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Teen Depression (transcript)
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Child: THERE ONCE WAS A TIME WHEN WE WERE TRULY FREE -- FREE OF WORRY, FREE OF FEAR, FAR FROM DOUBT. THAT IS STRENGTH. THAT IS POWER. THAT IS FEARLESS. "SECOND OPINION" IS BROUGHT TO YOU BY BlueCross/BlueShield, ACCEPTED IN ALL 50 STATES. LIVE FEARLESS.

 

NARRATOR:

 

"SECOND OPINION" IS PRODUCED IN ASSOCIATION WITH THE UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.

 

PETER SALGO:

 

THIS IS "SECOND OPINION," AND I'M YOUR HOST, DR. PETER SALGO. THIS WEEK, MYTH OR MEDICINE -- ARE ANTIDEPRESSANTS SAFE FOR TEENAGERS?

 

MICHAEL SCHARF:

 

IT SHOULD BE UNDERSTOOD AS A POSSIBLE INTERVENTION FOR A GIVEN PERSON IN A GIVEN SITUATION, WEIGHING THE POTENTIAL RISKS VERSUS THE POTENTIAL BENEFITS.

 

PETER SALGO:

 

AND SPECIAL GUEST OLIVIA REARDON, WHOSE STRUGGLES WITH DEPRESSION BEGAN AS A TEEN. SHE'S HERE FOR HER SECOND OPINION.

 

OLIVIA REARDON

 

I WAS EXTREMELY CONFUSED. I HAD NO IDEA WHAT WAS GOING ON AND WHAT WAS WRONG.

 

PETER SALGO:

 

OLIVIA, THANK YOU FOR JOINING US TODAY. WE'VE GOT A PANEL OF DOCTORS WHO ARE GOING TO ANSWER YOUR "SECOND OPINION" QUESTIONS. THEY'RE REALLY GOOD ONES TOO. WE'VE GOT LOU PAPA FROM THE UNIVERSITY OF ROCHESTER MEDICAL CENTER. JEFF PRINCE FROM HARVARD MEDICAL SCHOOL AND MASSACHUSETTS GENERAL HOSPITAL, OVER THERE ON THE EAST SIDE OF THE CONTINENT. AND ORDINARILY I WOULD SAY WE HAVE SPECIAL SURPRISE GUEST, BUT THIS IS HARDLY A SURPRISE -- YOUR MOTHER HAS JOINED US AS WELL. ELLEN REARDON, THANK YOU SO MUCH FOR JOINING US TOO. SO HERE WE ARE, AND WHAT I REALLY SHOULD DO IS GET US STARTED BY ASKING YOU -- UM, YOU HAD A PRETTY HAPPY EARLY CHILDHOOD. TELL ME A LITTLE BIT ABOUT THAT.

 

OLIVIA REARDON:

 

WELL, WHEN I STARTED HIGH SCHOOL, I WAS AN HONOR STUDENT AND I PLAYED FIELD HOCKEY AND LACROSSE. I WAS THE CAPTAIN IN BOTH THOSE TEAMS.

 

PETER SALGO:

 

WHEN YOU WERE 15, WE WERE TALKING, WHAT HAPPENED? SOMETHING CHANGED.

 

OLIVIA REARDON:

 

I NOTICED THAT MY MOODS STARTED TO GET PRETTY HORRIBLE. I WAS FEELING VERY DOWN AND NOT FEELING WELL, AND MY GRADES STARTED TO DROP AND STARTED TO --

 

PETER SALGO:

 

I NOTICE -- AND I DON'T MEAN TO BE TOO INTRUSIVE HERE -- BUT WHEN YOU TALK ABOUT THAT, ACTUALLY, YOUR MOOD CHANGES RIGHT HERE ON THE SET WITH US. YOUR VOICE GETS A LITTLE SLOWER, AND YOUR AFFECT GETS A LITTLE LESS HAPPY. I MEAN, THAT MUST HAVE BEEN VERY PAINFUL.

 

OLIVIA REARDON:

 

YEAH. WELL, AS A TEEN, IT WAS PRETTY BRUTAL, BECAUSE THAT WAS, LIKE, ALL I KNEW WAS HIGH SCHOOL AND GRADES AND SPORTS AND SUCH.

