10th day of September 2018…

Dear Blog,

In this special month dedicated to suicide prevention awareness, and on this day particularly assigned for it’s commemoration, I wanted to take a moment to share a brief insight into teen depression and teen suicide from my perspective.

Let’s face it, teens have stressors just like we adults, sometimes more. I know most of us parents think teenage years are full of fun and games and carefree living–I am here to tell you that it is often not as we think. Not only do they have to deal with issues relating to adolescence, like the hormonal and physical body changes that accompany it, they also have to deal with school work big time. This may include dealing with AP classes, preparing for SATs and other standardized tests, taking college prep courses, as well as picking colleges and interviewing. They also may deal with dating and the drama that comes along with that, nuances of peer pressure from classmates, and pressure from coaches and teammates for those that participate in sports and other extracurricular activities like band, cheer-leading, and orchestra. I won’t even begin to mention how we parents have our own unique requirements for teens to either “be grown” or act grown, or how their siblings and other family members all have different opinions on whether the teens are grown or still children. 

Phew! That can make for tough teen years!!

So, now that we all agree that teens do have it rough, the onus is on us as family members and the community (the entire village it takes to raise them) to be more cognizant of that fact and act accordingly.

Amidst all of these teen issues listed above, it is easy for us to miss true signs of depression and or suicidal thoughts in our teens. I, for one, missed the depressive signs in my son who was then 12-year old son, and  was bullied in middle school. That sadness that has persisted for longer than 2 weeks now, might not be as a result of his or her school workload. It might not be as a result of the recent breakup from a dating partner; it might not be stress from their overscheduled life, nor pressure from their teachers or band director.

It might be depression and your teen might be suicidal as well.

Teens might become gradually withdrawn or lose their appetite, they might start losing interest in their normal daily activities or extracurriculars. Suddenly, they may no longer want to participate in competitive sports or they might simply drop out of the swim team. In some of my patients, I often note the spark is gone from their eyes–their air is of melancholy, with ashen faces and poor or no eye contact. They may begin hanging out with the wrong crowd, experimenting with drugs, or worse still, they may drop out of school altogether. Self-harm usually in the form of cutting themselves may also occur, and they often find creative ways to hide the marks and scars. For instance, be wary of the teen who always wears long sleeved sweatshirts or jogging pants in the (hot) summer. If suicidal, they might start giving away their favorite stuff, asking questions about death or asking about suicide. They often wish they are better off dead, and might mention it in passing. In truth they might be trying to reach out for help, but do not know how, or who to turn to. Regardless of the presence of friends and close family members, they might not want anyone they know, to know.

The average teen who is suffering from depression is most likely not going to tell you–their parent.

rear view of a boy sitting on grassland
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Where do you begin?

A family history of depression is sometimes the best place to start when it comes to honing in on our suspicions about our children and their prolonged moodiness. If you have a family history of mental illness, do not ignore it… it could happen to you or your child. Adolescence is often an easy period for symptoms of depression and other mental health issues to arise. Since the teens are already faced with a myriad of other stressors, depression simply slithers in, takes a seat, and gets comfortable.

When in doubt, ask their siblings, friends, or school mates about the behavior or mood of your teen. You will be surprised at the wealth of knowledge they possess. Afterall, they often spend a lot more time with your children than you do. Furthermore, these friends might not know how to approach the topic and might not know who to go to.

Your teens’ teachers and counselors will be another great resource. They are there to help and are often very willing to assist in any capacity.

Note that your child might not tell anyone at all and might even concoct stories to hide the truth. In fact, a patient’s mom recently recounted an instance when her son had told his curious sibling that the family cat had scratched him, in response to his sibling’s inquiry about the strange cuts on his forearms.

I recommend you find a nice neutral place to sit and talk, or a simple walk around the neighborhood, or a nice long drive, or even a picnic. A good ambience might help facilitate the communication on a face-to-face basis with your child. This might be a fruitful exercise if your child will cooperate, unfortunately, most teens really do not want to confide in, nor discuss these issues with their parents, however, it is still worth a try.

A short visit to the health professional, like the family pediatrician, family doctor, counselor or therapist is always a very good decision. They will ask you the proper questions and point you in the right direction to get your teen the appropriate kind of help they need. There are multiple places you can get help for your teen as well as their siblings (because there is often a need for siblings to participate in the treatment sessions in order to adequately understand exactly what is going on) and for yourself as well (especially if there is a family history of depression). These can either be online virtually, as telemedicine, or at your regular doctor’s office.

photo of woman in white blouse leaning on gray steel shed

#endteendepression

#endteensuicide

#askdoctorlulu

1-800-273-TALK

BB

PS: My website dedicated to fighting teen depression and teen suicide, teenalive.com is LIVE, click the link to check it out!

