Suicide - The Silent Killer

I recently heard shocking news from my son that one of his classmates had taken his own life. As a parent, I cannot fathom the pain that child's parents are going through right now.

Since the days of Memoriam, suicide has always been a silent stigma in our society. Teen depression is a serious problem, affecting 10.7% of all teens and 29.9% of high school students; 17% of high school students thought about suicide. Nevertheless, depression in adolescents is often unrecognized. This article describes the tragic death of a 17-year-old along with symptoms of adolescent depression and suicide; DSM-5 criteria for depression; treatments including protective factors, psychotherapy, and medication; and provides interventions to address this huge but silent crisis.

Most of us have observed sadness in teenagers. We may think that their melancholy is due to hormonal imbalance, moodiness, or teenage rebellion. But teen depression is a life-threatening problem. The reality is that teen depression is a serious problem. The 2001-2004 National Comorbidity Survey-Adolescent Supplement of 10,123 adolescents found that 11% of adolescents had major depressive disorder by age 18. Recently, the US National Institute of Mental Health (NIMH, n.d., a) found that 2.7 million adolescents aged 12 to 17 (10.7% of all adolescents) experienced a major depressive episode in 2013. If depression is not treated, intense feelings of sadness, hopelessness, anger, or frustration can last for weeks, months, or years. The World Health Organization reports that more than 350 million people worldwide suffer from depression, making it a leading cause of disability and contributing to the overall global burden of disease. It is important to recognize the symptoms of depression so that early treatment is possible and pain, suffering, and possible death can be avoided.

My goal in sharing this tragic story of the death of a 17-year-old is to highlight the vital need to talk to parents and professionals early when a teen shows signs of depression. Suicide is the second leading cause of death among 15- to 24-year-olds. Learning from our personal experiences can help save the life of someone suffering from depression and suicidal thoughts. Our words and actions can help end the silent crisis of teen depression.

At some point, most of us experience or have experienced grief. However, sadness is usually short-lived. When a person suffers from depression, it can affect work, school, eating, and the ability to enjoy life for a long time. It is imperative to distinguish between sadness and clinical depression; when depression is recognized, the necessary treatment can be obtained.

Depression can affect a person's ability to do the simplest things, such as waking up in the morning, brushing their teeth, going to school or work, and eating. Depressive feelings make it difficult to function normally, concentrate and participate in once enjoyable activities. Depressed feelings result in little or no motivation or energy, making it difficult to get through each day.

Symptoms of depression range from sadness, emptiness, hopelessness, anger, annoyance, or frustration; to losing or gaining weight; thinking about death, and/or having suicidal thoughts. A more detailed list of symptoms of depression is shown in Table 1. In addition to recognizing the symptoms of depression, it is important to realize that each person experiences depression differently. Although someone may not have all the classic symptoms of depression, they may still have clinical depression.

What causes depression? Heredity plays a significant role, accounting for half of the etiology of depression. Depressed individuals are often immediate family members of others who suffer from depression. Depressed individuals may not have the same thoughts as healthy people due to an imbalance of neurotransmitters in the brain. Specifically, depressed individuals experience abnormal regulation of cholinergic, catecholaminergic (noradrenergic or dopaminergic), and serotonergic (5-hydroxytryptamine) neurotransmission. Neurotransmitter imbalances can prevent someone from realizing that they might be able to find help. Many depressed individuals cannot imagine being happy again. They feel excruciating emotional and sometimes physical pain that seems to have only two options: die or live with the pain (SAVE, 2015b). Neuroendocrine dysregulation can involve problems with the hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, or growth hormone systems, which are areas that can be treated (Coryell).

The first step to preventing teen suicide is recognizing and treating depression. Effective early intervention will help reduce the burden and disability of depression. A combination of proactive support, mood-enhancing medications, and psychotherapy such as cognitive behavioral therapy can effectively treat teen depression. The earlier treatment is started, the better the response to treatment.

Teen depression is a serious problem, affecting 10.7% of all teens and 29.9% of high school students; 17% of high school students thought about suicide. Nevertheless, depression in adolescents is often unrecognized. This article describes the tragic death of a 17-year-old along with symptoms of adolescent depression and suicide; DSM-5 criteria for depression; treatments including protective factors, psychotherapy, and medication; and provides interventions to address this huge but silent crisis.

Most of us have observed sadness in teenagers. We may think that their melancholy is due to hormonal imbalance, moodiness, or teenage rebellion. But teen depression is a life-threatening problem. My daughter Kayla watched her 17-year-old best friend struggle with depression and eventually commit suicide. Feelings of loss, frustration, guilt and unanswered questions continue to haunt Kayla. She wished she could help her friend, say something that changed the situation, or somehow answer his cry for help. She regrets not being able to change that terrible morning when she got the news of her best friend's suicide (see Sidebar: My Best Friend).

The reality is that teen depression is a serious problem. The National Comorbidity Survey-Adolescent Supplement of 10,123 adolescents from 2001–2004 found that 11% of adolescents had major depressive disorder by age 18 (Avenevoli, Swendsen, He, Burstein, & Merikangas, 2015). Recently, the US National Institute of Mental Health (NIMH, n.d., a) found that 2.7 million adolescents aged 12 to 17 (10.7% of all adolescents) experienced a major depressive episode in 2013. If depression is not treated, intense feelings of sadness, hopelessness, anger, or frustration can