 

PETER SALOG:

 

WHAT WAS SHE LIKE? DID YOU NOTICE A CHANGE?

 

ELLEN REARDON:

 

SLOWLY, VERY SLOWLY, OVER TIME, I DID. I MEAN, IT CAME -- IT WASN'T WHAT I WAS LOOKING FOR. WHEN YOU'RE A PARENT, AND AS YOUR TEENS -- OR AS YOUR CHILDREN GO INTO THE TEENAGE YEARS, THEY GIVE YOU THIS, LIKE, LAUNDRY LIST OF BEHAVIORS TO LOOK FOR.

 

PETER SALGO:

 

I'VE BEEN WARNED ABOUT THAT.

 

ELLEN REARDON:

 

REALLY. AND I WAS LOOKING FOR THEM, BECAUSE THAT'S WHAT YOU DO. AND WHEN YOU'RE A PARENT, THAT'S ALL YOU DO, IS WATCH YOUR CHILDREN. AND WHAT WAS HAPPENING WASN'T WHAT I THOUGHT I SHOULD BE LOOKING FOR. I MEAN, THEY SAY THAT YOU SHOULD LOOK FOR THINGS LIKE WITHDRAWAL, AND SHE WAS WITHDRAWING, BUT IT DIDN'T LOOK LIKE I THOUGHT IT WOULD LOOK. I THOUGHT WHEN A TEENAGER WITHDRAWS, THEY COME HOME ONE DAY, THEY'RE KIND OF ANGRY, THEY GO UP IN THEIR ROOM, THEY CLOSE THE DOOR, AND THEY DON'T COME DOWN, AND THAT'S WHAT I WAS WAITING FOR -- THAT'S --

 

PETER SALGO:

 

AND THAT DIDN'T HAPPEN?

 

ELEN REARDON:

 

NEVER --

 

PETER SALGO:

 

AND DID YOU SHARE ANY OF WHAT YOU WERE FEELING, ANY OF THIS SADNESS OR ANY OF THIS WORRY, WITH YOUR MOM?

 

OLIVIA REARDON:

 

NO, I DIDN'T WANT HER TO WORRY. I BOTTLED IT ALL UP. I DIDN'T WANT TO TALK ABOUT IT AND THOUGHT IT WAS MY RESPONSIBILITY TO IMPROVE MY OWN MOOD, SO DIDN'T EVER TALK ABOUT IT.

 

PETER SALGO:

 

DOES THIS SOUND NORMAL? I MEAN, DOES THIS -- I DON'T MEAN TO SAY "NORMAL." DOES IT SOUND LIKE TEENAGE DEPRESSION, OR DOES IT SOUND LIKE NORMAL TEENAGE ANGST TO YOU?

 

LOU PAPA:

 

WELL, I MEAN, ANY TIME -- AND I DON'T TAKE CARE OF A LOT OF TEENAGERS, BUT IT'S VERY SIMILAR IN ADULTS -- ANY TIME THERE'S A SIGNIFICANT CHANGE OF BEHAVIOR WHERE THERE'S THAT SENSE OF LOSS OF DRIVE AND MOTIVATION AND ENJOYMENT FOR THINGS, THAT SENSE OF GUILT -- YOU KNOW, YOU DON'T WANT TO BOTHER MOM -- WHERE THERE'S A SUDDEN LEVEL OF INTERACTION AND ENJOYMENT IN THINGS AND THERE'S A BIG DROP-OFF -- RAISES A LOT OF CONCERNS, AND DEPRESSION IS ONE OF THEM.

 

PETER SALGO:

 

DOES THIS SOUND LIKE DEPRESSION TO YOU, OR DOES THIS SOUND LIKE SHE'S A TEENAGER?

 

JEFF PRINCE:

 

WELL, YES, AND SO THE REAL --

 

PETER SALGO:

 

YES TO BOTH?