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Physicians, never forget your WHY…

 

Dear Blog,

Last Friday, as I sat finishing up notes on the last of my almost 30 physicals (this number is never any surprise for us Pediatricians this time of the year, it’s back to school week, so every Thomason, Dickinson and Harrison is lining up for sports physicals and regular physicals and all sorts of clearance and medication forms that need to be filled out and turned in “yesterday”) I took a deep breath and exhaled, my mind filled with the events of the day. As is customary, my beloved patients often postpone their physicals all summer, in search of sandy beaches and clear blue vacation skies, so it’s usually a mad rush the first week of school.

I found myself reflecting on the patients I had seen that day as I often do at the end of my day. Most of them were mundane well baby and well child checkups, nothing really of note, a few of them had minor issues to clear up before returning to play…but one of them stood out clearly like a lily in a field of carnations…a 16year old we shall call “Maya”. I have met Maya only a couple of times in the past and I have known her to be a troubled teen, plagued with depression and anguish, never really smiling, not much eye contact, not much of an affect…just sad. I have tried to manage her depression the best I can with counseling in the office, a referral for proper psychotherapy. My good friend, and child psychiatrist sees her regularly and has placed her on an appropriate dose of antidepressants, and she reportedly goes to counseling regularly, all with little or no change in her mood(s)

Image result for crying teen

She came in that day in the company of her mother and her older 17yr old sister. I sensed something wrong right away, but I continued my usual intros and salutations and other little talk. Her mom could not stop fidgeting, with the characteristic continuous knee shaking. Her sister’s face was buried in her mobile device for pretty much the duration of the visit, except when I inquired about her. It turned out her sister was also to be seen that day. Both mother and child proceeded to explain to me that her sister needed to be seen for “stomach problems” that only happen at her high school, stemming from her “unique eating habits”, and her lunch time not being fixed at a particular time of the school day. This apparently never happens at home or during the holidays or vacation, when she reportedly “has her own eating schedule”. She wanted a note from me to the school nurse authorizing her to eat her lunch at the exact time she wanted, or she would develop abdominal cramps, nausea and headaches and “get so sick” she would end up being sent home from school. This story line and request stuck me as bizarre, I recognized a familiar thread of possible anxiety in her sister, and maybe some co-dependency in her mom, but I digress…

Maya on the other hand, wore a thick black sweat shirt and jogging pants…mind you, it is 105F outdoors in San Antonio Texas in July! As I indicated in my first two Kevinmd articles https://www.kevinmd.com/blog/2018/07/a-pediatricians-healing-spirit-treating-depressed-anxious-and-suicidal-teens.html, and https://www.kevinmd.com/blog/2018/08/why-this-physician-quit-her-job.html

I somehow am a magnet for depressed and suicidal teens, and Maya, was no different. She made absolutely no attempt to engage with me, no eye contact, shoulders drooped over, melancholic and flat affected. She appeared pale, ashen and sullen, with dark circles around her eyes, she simply looked like she could use a looooong-warm-heart-filled-hug. During the physical exam, she hesitated to take off her sweat shirt, but I insisted, eventually, her mother ordered her to do so. She did so veeerrry-reluctantly, and immediately pronated both forearms…I gently supinated them, and to my horror, revealed numerous, clearly visible, freshly carved cuts all over her forearms, extending from her wrists all the way to her elbows, on her left and right forearms respectively. I said nothing, gently turned them back to her preferred position, completed her examination, and walked back to my seat. I then calmly asked her mom about Maya’s depression and how her cutting behavior was fairing. She hurriedly replied “oh, a lot better, she is receiving counseling, and has not cut in 2years. 2yrears?? I thought to myself, more like 2days!!… Her response immediately made me stop typing on my laptop EMR,  I looked up at her, made sure my words came out clearly and as gently as my rapidly beating heart could muster, as I said, “No ma’am, I am afraid but I have to tell you that Maya has fresh cuts on her forearms and wrists, that are probably not more than 2 days old…”Self-inflicted lacerations on arm of man : Stock Photo

The rest of the visit was a bit awkward. Her mom asked to see the cuts, Maya vehemently refused, and an uneasy silence set in after I explained to mom that, she would probably do better waiting until they got home to approach her alone in her bedroom. Meanwhile, we should probably revisit her counseling sessions, and explore the possibility of an in-house facility if possible, especially since her self-completed PHQ-9 score that day was a total of zero.

I write this story today to remind myself of my why. To urge each one of us doctors to remember our why(s) Never lose sight of the reason you went into medicine, no matter what. We are a special breed, a unique set of like-minded individuals who choose service to humanity above all. We choose to make a difference in our patients’ lives regardless of all the administrative, legislative, personal and sometimes insurmountable difficulties we face daily in the field. I was reminded that day of my reason for leaving my beloved 9-5 job to follow a passion of fighting to end teen depression and teen suicide. I was reminded to follow my heart and believe in my dream. I was reminded to stay the course, because, for every Maya in my office, there are a hundred or even a thousand more out there, so, I must go forth. “The harvest is plenty, the laborers, few…”, Luke 10:2

rear view of a boy sitting on grassland

#endteendepression

#endteensuicide

#askdocotorlulu

BB

PS: My website dedicated to fighting teen depression and teen suicide, teenalive.com is LIVE, click the link to check it out!