Sue Scheff: Mistreated Depression

Source: Connect with Kids

“Basically, psychiatrists are pretty busy. They don’t want to spend a lot of time with people. They want to get people in and out, maybe two or three an hour. … It pays better to do that than spending an hour doing psychotherapy.”

– David Gore, Ph.D., clinical psychologist

Fifteen-year-old Sarah McMenamin suffers from depression. It started a year ago with the death of her father.

“I was just like, ‘I just want to die,’” she says, describing her feeling before seeing a therapist. “I would never kill myself, but I just wish I was dead, I just wish I was never going to wake up.”

For depressed teens, experts at the American Academy of Child and Adolescent Psychiatry say what can help is medicine – combined with talk therapy.

“I think the therapist helped me,” explains Sarah, “’cause it was talking, you know, I got it out. I didn’t bottle everything up.”

“The advantage to getting some therapy along with medication is that you get to the root of the problem,” explains Dr. David Gore, clinical psychologist. “You get to see why you’re feeling that way. And if you start understanding why you’re feeling that way, chances are pretty good you’ll stop feeling that way.”

But according to a new study from Thomson-Reuters, more teens than ever are getting medication without psychotherapy. Why? Gore has an answer.

“Basically, psychiatrists are pretty busy,” Dr. Gore says. “They don’t want to spend a lot of time with people. They want to get people in and out, maybe two or three an hour. … It pays better to do that than spending an hour doing psychotherapy.”

Three months ago, Sarah started seeing a new doctor.

“Right away he put me on Zoloft,” she says. “He didn’t even know me for an hour and he put me on it.”

But psychologists say medicine alone just won’t work as well.

“You take your pill, you’ll get some immediate relief,” explains Dr. Gore, “but the problem’s going to crop up again in two months or four months or six months. You’ve got to get to the root of the problem.”

Sarah will resume talk therapy again in a few months. She says she is looking forward to it.

“You get it out on the table and you know your feelings’” she says, “and you go in thinking it’s one thing and you come out finding out it’s like 10 different things and you’re like, ‘Wow.’”

Tips for Parents

All teens experience ups and downs. Every day poses a new test of their emotional stability – fighting with a friend, feeling peer pressure to “fit in” with a particular crowd or experiencing anxiety over a failed quiz – all of which can lead to normal feelings of sadness or grief. These feelings are usually brief and subside with time, unlike depression, which is more than feeling blue, sad or down in the dumps once in a while.

According to the Nemours Foundation, depression is a strong mood involving sadness, discouragement, despair or hopelessness that lasts for weeks, months or even longer. It also interferes with a person’s ability to participate in normal activities. Often, depression in teens is overlooked because parents and teachers feel that unhappiness or “moodiness” is typical in young people. They blame hormones or other factors for teens’ feelings of sadness or grief, which leaves many teens undiagnosed and untreated for their illness.

The Mayo Clinic reports that sometimes a stressful life event triggers depression. Other times, it seems to occur spontaneously, with no identifiable specific cause. However, certain risk factors may be associated with developing the disorder. Johns Hopkins University cites the following risk factors for becoming depressed:

Children under stress who have experienced loss or who suffer attention, learning or conduct disorders are more susceptible to depression.
Girls are more likely than boys to develop depression.
Youth, particularly younger children, who develop depression are likely to have a family history of the disorder.
If you suspect that your teen is clinically depressed, it is important to evaluate his or her symptoms and signs as soon as possible. The National Depressive and Manic-Depressive Association cites the following warning signs indicating that your teen may suffer from depression:

Prolonged sadness or unexplained crying spells
Significant changes in appetite and sleep patterns
Irritability, anger, worry, agitation or anxiety
Pessimism or indifference
Loss of energy or persistent lethargy
Feelings of guilt and worthlessness
Inability to concentrate and indecisiveness
Inability to take pleasure in former interests or social withdrawal
Unexplained aches and pains
Recurring thoughts of death or suicide

It is important to acknowledge that teens may experiment with drugs or alcohol or become sexually promiscuous to avoid feelings of depression. According to the National Mental Health Association, teens may also express their depression through other hostile, aggressive, risk-taking behaviors. These behaviors will only lead to new problems, deeper levels of depression and destroyed relationships with friends and family, as well as difficulties with law enforcement or school officials.

The development of newer antidepressant medications and mood-stabilizing drugs in the last 20 years has revolutionized the treatment of depression. According to the Mayo Clinic, medication can relieve the symptoms of depression, and it has become the first line of treatment for most types of the disorder. Psychotherapy may also help teens cope with ongoing problems that trigger or contribute to their depression. A combination of medications and a brief course of psychotherapy are usually effective if a teen suffers from mild to moderate depression. For severely depressed teens, initial treatment usually includes medications. Once they improve, psychotherapy can be more effective.