 

JEFF PRINCE:

 

YES, AND SO THE FACTS WITH DEPRESSION IN ADOLESCENTS REALLY IS THREE THINGS. IT'S ONE -- IT'S COMMON. IT'S IDENTIFIABLE. AND IT'S TREATABLE. IT DIFFERS A LOT FROM ADULT DEPRESSION IN SOME IMPORTANT WAYS, SO IT'S VERY COMMON THAT ADOLESCENTS WITH DEPRESSION HAVE WHAT WE CALL MOOD REACTIVITY. ALL ADOLESCENTS ARE MOOD REACTIVE, AND, YOU KNOW, THE ONLY ONES THAT AREN'T ARE THE ONES WHO ARE SLEEPING. AND SOMETIMES THEY ARE. BUT THE NEGATIVE COMES OUT MORE OFTEN THAN SADNESS, SO THE MOST COMMON AFFECTIVE DISTURBANCE IN ADOLESCENT DEPRESSION IS, IN FACT, ANGER, IRRITABILITY, HOSTILITY, RAGE, ANGER -- WHICH, AGAIN, ALL ADOLESCENTS HAVE, BUT WITH ADOLESCENTS WHO ARE SUFFERING WITH A DEPRESSED MOOD, IT'S REALLY THE BOTH INTERNAL AND EXTERNAL CLIMATE, AND THEY REACT TO VERY LITTLE, LIKE, ON A 1 TO 10 SCALE, SOMETHING LIKE A 2 OR A 3 THAT'S ANNOYING COULD HAPPEN, IT'S EXPERIENCED OFTEN AS LIKE A 7 OR 8 OR 9. SOMETHING GOOD THAT'S LIKE A 7 OR 8, IT MIGHT BE OKAY, IT FELT MORE LIKE A 3 OR A 4. AND THE NEGATIVE STAYS WITH THEM LIKE VELCRO, AND THE POSITIVE IS MORE LIKE TEFLON.

 

PETER SALGO:

 

DID THAT SOUND LIKE WHAT YOU WERE GOING THROUGH?

 

OLIVIA REARDON:

 

THAT'S TRUE, YEAH. DEFINITELY ANYTHING BAD THAT HAPPENED AFFECTED ME WAY DEEPER THAN IT WOULD HAVE NORMALLY, I THINK.

 

PETER SALGO:

 

AND AT SOME POINT, YOU GOT KEYED IN TO THIS, GOT WORRIED, AND THEN THE TWO OF YOU WENT TO SEE A DOCTOR, IS THAT RIGHT?

 

ELLEN REARDON:

 

WE DID, SHE HAD A REALLY BAD WEEKEND, AND I KNEW SOMETHING WAS GOING ON, AND I DIDN'T KNOW WHAT IT WAS. I DIDN'T -- I JUST KNEW I NEEDED A LOT OF HELP AND I NEEDED IT REALLY FAST, AND I TOOK HER TO AN EMERGENCY ROOM.

 

PETER SALGO:

 

OKAY, AND WHAT HAPPENED?

 

ELLEN REARDON:

 

THEY WENT, "YEAH, YOU'RE RIGHT, THERE'S SOMETHING REALLY BAD GOING ON HERE. WE THINK THAT SHE NEEDS FURTHER HOSPITALIZATION." AND THAT WAS LIKE -- IT WAS A DOUBLE-EDGED SWORD. I WAS, LIKE, SORT OF RELIEVED THAT SOMEONE ELSE SAW WHAT I WAS SEEING, BUT TO HAVE TO ADMIT TO MYSELF THAT, YOU KNOW, OH, WOW, IT'S BAD, AND I HAVE TO PUT HER IN THE HOSPITAL, AND --

 

PETER SALGO:

 

BUT BEFORE -- LET ME BACK YOU UP A LITTLE BIT, BECAUSE WHEN WE WERE TALKING, YOU SAID THAT THAT CAME AT THE END OF A PERIOD WHEN YOU'D ALREADY SEEN A DOCTOR AND YOU WERE TAKING SOME MEDICATION FIRST SO THAT WAS AT THE END OF A CHAIN OF THINGS, RIGHT?

 

ELLEN REARDON:

 

IT WAS, RIGHT.

 

PETER SALGO:

 

SO WHEN YOUR MOM SAID, "LET'S GO SEE A DOCTOR," AND THE DOCTOR PRESCRIBED MEDICATION, WHAT DID YOU THINK?

