Over the last month I've read news stories about young adult suicides with alarming regularity. I'm speaking of the children of celebrities, of course, whose lives and deaths are ultimately narrated by journalists. Most recently, Marie Osmond's teenage son, Michael Blosil, leapt to his death from his apartment building in downtown Los Angeles. Imagine what he saw on the ledge, 15 stories up, peering down through the dark at asphalt and concrete, glancing at moving cars and streetlights and lit-up billboards. And imagine the pain he was experiencing to believe that jumping would bring relief. He was only 18. There's a particular arc to these stories of suicide, and while these privileged young lives don't typify the experience of being a teenager in America, the developmental tasks they must accomplish and the brain changes they undergo are typical of depressed teens everywhere.
Michael Blosil's suicide should bring to the fore a number of important points about adolescent depression as well as suicide risk. We often hear that suicide is the third leading cause of death--after accidents and homicide--among teens and young adults between 15 and 24 years of age. What we don't often hear is that over 90 percent of all young people who commit suicide are suffering from severe mental illness. Depression is the leading condition in the suicides of adolescent boys and girls. It's crucial, given these facts, that we directly confront the antidepressant question: Should we prescribe these medications to young people?
The answer, I believe, is absolutely yes--a judgment I stand by with a deep understanding of the counterarguments, and as a physician who does not receive funding from pharmaceutical companies. There are those in the research community, and certainly in social sciences and media, who will argue that the jury is still out on the efficacy of antidepressant medications. There are those who will point to articles in the popular press, of which there have been many lately, and say, "Antidepressants aren't worth the side-effects," or that we're overmedicated as a nation, or that antidepressants themselves can induce thoughts of suicide. There will always be caveats when it comes to starting a treatment course with antidepressants, but as a child and adolescent psychiatrist with nearly three decades' experience at some of our nation's best psychiatric research institutions, I can tell you that the negative messages swirling around antidepressants distort a public health tragedy and impede access to treatments, including antidepressant medications, which can protect against suicide.
When parents are faced with the question of whether to medicate their clinically depressed teen, I offer them these facts:
- As many as 80 percent of teens suffering from depression can be successfully treated if they seek help from a doctor or therapist. The same holds true for adults, 80 percent of whom will respond to antidepressant medications, either one medication or a combination of two or more.
- About 40 percent of adolescents with depression do not adequately respond to a first treatment course with an antidepressant medication. Persistence in finding the right medication, or combination of medications, is key to the success of any treatment regimen.
- There is no gold-standard set of guidelines for clinicians to follow when choosing a treatment course with or without antidepressant medications.
- Studies that compare antidepressant medications to placebos don't include subjects who are suicidal. Research has shown, however, that antidepressants effectively lift depressions in subjects with the most severe symptoms--the very patients who are most likely to attempt suicide.
- After 2003, the Centers for Disease Control and Prevention (CDC) reported a sharp increase in the suicide rate for 10-to 19-year-olds. This dramatic increase coincided with a drop in antidepressant prescriptions for teens.
Untreated depression is the number one cause of teen suicide, and while it may be tempting to look the other way or to blame celebrity parents when a young person like Michael Blosil throws himself from his building's 15th story, I encourage you to look at this tragedy straight-on.
Recognize that adolescent angst is part of normal development, but adolescent depression is not: it's a very real illness that, left untreated, is potentially lethal. It requires both parental and medical attention.
Harold S. Koplewicz, M.D.
President, The Child Study Center Foundation, Inc.
Director, Nathan S. Kline Institute for Psychiatric Research
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