April 14, 2004

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Palo Alto Online

The spiral of depression

by Jocelyn Dong

It was an ordinary summer day in Palo Alto when young Julia Brown* took what she hoped would be a fatal overdose of Alleve.

Sixth grade had been miserable. Like many kids entering middle school, she desperately sought acceptance by her peers. Unfortunately, the popular crowd wasn't interested in her company.

"I was trying to grow up in a year, and it wasn't working," she recalled recently.

As winter gave way to spring, Julia felt worse about herself, and even cut and burned herself as a cry for help before her ultimate attempt at ending her life.

Fortunately, she didn't succeed. But the effort got her the medical help she needed to deal with her severe depression. Her alarmed parents quickly admitted their daughter into a mental hospital, where she was prescribed antidepressant medications and psychotherapy.

The issue of teen suicide is especially heartrending in Palo Alto, where two high-school boys have committed suicide in the past 18 months. The parents of one of the teens are suing the makers of Accutane, the acne medicine their son took, alleging the drug prompted him to kill himself.

Depression is a major contributor to suicide, the third leading cause of death among 15-24 years olds, statistics indicate. Among the general population, 19 percent of youth think about suicide at some point. Of kids being treated for depression, 35-50 percent have tried or will try to end their lives. Over the span of a decade, as many as 8 percent succeed.

Depression, anxiety and other psychiatric disorders affect children much in the same way they do adults, according to Dr. Alan J. Rosenthal, child and adolescent psychiatrist with the Palo Alto Medical Foundation. Symptoms can include feelings of hopelessness, persistent sadness, lack of energy, frequent crying, loss of self-esteem, stomachache or headache, difficulty concentrating, extreme changes in sleeping patterns, and thinking or talking about suicide or death.

Like other medical conditions, mental illnesses stem from family history and environmental factors, Rosenthal said.

Dr. Lena Osher, child and adolescent psychiatrist with the Children's Health Council, calls depression "a vicious cycle." Kids who are depressed have trouble thinking sharply and can't study, so they feel badly. Then they have no energy and get even more depressed. For them, she said, the glass is always half empty.

Medication sometimes breaks that cycle. "From that point on, they have the energy to be positive," Osher said. "It helps normalize their interactions with the world."

Patients with milder symptoms may only need psychotherapy and counseling to teach them how to change their lifestyles and manage stress. Sometimes, adjustments should be made to home or school environments.

But people with symptoms that are more severe and interfere with life may need medication, which Osher describes as a "crutch" -- it helps them walk on their own, but it doesn't do the walking for them.

Or as Rosenthal put it, medications provide relief of symptoms, but they are far from magic pills that cure patients of their illnesses. *Names have been changed to protect privacy

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