 

OLIVIA REARDON:

 

I THOUGHT THAT IT WAS GOING TO BE THE CURE TO EVERYTHING AND IT WAS GOING TO BE OVER WITHIN A COUPLE WEEKS, FEEL BETTER. BUT IT ENDED UP BEING A LOT LONGER THAN THAT.

 

ELLEN REARDON:

 

AND A LOT WORSE.

 

PETER SALGO:

 

IS IT OFTEN LIKE THAT? I MEAN, YOU GO, YOU SEE A DOC, YOU GET A PILL, IT'S ALL OKAY? I MEAN, DOES THAT MAKE ANY SENSE? OR IS IT -- THAT'S THE EXPECTATION, BUT IS THAT A REALISTIC EXPECTATION?

 

JEFF PRINCE:

 

 WELL, IT'S THE WISH, AND OFTEN THE MEDICINES ARE A WAY THAT -- THEY MAY DIMINISH OR LESSEN THE SYMPTOMS. HOWEVER, TAKING A PILL NEVER TEACHES PEOPLE HOW TO WORK WITH THEIR THOUGHTS, WORK WITH THEIR EMOTIONS, LEARN TO TOLERATE THEM, AND THAT'S REALLY WHERE THE WORK STARTS. AND SO THE MEDICINE SETS UP THE WORK THAT NEEDS TO COME.

 

PETER SALGO:

 

WELL, FIRST OF ALL, DID YOU GET ANYTHING OTHER THAN THE PILLS?

 

OLIVIA REARDON:

 

TALK THERAPY, YES.

 

PETER SALGO:

 

OKAY, SO YOU'RE ON THE PILLS, YOU'RE GETTING TALK THERAPY, BUT THEN THE WORD THAT I KNOW YOU USED WAS "UNGLUED." SOMETHING CAME APART.

 

ELLEN REARDON:

 

TOTALLY. SHE DID.

 

PETER SALGO:

 

WHAT HAPP-- YOU WERE WATCHING IT FROM THE OUTSIDE. LET ME ASK YOU FIRST. WHAT WAS THAT?

 

ELLEN REARDON:

 

IT WAS -- EVERYTHING -- ALL OF HER BEHAVIOR AND HER SPEECH, IT JUST BECAME SO AMPLIFIED, AND SHE WAS CRYING, AND SHE COULDN'T HOLD A THOUGHT FOR, YOU KNOW, MORE THAN A FEW SECONDS, AND I, AT THE TIME, THOUGHT SHE WAS MAYBE ON DRUGS, LIKE, YOU KNOW, ILLEGAL DRUGS, AND I THOUGHT, "WELL, IF I CAN JUST SORT OF WAIT, YOU KNOW, HOW LONG DOES AN ILLEGAL DRUG TAKE, 24 HOURS, IT'LL BE OUT OF HER SYSTEM, SO WE'LL JUST WAIT IT OUT, AND IN 24 HOURS, SHE'LL BE BETTER." AND I THINK THAT WAS ON A SATURDAY, AND ON A SUNDAY, LATE, I KNEW WE WERE INTO THIS A LOT DEEPER AND THAT WE NEEDED MORE HELP.

 

PETER  SALGO:

 

WHAT DID IT FEEL LIKE FROM THE INSIDE?

 

OLIVIA REARDON:

 

WELL, IT FELT GREAT, BUT THAT'S -- BUT IT WAS A FALSE SENSE OF... HAPPINESS, LIKE -- DOES THAT MAKE SENSE?

 

PETER SALGO:

 

SURE. WERE YOU HYPERACTIVE? WERE YOU JUMPING AROUND?

 

OLIVIA REARDON:

 

IT WAS LIKE HYPERACTIVITY, AND I WAS HAVING RACING THOUGHTS, AND LIKE SHE SAID, I COULDN'T HOLD ON TO A THOUGHT. I JUST HAD SO MUCH I WANTED TO SAY AND COULDN'T GET IT OUT FAST ENOUGH.

