Teaching in the Shadow of Teen Depression

By Colman McCarthy

In more than 20 years of high school and college teaching I’ve lost several students to suicide. Each had been depressed, each was on medication, each had a supportive family, each was likeable. For me, and I imagine for all teachers, nothing is more worrisome than having a depressed student while I misread the emotional signals that he or she was ill and in such pain that only self-destruction could ease it.

Could I have intervened? How? What’s the outward difference between a child who is temporarily caught in a mood swing and one who has a complex psychiatric disorder that needs the trained hand of a professional? It isn’t always obvious.

Although treatment options for a child belong, finally, to the parents or parent, one precaution I have taken is to set aside one class early in the semester to remind students of two realities.

First, you can always talk to, or call, someone. Tell them you’re in pain, that you’re afraid and that life’s hills look right now to be too steep to climb. Though hardly a cure, mere communication can be a relief. True, some cries for help get no response, but few children are so alone, at least in the United States, that no one is there to offer help.

Second, no depression is so severe that you are the only person who has ever had it. Others have been as sick, and, not giving up, they came back to full health.

According to the American Psychiatric Association, five percent of the nation’s children are ill with depression. Yet, as certain as that number is, parents of a depressed child face uncertainty on which treatment can work best. And that assumes that the child is cooperative and has the stability to steer through the emotional fogs of adolescence—sleep management, hormonal fluxes, eating disorders, the availability of drugs and sex, performance pressure in school and, the worst add on, living in a dysfunctional family.

Psychiatrists themselves are divided on treatments. Should it be cognitive behavior therapy, interpersonal therapy, psychodynamic therapy, family therapy? Or none of those, but instead medication. Chose one: Prozac, Paxil, Celexa, Zoloft, Wellbutrin, Effexor, Remeron, Serzone, Luvox, Lexapro.. Or should it be a combination of talk therapy and meds: the psychiatrist and/or the pharmacist.

In the background are the profit-seeking drug companies. How ethical are their marketing strategies and how thorough is the reporting of their drug trials?

This summer has seen a run of news stories on children and antidepressants. In early June, the New York Times reported that federal regulators are “scrambling to reassess the effectiveness and safety of antidepressants like Paxil, after British regulators touched off a controversy last year by asking drug companies for unpublished data from antidepressant trials. That data suggested that several antidepressants, including Paxil, might give rise to suicidal thoughts in some young users—a potential problem not revealed in any published studies.”

On August 21, The Washington Pos reported that the Food and Drug Administration “has once again found a connection” linking suicide risks and antidepressants.

Psychiatrists in their offices usually depend on medical journals for the lowdown on drugs, assuming they want to go beyond the hype of gift-bearing pharmaceutical sales people who walk in. Here, too, the journals can be suspect. The Times reported that the June 2004 issue of the American Journal of Psychiatry told of the effectiveness of Celexa: “But neither the article nor the 27 scholarly footnotes that accompanied it mentioned another major drug-industry sponsored trial completed in 2002, which found that Celexa did not help depressed adolescents any more than a placebo.”

Congress is now involved. Sen. Charles Grassley of Iowa, with oversight authority, is investigating how well the Food and Drug Administration is informing the public of the links between antidepressants and suicide.

Back in the classrooms, we teachers need to be as caring and alert as possible--but having no delusions that that will always be enough.