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Teenage depression needs to be handled carefully, Las Vegas director says

Summerlin South View - 8/12/2016

Many parents would say that moodiness, depression and acting out are hallmarks of being a teenager, but there's a line between normal adolescent behavior and mental health issues, and spotting the difference is often simply a matter of intensity.

"With teenagers, there's always going to be a certain amount of moodiness and acting out," said Joelyne Gold, director of clinical services at Montevista Hospital, 5900 W. Rochelle Ave. "We're looking for persistent changes in the personality. If someone is unsure whether their child is depressed or just being a so-called teenager, you have to consider how long the problem has been going on, how the problems are and how different your child is acting from themselves."

The hospital sees an array of disorders including teens with bipolar disorder and homicidal thoughts, but by far, the issues it deals with the most with teens are depression and suicidal ideation, or serious suicidal thoughts.

"Hormones and stress can explain occasional teenage angst, but when we see that there's an unrelenting unhappiness or irritability, those are the times we want to step in," Gold said.

According to the National Institute of Mental Health in 2014, an estimated 2.8 million adolescents ages 12 to 17 in the United States had at least one major depressive episode. This number represented 11.4 percent of the U.S. population ages 12 to 17.

Gold noted that the signs and symptoms of depression and suicidal ideation are going to be notable and include sadness, hopelessness, irritability, anger, hostility, frequent crying, withdrawal from friends and family, loss of interest in activities, poor school performance, and changes in eating and sleeping habits.

Any items on the list can occur in a child who isn't having serious issues, but persistent and intense recurring incidents are a cause for concern, she said.

"Often there will be suicidal warning signs," Gold said. "Teens may talk about or joke about suicide, saying things like, 'I'd be better off dead,' 'I wish I could disappear forever,' or 'There's no way out.' Sometimes they speak positively of death or romance it, saying things like, 'If I died, people might love me more.' It's important that we communicate with a teenager who is depressed to find out what they're thinking or feeling rather than believing it's something that's going to work out on its own."

Gold said that some of the tips for doing this include concentrating on listening instead of lecturing and being receptive to their thoughts. Parents' conversation should be gentle and persistent, acknowledging their feelings and not trying to talk them out of being depressed.

"Don't rationalize or minimize their thoughts and their depression," Gold said. "You shouldn't say, 'Life isn't that bad,' rather than validating that they've been going through a lot lately."

Since withdrawal from friends and family is one of the symptoms of depression and suicidal ideation, it is important to talk to your child's teachers and counselors at school or contact a mental health professional.

Each school in the Clark County School District has a school-based intervention team comprising a school psychologist, a school nurse and one or more counselors assigned at the school.

"Each of our schools at CCSD has a psychologist lined up with it," said Robert Weires, director of psychological services with the district. "It may not be a full-time position. Most of them are itinerant and go to a couple of schools."

The district's professionals keep an eye out for radical changes in behavior and indications students may be hurting themselves, such as cutting, he said.

"Teens are targeted for students in acute stress or approaching a crisis scenario," Weires said. "Early in the process, we reach out to the parents and let them know there are concerns with their child. For the more severe cases, we have procedures in place where we can help support the parents in taking the child for screening at a hospital to make sure there's no immediate health crisis."

There are many possible causes of depression, anxiety, feelings of low self-worth or negative beliefs. These include early childhood trauma, family issues such as divorce, moving or financial difficulties, genetics, some medical conditions, and drug and/or alcohol abuse.

Once a teenager is at Montevista or a similar facility, the staff will assess the situation and determine if he needs to be placed in the acute unit, an inpatient program. For suicidal thoughts, it's important to determine if the patient has intent and method and needs to be protected from himself.

For less severe problems, a patient might be placed in an outpatient program where the patient spends part of the day in the facility getting help and instruction, similar to what the inpatient clients receive. In both cases, medications may be prescribed by a medical professional.

"They learn a lot about why they are having depression or anxiety," Gold said. "We talk about the effects of bullying, of trauma, how they feel in regards to their own beliefs about themselves and how they see themselves. It really comes down to self-worth, self-esteem and what their goals are. We try to put them back on that path to seeing their worth, rather than seeing only their negative beliefs."

The clients may receive and participate in several therapies and mental health techniques, including recreational therapy, meeting with a psychiatrist, discussing educational groups for building self-esteem, talking about safety and about having healthy relationships and stepping away from codependency and relationships that are toxic and commitment to change. Clients may also discuss commitment to school, family and being honest.

"We also discuss co-occurring conditions such as using drugs or alcohol as a means to escape their feelings and negative beliefs about themselves," Gold said. "We implement a program to discuss the effects of drugs and alcohol. Drug and alcohol use are more prevalent in the 12-to-17-year range, but we've seen it as young as 8 or 9."

For a lot of people, it's shocking to find out that their child is chronically depressed or even suicidal. Gold said there may be a tendency to shut down rather than to sit down with a child and ask the important questions, such as how long the child has had these thoughts and if they have a suicide plan.

"It's important for parents to know that there are services out there that can help people and be there for their crises," Gold said.

For more information about Montevista Hospital, call 702-364-1111 or visit montevistahospital.com.

To reach East Valley View reporter F. Andrew Taylor, email ataylor@viewnews.com or call 702-380-4532.

Upcoming Mind Matters story topics:

In August: How the Clark County School District offers support for students living with a mental health issue, and a look at mental health care for the 55-or-older population.

In September: What is the process to have someone involuntarily committed in Nevada? A look at the laws and what the options are, also a preview of pending legislation affecting mental health care and existing laws and policies that shape the current system in Nevada.

In October: A look at how the prison system and local law enforcement handle those with a mental health issue, also a look at how we begin to improve the mental health system in Nevada.