 

PETER SALGO:

 

SO I'LL JUST SAY THE WORD FOR EVERYBODY -- YOU SOUNDED MANIC.

 

OLIVIA REARDON:

 

YES.

 

PETER SALGO:

 

IS THAT WHAT THEY SAID IN THE EMERGENCY ROOM WHEN YOU BROUGHT HER IN?

 

ELLEN REARDON:

 

YES, YES, SHE WAS DEFINITELY MANIC.

 

PETER SALGO:

 

AND THAT'S WHEN THEY SAID, "WE REALLY THINK YOU OUGHT TO COME IN THE HOSPITAL." WHEN THEY TOLD YOU THAT, THAT YOU HAD TO COME IN THE HOSPITAL, WHAT DID YOU THINK?

 

OLIVIA REARDON:

 

AT THAT POINT, I KIND OF WAS IN ANOTHER WORLD, LIKE, I DIDN'T EVEN KNOW WHAT WAS GOING ON. BUT ONCE I WAS THERE AND STARTED SOME MEDICATION AND KIND OF CAME TO, I WAS EXTREMELY CONFUSED. I HAD NO IDEA WHAT WAS GOING ON AND WHAT WAS WRONG, BECAUSE I HAD JUST BEEN USED TO BEING DEPRESSED FOR MONTHS, SO...

 

PETER SALGO:

 

DOES THIS SOUND LIKE SOMETHING YOU SEE A LOT?

 

JEFF PRINCE:

 

WELL, ABSOLUTELY, SO THAT THE -- FIRST THE EXPERIENCE OF DEPRESSION IS VERY TAXING, AND THE MEDICINES CAN BE VERY ACTIVATING, IN TERMS OF, THEY ENERGIZE PEOPLE, AND THAT ENERGY COULD GO AND MANIFEST IN THE BODY OR IN THE THINKING OR IN THE EMOTIONS, OR PERHAPS WHEN PEOPLE GET MANIC, AND THAT'S REALLY DIFFERENT THAN BEING ACTIVATED -- THAT'S SOMETHING WE ALWAYS LOOK FOR, BUT WHEN SOMEONE'S REALLY MANIC, IT'S VERY DANGEROUS. IT'S AN ACUTE SITUATION AND REALLY REQUIRES HOSPITALIZATION, AND IT'S VERY CONFUSING. PEOPLE WHO ARE MANIC REALLY HAVE -- THEY BELIEVE THEY KNOW WHAT'S GOING ON, BUT THEY REALLY ARE NOT IN TOUCH WITH IT.

 

PETER SALGO:

 

LET'S PAUSE RIGHT HERE, I WANT YOU TWO TO STAY WHERE YOU ARE, BECAUSE IT'S TIME FOR THIS WEEK'S "MYTH OR MEDICINE."

 

NARRATOR:

 

TEEN DEPRESSION IS A SERIOUS MEDICAL PROBLEM, AND APPROPRIATE TREATMENT IS CRITICAL. PART OF THAT TREATMENT MAY INCLUDE ANTIDEPRESSANTS, BUT THESE MEDICATIONS CARRY A WARNING OF INCREASED SUICIDAL BEHAVIOR IN CHILDREN AND ADOLESCENTS, SO ANTIDEPRESSANTS ARE NOT SAFE FOR TEENAGERS. IS THAT MYTH OR MEDICINE?

 

MICHAEL SCHARF:

 

"ANTIDEPRESSANTS ARE NOT SAFE FOR TEENAGERS." THAT IS A MYTH, AND I'M GOING TO TELL YOU WHY. I'M MICHAEL SCHARF. I'M THE CHIEF OF THE DIVISION OF CHILD AND ADOLESCENT PSYCHIATRY AT THE UNIVERSITY OF ROCHESTER MEDICAL CENTER. ANY STATEMENT SUCH AS, "ANTIDEPRESSANTS ARE SAFE," OR, "ANTIDEPRESSANTS ARE UNSAFE," IS AN OVERSIMPLIFICATION, AND IN FACT, IT SHOULD BE UNDERSTOOD AS A POSSIBLE INTERVENTION FOR A GIVEN PERSON IN A GIVEN SITUATION, WEIGHING THE POTENTIAL RISKS VERSUS THE POTENTIAL BENEFITS. AND THIS UNDERSCORES THE IMPORTANCE OF DOING A GOOD EVALUATION AND COMING TO A CORRECT DIAGNOSIS. WHEN TALKING ABOUT USE OF ANTIDEPRESSANTS FOR TEENAGERS IN THE CONTEXT OF MAJOR DEPRESSIVE DISORDER, FOR SERIOUS AND PERSISTENT ANXIETY DISORDERS, THAT RISK/BENEFIT RATIO ALMOST ALWAYS COMES OUT ON THE SIDE OF THE BENEFIT OUTWEIGHING THE POTENTIAL RISK.

