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Coping with depression among children.

In 23 years of high school 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 misread the emotional signals that a student was ill and in such pain that only serf-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 someone. Tell them you're in pain, that you're afraid and that life's hills right now look 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 the ailment, and, not giving up, they came back to full health.

According to the American Psychiatric Association, 5 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 behavioral therapy, interpersonal therapy, psychodynamic therapy, family therapy? Or none of those, but medication instead? Choose one: Prozac, Paxil, Celexa, Zoloft, Wellbutrin, Effexor, Remeron, Serzone, Luvox, Lexapro. Or should it be a combination of talk therapy and meds, the psychiatrist or the pharmacist?

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

The New York state attorney general recently sued Paxil's maker, GlaxoSmithKline, charging consumer fraud for not disclosing negative data about the antidepressant.

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 salespeople 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 also 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 classroom, we teachers need to be as caring and alert as possible--while having no delusions that that will always be enough.

[Colman McCarthy directs the Center for Teaching Peace in Washington.]
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Title Annotation:Columns
Author:McCarthy, Colman
Publication:National Catholic Reporter
Geographic Code:1USA
Date:Sep 17, 2004
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