NAMI NORTH CAROLINA

Brain biology:

      ·        Probably many forms and causes, multiple genes.
·        Overall, decreased brain activity; abnormal limbic activity.
·        Serotonin and norepinephrine neurotransmitter systems have lower-than-normal activity.
·        Childhood-onset depression tends to be more continuous and/or recurrent than adult-onset.   
·        Low nerve growth factor; high cortisol (stress hormone) in many cases.
·        Prevalence of Major Depression:  teens – at least 5 per cent; children – at least 3 per cent. 
·        Dysthymia – a less acute, more chronic form of depression – prevalence at least 3 per cent in teens.

 Treatment: 

        ·         For mild-to-moderate depression, psychotherapy alone may suffice.
·         For major depression, medication combined with cognitive behavioral therapy is most effective.
·         Every episode makes further episodes more likely, so prompt treatment improves the long-range course of the illness.
·         Rule out other possible medical causes of symptoms (anemia, mononucleosis, thyroid problem, etc.) before treating for depression.
·         Ask the doctor to consider whether the diagnosis could be bipolar disorder before prescribing antidepressants, which may trigger mania.
·         If antidepressants are prescribed, the youth must be carefully monitored for suicidal thinking, manic symptoms, and/or other serious symptoms. 

 Classroom applications:

        ·         Achievement increases self-esteem; insure the student has chances to achieve, even at his/her lower energy level and reduced ability to concentrate. 
·         Eliminate less important work until the student is in recovery.
·         Avoid chastising the student or calling him/her “lazy.” 
·         The student may have increased physical complaints, resulting in frequent absences.
·         Collaborate with parents and treatment providers for a unified approach.
·         Take talk of suicide seriously.  (See “Suicide” on page 2 of this fact sheet.)
·         Advocate for school-based depression screening and intervention for all teens.

Advice for parents/care givers

        ·         Read first-person accounts to gain empathy (e.g. Darkness Visible by William Styron.)
·         Consult mental health professional immediately if there is talk of suicide or runaway.
·         Prompt treatment makes substance-use less likely.

 Books for children and teens:

        ·         Kid Power Tactics for Dealing with Depression by Nicholas Dubuque.
·         Recovering from Depression:  A Workbook for Teens, by Mary Ellen Copeland, Stuart Copans.

 Video for Teens: 

·         Day for Night: Recognizing Teenage Depression, produced by Johns Hopkins University for the Depression & Related Affective Disorders Association, www.drada.org or call 410-583-2919.

 Book for teachers and parents:

·         "Help Me, I'm Sad": Recognizing, Treating, and Preventing Childhood and Adolescent Depression, by David G. Fassler, Lynne S. Dumas
 

Suicide 

“Suicide is a fatal complication of untreated mental illness.” –David Shaffer, M.D., teen suicide researcher, New York Psychiatric Institute  

Note:  Copy cat suicide is a risk among teens.  Rates increase following television dramas and newspaper coverage of suicide.  School-wide education programs, while well-meaning, may actually increase risk, especially among those students who have already attempted suicide.   

      ·        At least 90% of teens who kill themselves have a psychiatric disorder.  Depression, bipolar disorder (manic-depression), anxiety disorders, schizophrenia, and eating disorders all dramatically increase risk for suicide.
·        Suicide may be triggered by a life event, but it has been building over a long period of time.  When associated with severe depression, it is an attempt to end the unbearable pain of living.
·        The biggest risk factor for suicide is a previous attempt.  Substance use increases risk.
·        Suicide is preventable. 

 ·        Warning signs:

  o       Symptoms of depression
o       Speaks of being bad, feeling worthless
o       Verbal hints (“I’d rather be dead.” “You won’t have to worry about me much longer.”)
o       Gives away favorite possessions, cleans room, throws away treasured belongings
o       Suddenly cheerful after being depressed
o       Hallucinations or bizarre thoughts 

·        While treatment dramatically lowers risk, there is an increased risk increases just after treatment begins.  The person may feel enough better to complete previously-made plans before the treatment takes full effect.  Monitor closely.

·        If you suspect a student is thinking about suicide, contact parents, and refer to a qualified mental health professional.  If the risk seems imminent, the student should be seen immediately at a hospital emergency room.