 

NARRATOR:

 

RACHEL FROM VERONA, WISCONSIN, ASKS, "IS MEDICATION THE ONLY OPTION?"

 

MICHAEL SCHARF:

 

ONCE YOU'VE DONE A GOOD ASSESSMENT AND YOU HAVE A DIAGNOSIS, IT'S ALSO IMPORTANT TO RECOGNIZE THAT MEDICATION IS ONE OF MULTIPLE POTENTIAL TREATMENT OPTIONS. FOR MANY YOUTH, PARTICULAR YOUNGER CHILDREN, BUT CONTINUING ON THROUGH TEENAGE YEARS AND EVEN AS ADULTS, PSYCHOTHERAPY IS OFTEN THE FIRST OPTION TO TREAT DEPRESSION, BEFORE CONSIDERING MEDICATION. SO MEDICATION, IN MOST GENERAL TERMS, SHOULD REALLY BE THOUGHT OF AS ONE OF MULTIPLE POTENTIAL TREATMENT OPTIONS, AND ITS APPROPRIATENESS FOR ANY INDIVIDUAL DEPENDS ON A GOOD INDIVIDUAL EVALUATION AND A CONSIDERATION OF THE ROLE OF ALTERNATIVE TREATMENT MODALITIES AS WELL. AND THAT'S MEDICINE.

 

NARRATOR:

 

NOT SURE IF IT'S MYTH OR MEDICINE? CONNECT WITH US ONLINE. WE WILL GET TO WORK AND GET YOU A SECOND OPINION.

 

PETER SALGO:

 

NOW, WE'RE HERE WITH OLIVIA, AND, OLIVIA, YOU WERE HOSPITALIZED WITH MANIC BEHAVIOR, RACING THOUGHTS. YOU SAID YOU WERE CONFUSED. WHAT WAS THE DECISION LIKE, MOM, WHEN YOU HEARD THAT YOU OUGHT TO HAVE HER HOSPITALIZED? HERE'S YOUR DAUGHTER, AND THEY'RE TELLING YOU TO HOSPITALIZE HER.

 

ELLEN REARDON:

 

I HAD A VERY HARD TIME SORT OF WRAPPING MY BRAIN AROUND IT, BECAUSE IT'S SOMETHING THAT HAS TO HAPPEN REALLY FAST. YOU'RE IN THE EMERGENCY ROOM, YOU KNOW SOMETHING'S WRONG, YOU DON'T KNOW WHERE TO TURN, AND PEOPLE ARE COMING AND GOING, AND SOMEONE COMES IN AND SAYS, "HI, I'M DR. SO-AND-SO, AND YOU CAN TELL THERE'S PROBLEMS WITH YOUR DAUGHTER. IT'S NOTHING WE CAN TREAT HERE. SHE'S GOING TO NEED FURTHER HOSPITALIZATION." AND YOU HAVE TO TAKE HER SOMEWHERE AND SIGN HER IN AND LEAVE HER THERE. AND, YOU KNOW, HOW DID THIS HAPPEN? WHERE IS SHE? WHO ARE THESE PEOPLE? AND IS THIS REALLY GOING TO TAKE US BACK TO THE CHILD THAT, YOU KNOW, I HAD AND THE CHILD THAT I WANT?

 

PETER SALGO:

 

MY GUESS IS, YOU'VE BEEN DOING YOUR ABSOLUTE BEST TO MANAGE ALL THESE PROBLEMS. AND AT THE END OF THE DAY, NOTHING YOU DID SEEMED TO WORK. THAT MUST HAVE BEEN A BIT OF A SHOCK.