Immediate treatment of your teen’s depression is crucial. Adolescents and children suffering from depression may turn to suicide if they do not receive proper treatment. Suicide is the third leading cause of death for Americans aged 10-24. The National Association of School Psychologists suggests looking for the following warning signs that may indicate your depressed teen if contemplating suicide:

Suicide notes: Notes or journal entries are a very real sign of danger and should be taken seriously.

Threats: Threats may be direct statements (“I want to die.” “I am going to kill myself”) or, unfortunately, indirect comments (“The world would be better without me.” “Nobody will miss me anyway”). Among teens, indirect clues could be offered through joking or through comments in school assignments, particularly creative writing or artwork.

Previous attempts: If your child or teen has attempted suicide in the past, a greater likelihood that he or she will try again exists. Be very observant of any friends who have tried suicide before.

Depression (helplessness/hopelessness): When symptoms of depression include strong thoughts of helplessness and hopelessness, your teen is possibly at greater risk for suicide. Watch out for behaviors or comments that indicate your teen is feeling overwhelmed by sadness or pessimistic views of his or her future.

“Masked” depression: Sometimes risk-taking behaviors can include acts of aggression, gunplay and alcohol or substance abuse. While your teen does not act “depressed,” his or her behavior suggests that he or she is not concerned about his or her own safety.

Final arrangements: This behavior may take many forms. In adolescents, it might be giving away prized possessions, such as jewelry, clothing, journals or pictures.

Efforts to hurt himself or herself: Self-injury behaviors are warning signs for young children as well as teens. Common self-destructive behaviors include running into traffic, jumping from heights and scratching, cutting or marking his or her body.

Changes in physical habits and appearance: Changes include inability to sleep or sleeping all the time, sudden weight gain or loss and disinterest in appearance or hygiene.

Sudden changes in personality, friends or behaviors: Changes can include withdrawing from friends and family, skipping school or classes, loss of involvement in activities that were once important and avoiding friends.

Plan/method/access: A suicidal child or adolescent may show an increased interest in guns and other weapons, may seem to have increased access to guns, pills, etc., and/or may talk about or hint at a suicide plan. The greater the planning, the greater the potential for suicide.

Death and suicidal themes: These themes might appear in classroom drawings, work samples, journals or homework.

If you suspect suicide, it is important to contact a medical professional immediately. A counselor or psychologist can also help offer additional support.

References
American Academy of Child and Adolescent Psychiatry
American Foundation for Suicidal Prevention
Johns Hopkins University
Mayo Clinic
National Association of School Psychologists
National Depressive and Manic-Depressive Association
National Institute of Mental Health
National Mental Health Association
Nemours Foundation
Thomson-Reuters

Sue Scheff: Teens, Sex and Depression

Source: Connect with Kids

“It hurts, because I care so much about him.”

– Teagan, 15 years old

Fifteen-year-old Teagan says her new boyfriend is wonderful. “I never thought anyone like Preston could come along,” Teagan says. “He’s the greatest guy I’ve ever known.”

But is she as lucky as she thinks?

Studies show that romantic involvement brings adolescents down, rather than up. What’s more, researchers at the University of North Carolina find that teen girls who are sexually active are twice as likely to be depressed compared to girls not having sex.

But, even among abstinent teens who date, one of the problems is trust.

“Say your boyfriend went off to work and never called you that day,” Teagan says. “And you talked every single day on the phone. I mean you’d be kind of concerned and kind of wondering why. And then someone comes along and says ‘well maybe he’s cheating on you…’”

Combine adolescent insecurity with imagination and the result is a lot of questions: Where is he? Why doesn’t she call? Does he really like me? Why is she talking to that other boy?

That’s where most of the stress comes in,” Teagan says. “Getting thoughts in your head about what might be going on, when it probably isn’t going on at all.”

Experts say parents can help ease their child’s pain by listening and taking them seriously. It’s not puppy love to them, it’s real. “It hurts,” Teagan says, “because I care so much about him.”

Experts also advise teaching your child that early relationships may hurt, but they’re indispensable. “They will have many relationships before they finally settle on a life mate,” says Cheryl Benefield, a school counselor. “Let them know that when things happen, it’s maybe just preparing them for a better relationship in the future.”

Tips for Parents
According to the National Institute of Mental Health, boys and girls seem to be equally at risk for depressive disorders during childhood, but during adolescence, girls are twice as likely as boys to develop depression. Family history and stress are listed as factors, but another factor that often causes depression in girls is the break-up of a romantic relationship.

