Board of Contributors: Some therapist (and mom) thoughts on adolescent depression | June 12, 2009 | Palo Alto Weekly | Palo Alto Online |

Palo Alto Weekly

Spectrum - June 12, 2009

Board of Contributors: Some therapist (and mom) thoughts on adolescent depression

by Elizabeth Lee

Since my kids have been in Palo Alto schools, four teens have committed suicide on the train tracks, and one more attempted it. Suicide nationally is the third leading cause of death among adolescents.

Suicide is frequently caused by depression, which in young persons can be especially acute. Symptoms are feelings of sadness or emptiness for most of the day nearly every day (or a persistent irritable mood in children or adolescents). Symptoms can include loss of pleasure, increased or decreased appetite, disruptions in sleep patterns, restlessness or sluggishness, fatigue, feelings of worthlessness, and excessive or inappropriate guilt.

Depression can contribute to lack of concentration (resulting in bad grades) or indecisiveness, thoughts of death, or suicidal ideation — with or without a plan.

All symptoms may be either subjective and internal or observable by others. The depressed young person may confide in some friends or family members but hide the depression from the rest of the world. Some hide it from everyone.

Clues that someone is depressed or suicidal may be subtle. Some young persons may make comments such as, "I don't see how I can go on. ..." or more obvious comments such as, "If this happens again I'll kill myself." Such comments can easily be dismissed as adolescent angst, the kind of things kids say but don't really mean. But they should be taken seriously.

If you know a teen who either exhibits depressive symptoms or makes such comments, the following "risk assessment" tips may save a life: Ask if the young person feels like killing himself or herself. Contrary to what some people fear, asking that won't make a non-suicidal person suicidal. If the response is affirmative, ask if they have a plan. If they don't have a plan, they are at low risk. If they have a plan but lack the means to carry it out, they are at moderate risk. If they have a plan and the means to carry it out, they are at high risk and must be helped immediately.

At-risk teens can be helped in the following ways. If they are at high risk, it is safest to call 911 and have them hospitalized immediately. They must be supervised at all times.

For teens at any risk level, write up a "no suicide" contract for a specific time period and have them and anyone else in the family sign it. Check in with the teen and renew the contract regularly. If they are at moderate or high risk and refuse to sign it, their suicide risk is greater. If they have a history of past attempts or gestures, their risk is increased.

Mobilize their coping strategies and support systems. Include on the contract specific people whom they agree to call if they have the impulse to hurt themselves. Contacts can be family, friends, a therapist, a school counselor, clergy or even a suicide hotline, or any other resources. The more "cared about" young people feel the safer they are.

The signs can be subtle. People who decide to kill themselves may feel relieved that their pain will soon be over. They may give away special possessions.

They may seem full of life. I worked in a halfway house for severely emotionally disturbed adults, and a depressed teen often laughed hilariously with the other residents during dinner. She doesn't seem depressed, I thought. Yet the same young woman was grounded to the house for being a high suicide risk and refusing to sign a no-suicide contract.

Suicidal impulses for teens can be triggered suddenly. Teens are often "present" rather than future-oriented and are less able to understand that what seems horrible now will pass and will not ruin their lives. Academic or family problems, breaking up with a romantic partner or close friend, bullying, sexual assault, or sexual-orientation or gender identity issues can put kids at extra risk.

For years I've kept a list of crisis and suicide hotline numbers on our fridge.

"If you ever feel liked hurting yourself and don't feel you can come to me or anyone else, call these numbers and get help," I told my son.

Try to be someone to whom the kids in your life can talk. All it takes is being a compassionate, non-judgmental listener. Can your kids confide in you if they're bullied or sexually harassed, or if they get a bad grade? How about if they're having sex, or if they're gay? If they can confide in you about other things, they're more likely to confide if they're feeling depressed, or suicidal.

I share the concerns of many parents that our kids are under too much academic stress. I was the parent-network coordinator when my son was in 10th grade at Paly. The parents at network meetings fell into two categories. One group talked about their kids' success in academics, sports and music. The rest of us who had kids with special needs, myself included, became quiet during those discussions.

One day a dad with a special-needs kid showed up, and he and I talked.

"What does it matter if they don't do well in high school anyway?" he asked. "I mean, it's not the end of the world. We've just got to realize that there are more important things in life than school." Of everything said in those meetings, I remember his words the most.

Whatever the reason(s) for a teen suicide, it's usually useless to assign blame. If people knew, of course they would have helped. By knowing the signs of depression and risk, we're better equipped to intervene. Otherwise, the best we can do is to help our kids be happy with who they are.

Here are some numbers from my fridge: National Crisis Hotline: 1-800-SUICIDE; National Suicide Prevention Lifeline: 1-800-273-TALK, TTY Number 1-800-799-4TTY; Suicide and Crisis Service Hotline, Palo Alto: 650-494-8420.

Elizabeth Lee is a licensed marriage and family therapist, a writer, and a member of the Weekly's Board of Contributors. She lives in Palo Alto with her husband, two children and a dog and can be e-mailed at


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