 

ELLEN REARDON:

 

IT WAS AN EPIC FAIL.

 

PETER SALGO:

 

DID YOU FEEL --

 

LOU PAPA:

 

I THINK THAT'S UNFAIR. I MEAN, WE DO THE BEST YOU CAN IN MEDICINE TO TREAT, JUST AS YOU WERE TALKING ABOUT, JEFF, AND IT'S IMPORTANT TO RECOGNIZE WHEN THERE'S WARNING SIGNS, JUST LIKE THERE IS IN ANY OTHER DISEASE. YOU KNOW, WE DO OUR BEST TO TREAT HEART DISEASE, BUT SOMEONE CAN STILL HAVE CHEST PAIN. IT'S NOT NECESSARY A FAILURE. IT'S GREAT THAT YOU RECOGNIZED IT. THAT'S A SUCCESS. A LOT OF PEOPLE DON'T.

 

PETER SALGO:

 

THAT'S WHERE I WANTED TO GO WITH THIS.

 

ELLEN REARDON:

 

I THINK THE ONLY I RECOGNIZED, THOUGH, WAS THAT I DIDN'T KNOW WHAT IT WAS, AND I DIDN'T KNOW WHAT TO DO ABOUT IT. AND I DON'T KNOW IF THAT'S A POSITIVE OR A NEGATIVE. BUT I KNEW I WAS IN REALLY TROUBLED WATERS.

 

PETER SALGO:

 

BUT LET ME ASK YOU THIS. IF OLIVIA'S BLOOD SUGAR HAD BEEN 500 AND YOU HAD TO ADMIT HER TO THE HOSPITAL TO GET FIXED, OR IF SHE NEEDED -- IF SHE HAD PAIN IN HER BELLY AND HER APPENDIX HAD TO COME OUT, YOU WOULDN'T HAVE FELT BAD.

 

ELLEN REARDON:

 

I KNOW, BUT THIS IS GOING TO A PLACE THAT PEOPLE DON'T LIKE TO GO -- THIS IS HAVING TO SAY THE WORDS OUT LOUD, "MENTAL HEALTH," "MENTAL ILLNESS." THOSE ARE HARD WORDS TO SAY OUT LOUD.

 

PETER SALGO:

 

THEY ARE, WHICH BRINGS US TO THE OBVIOUS QUESTION. IS DEPRESSION A PHYSICAL ILLNESS?

 

JEFF PRINCE:

 

YES, AND IT AFFECTS ALL AREAS OF FUNCTIONING, AND IT AFFECTS PEOPLE'S PSYCHOLOGY, THEIR RELATIONSHIPS, BOTH WITH THEMSELVES, WITH OTHER PEOPLE. IT AFFECTS THEIR FUNCTION PHYSICALLY, WITHIN RELATIONSHIPS, ACADEMICALLY, SOCIALLY, WITHIN THE FAMILY, WITHIN THEIR OWN SELF-CONCEPT. AND IT BECOMES IN SOME WAYS LIKE THE CLIMATE, AND THAT'S REALLY THE DIFFERENCE HERE, IS BECAUSE THIS WENT FROM SOMETHING THAT WAS LIKE STORMY WEATHER TO BECOMING A CLIMATE, AND THAT OFTEN PARENTS -- WHO WORK SO HARD, AND IT'S SUCH A DILEMMA WHAT TO DO -- PEOPLE FEEL SO HELPLESS, AND IT IS IMPORTANT, YOU KNOW, AS YOU WERE SAYING, LOU, THAT -- RECOGNIZING, LIKE, THIS ISN'T RIGHT, THIS ISN'T -- AND IT'S NOT THAT IT'S NOT OLIVIA, BUT IT COMES TO DOMINATE OLIVIA, AND AT THAT POINT, YOU REALLY NEED TO BROADEN THE HELP.

 

PETER SALGO:

 

BUT AGAIN, I'M GOING TO POUND THIS POINT AGAIN. IS DEPRESSION A PHYSICAL ILLNESS? IS IT A MENTAL ILLNESS? IS THERE A DISTINCTION?