The authors of a study conducted at Cornell University titled “You Don’t Bring Me Anything but Down: Adolescent Romance and Depression,” found that females become “more depressed than males in adolescence partly as a consequence of their involvement in romantic relationships.” The reason? According to the study, “females’ greater vulnerability to romantic involvement explains a large part of the emerging sex difference in depression during adolescence.”

At any given time, five percent of children suffer from depression. Children under stress, who have experienced a loss, or who suffer from other disorders are at a higher risk for depression. Here are some signs of depression from the American Academy of Child and Adolescent Psychiatry (if one or more of these signs of depression persist, parents should seek help):

Frequent sadness, tearfulness, crying
Hopelessness
Decreased interest in activities, or inability to enjoy previously favorite activities
Persistent boredom; low energy
Social isolation, poor communication
Low self-esteem and guilt
Extreme sensitivity to rejection or failure
Increased irritability, anger or hostility
Difficulty with relationships
Frequent complaints of physical illnesses such as headaches and stomachaches
Frequent absences from school or poor performance in school
Poor concentration
A major change in eating and/or sleeping patterns
Talk of or efforts to run away from home
Thoughts or expressions of suicide or self destructive behavior
Getting an early diagnosis and medical treatment are critical for depressed children.

Depression is a serious condition, which, if left untreated, can even become life threatening. Suicide is the third leading cause of death among young people, leading to nearly 4,000 deaths a year. The rate has tripled since 1960. Therapy can help teenagers understand why they are depressed and learn how to handle stressful situations. Treatment may consist of individual, group or family counseling. Medications prescribed by a psychiatrist may be needed to help teens feel better.

Ways of treating depression include:

Psychotherapy: to explore events and feelings that are painful and troubling. Psychotherapy also teaches coping skills.
Cognitive-behavioral therapy: to help teens change negative patterns of thinking and behaving.
Interpersonal therapy: to focus on ways of developing healthier relationships at home and school.
Medication: to relieve some symptoms of depression (often prescribed along with therapy).
References
Journal of Health and Social Behavior
National Institute of Mental Health
American Academy of Child and Adolescent Psychiatry
National Mental Health Association
University of North Carolina

Sue Scheff - Teen Suicide

Suicide is the third most common cause of death amongst adolescents between 15-24 years of age, and the sixth most common cause of death amongst 5-14 year olds. It is estimated that over half of all teens suffering from depression will attempt suicide at least once, and of those teens, roughly seven percent will succeed on the first try. Teenagers are especially vulnerable to the threat of suicide, because in addition to increased stress from school, work and peers, teens are also dealing with hormonal fluctuations that can complicate even the most normal situations.
Because of these social and personal changes, teens are also at higher risk for depression, which can also increase feelings of despair and the desire to commit suicide.

In fact, according to a study by the National Institute of Mental Health (NIMH) almost all people who commit suicide suffer from a diagnosable mental disorder or substance abuse disorder. Often, teens feel as though they have no other way out of their problems, and may not realize that suicidal thoughts and feelings can be treated. Unfortunately, due to the often volatile relationship between teens and their parents, teens may not be as forthcoming about suicidal feelings as parents would hope. The good news is there are many signs parents can watch for in their teen without necessarily needing their teen to open up to them.

At some point in most teens’ lives, they will experience periods of sadness, worry and/or despair. While it is completely normal for a healthy person to have these types of responses to pain resulting from loss, dismissal, or disillusionment, those with serious (often undiagnosed) mental illnesses often experience much more drastic reactions. Many times these severe reactions will leave the teen in despair, and they may feel that there is no end in sight to their suffering. It is at this point that the teen may lose hope, and with the absence of hope comes more depression and the feeling that suicide is the only solution. It isn’t.

Teen girls are statistically twice as likely as their male counterparts to attempt suicide. They tend to turn to drugs (overdosing) or to cut themselves, while boys are traditionally more successful in their suicide attempts because they utilize more lethal methods such as guns and hanging. This method preference makes boys almost four times more successful in committing suicide.

Studies have borne out that suicide rates rise considerably when teens can access firearms in their home. In fact, nearly 60% of suicides committed in the United States that result in immediate death are accomplished with a gun. This is one crucial reason that any gun kept in a home with teens, even if that teen does not display any outward signs of depression, be stored in a locked compartment away from any ammunition. In fact, the ammunition should be stored in a locked compartment as well, and the keys to both the gun and ammunition compartments should be kept in a different area from where normal, everyday keys are kept. Remember to always keep firearms, ammunition, and the keys to the locks containing them, away from kids.Unfortunately, teen suicide is not a rare event.

In the United States, the Centers for Disease Control and Prevention (CDC) estimates that suicide is the third leading cause of death for people between the ages of 15 and 24. This disturbing trend is affecting younger children as well, with suicide rates experiencing dramatic increases in the under-15 age group from 1980 to 1996. Suicide attempts are even more prevalent, though it is difficult to track the exact rates.

