, overwhelming guilt.
For More Information, Contact:
-American Foundation for Suicide Prevention, 120 Wall St., 22nd Floor, New York, N.Y. 10005. Call 888-333-AFSP or 212-363-3500; fax 212-363-6237. Visit website, www.afsp.org; or send an email, email@example.com.
-Suicide Prevention Education Awareness for Kids (SPEAK)/American Foundation for Suicide Prevention (AFSP), Baltimore Chapter, P.O. Box 36802, Baltimore, Md. 21286. Call 410-377-7711. Visit the website, www.speakforthem.org; or send an email, firstname.lastname@example.org.
Warnings Regarding Teens and Antidepressants
The U.S. Food and Drug Administration has recently recommended that antidepressants carry a “black box” warning indicating that the drugs can be associated with increased risk of suicidal ideas or behaviors in children, adolescents and adults.
Dr. John Walkup, of the Johns Hopkins Children’s Center, says, “The risk is small and it is unknown at this time how antidepressants might actually increase suicidal risk. Experts have suggested that some aspects of depression may improve faster than others—people may have more energy, but still feel suicidal. Some have suggested that antidepressants may cause agitation that may lead to increased thoughts of suicide. Or, some who benefit from antidepressant may stop their medication too soon and experience an unanticipated return of depression and suicidal thoughts. In light of this, it is important to work closely with the doctor who will prescribe medication and to understand what the potential benefits and risks really are. Make sure all of your questions are answered and your concerns addressed. Most importantly pay attention early in treatment for signs that treatment is not going as expected. Immediately report any significant side effects or unexpected change in behavior to your doctor.”
“As long as youths taking antidepressants are monitored closely by their physicians, I believe the benefits of antidepressants for depressed teens really outweigh the risks,” continues Walkup. “Antidepressants can be a safe and effective treatment for teens with depression—a common condition that can be devastating if left untreated.”
(Originally published 04/06-Updated 09/08)