Learn more.

Sue Scheff: Getting Teens Talking

Source: Connect with Kids

“You can push too much and that’ll shut the child down. So it’s a fine balance: Be available, be a good listener, and also know when you do need to push in case they’re into some things that they shouldn’t be.”

– Gloria Meaux, Ph.D., psychologist

How much do teenagers tell their parents?

“I hardly share anything with my parents,” says 16-year-old Derek Kelley.

“I share very little with my parents,” says 18-year-old Tyler Wichelhaus.

And Jessie Donaghy gives an example of a question she hates: “How was your day?”

“When you’ve had a horrible day, you just feel like people at school are mad at you,” she says. “Your classes went horribly, you failed a test. It can almost be an insult without them knowing it, because it just seems insensitive.”

Experts say parents are better served asking about something specific: school projects coming up, weekend plans with a friend, or a test that the child may be worried about

“The specific questions, you’ll get more bang for your buck if you want them to communicate back to you than some general question that you could ask a stranger on the street,” says Dr. Meaux.

“Sometimes she’ll be like ‘so how is that situation going with this person’ and I’ll just burst out crying,” says Jessie.

Experts say it starts by being easy to talk to. “You’re sort of the approachable parent, that you listen more than you talk, and listening is the hard thing,” says Dr. Meaux.

And once they truly believe you’re listening, experts say they’ll open up more.

“The more talking they’ll do because they’ll be open,” says Licensed Clinical Social Worker Freddie Wilson. “[They’ll be more open if they feel] you’re open to hearing what I’m saying rather than talking and giving them solutions and solving their problems for them. They want someone to hear them.”

And knowing when your child really needs your ear comes from getting to know your child.

“I’ll look at her and I’ll say ‘You look like you’re down, did something happen?’ Yea. Was it so and so? Yea,” explains Mrs. Donaghy.

“It helps to know that she cares and that she’s actually wanting to know about things,” says Jessie.

Tips for Parents
While the teenage years can be a very frustrating time for parents and teenagers alike, no secret formula exists for talking to teens. But the Harvard School of Public Health’s Parenting Project, which conducted extensive research on parenting teens, found that “significant agreement” exists among experts regarding important basic principles for opening the communication lines.

The project’s most recent report highlights the basics of raising and communicating with your teenagers and includes a list of strategies for each. In the report, Dr. Rae Simpson says parents need to “love and connect” with their teen.

“Teens need parents to develop and maintain a relationship with them that offers support and acceptance,” Dr. Simpson writes, “while accommodating and affirming the teen’s increasing maturity.”

According to the report, you can connect with your teen by following these suggestions:

Watch for moments when you feel and can express genuine affection, respect and appreciation for your teen.
Acknowledge the good times made possible by your teen’s personality and growth.
Expect increased criticism and debate and strengthen your skills for discussing those ideas and disagreements in ways that respect both your teen’s opinions and your own.
Spend time just listening to your teen’s thoughts and feelings about his or her fears, concerns, interests, ideas, perspectives, activities, jobs, schoolwork and relationships.
Treat each teen as a unique individual distinct from siblings, stereotypes, his or her past or your own past.
Appreciate and acknowledge each teen’s new areas of interest, skills, strengths and accomplishments, as well as the positive aspects of adolescence generally, such as its passion, vitality, humor and deepening intellectual thought.

Provide meaningful roles for your teen in the family, ones that are genuinely useful and important to the family’s well being.

Spend time together one-on-one and as a family, continuing some familiar family routines, while also taking advantage of ways in which new activities, such as community volunteering, can offer alternative ways to connect.

By respecting and loving your teenager, you open the lines of communication and build a supportive and trusting environment so that your child feels comfortable opening up to you.

Dr. Simpson offers this key message to parents: “Most things about [your teen’s] world are changing. Don’t let your love be one of them.”

Research has shown that while teenagers want their freedom, they also appreciate their parents showing concern for them and being interested in their daily activities. Experts have listed guidelines for parents to set for their teenagers while still allowing them room to grow.

Monitor what your teen watches on television.
Monitor what your teen does on the Internet.
Put restrictions on the music your teen purchases.
Know where your teen spends his or her time after school and on the weekends.
Expect to be told the truth by your teen about where he or she is going.
Be “very aware” of your teen’s academic performance.
Impose a curfew.
Eat dinner with your teen six or seven nights a week.
Turn off the television during family meals.
Assign your teen regular chores.
By setting some or all of these rules, you will be in control and have a working knowledge of your teen’s activities, while still allowing them to make their own choices and decisions.

References
Bonus Families
Families are Talking
The Media Project
Focus on the Family