 

LOU PAPA:

 

IT'S AN ILLNESS. I MEAN, IN MY MIND, IT REALLY DOESN'T MATTER. THE ONLY DIFFERENCE WITH THOSE OTHER CONDITIONS IS THAT YOU HAVE A LABORATORY, AN OBJECTIVE LABORATORY VALUE, OR AN INFLAMED APPENDIX THAT YOU CAN TAKE OUT. THE PROBLEM WITH THIS CONDITION IS, IT'S WRAPPED UP IN YOUR PERSONALITY AND IT AFFECTS YOUR PERSONALITY --

 

PETER SALGO:

 

THERE'S A GENETIC COMPONENT?

 

JEFF PRINCE:

 

OF COURSE, YES.

 

LOU PAPA:

 

THE DISTINCTION OF SAYING PHYSICAL AND MENTAL -- BECAUSE EVEN PHYSICAL ILLNESSES HAVE A MENTAL COMPONENT. MENTAL ILLNESSES HAVE PHYSICAL COMPONENTS. IT'S A DISEASE THAT HAS SIGNIFICANT IMPACT ON QUALITY OF LIFE AND POTENTIALLY LIFE EXPECTANCY WITH THE RISK OF SUICIDE, AND THERE'S EFFECTIVE TREATMENT.

 

OLIVIA REARDON:

 

I THINK WHETHER IT'S PHYSICAL OR MENTAL DOESN'T MATTER, BECAUSE AS LONG AS SOMEONE IS GOING THROUGH SOMETHING THAT'S TROUBLING -- I KNOW THAT I PERSONALLY -- SOME OF THE PARTS OF DEPRESSION THAT I FELT THE MOST WERE THE PHYSICAL PARTS OF IT. OBVIOUSLY, THE MENTAL SIDE OF IT, LIKE, I WAS DEPRESSED, AND IN A BAD MOOD ALL THE TIME, AND IRRITABLE AND ANGRY, BUT

IT AFFECTS YOUR WHOLE BODY, AND I THINK IT'S IMPORTANT TO TAKE IT AS SERIOUSLY AS PHYSICAL ILLNESS, OR IT WON'T EVER BE --

 

JEFF PRINCE:

 

ABSOLUTELY.

 

PETER SALGO:

 

NOW, HOW LONG WERE YOU IN THE HOSPITAL?

 

OLIVIA REARDON:

 

3½ WEEKS.

 

PETER SALGO:

 

AND YOU GOT OUT, AND EVERYTHING WAS PEACHY KEEN, LIFE WAS JUST GREAT, A BOWL OF CHERRIES, NO?

 

OLIVIA REARDON:

 

NO, I THOUGHT IT WOULD BE THAT WAY, BUT IT'S ACTUALLY WHERE THE WORST OF IT STARTED.

 

PETER SALGO:

 

HOW SO?

 

OLIVIA REARDON:

 

WELL, IT'S THE TIME WHERE I WAS TRYING TO START TO STABILIZE ON MY MEDICATION. AND THAT'S WHERE A LOT OF PHYSICAL SIDE EFFECTS CAME THROUGH. IF YOU SEE, LIKE, ON TV, YOU HAVE THAT LITTLE VOICE THAT TRIES AND SAYS ALL THE SIDE EFFECTS. I PRETTY MUCH HAD EVERY SINGLE ONE ON THE PILL THAT YOU COULD HAVE -- WHICH I DON'T MEAN TO MAKE IT SOUND DAUNTING, BUT ONCE I GOT THROUGH THAT, IT WAS FINE, BUT IN THAT PERIOD OF TIME, IT WAS PRETTY PHYSICALLY DEMANDING.

 

PETER SALGO:

 

THEY WERE TRYING TO FIND THE RIGHT MEDICINE FOR YOU.

 

OLIVIA REARDON:

 

RIGHT.

 

PETER SALGO:

 

IS THAT MORE DIFFICULT IN TEENAGERS THAN IT IS IN ADULTS?

 

JEFF PRINCE:

 

I DON'T THINK IT'S MORE DIFFICULT -- WE ARE JUST NOT SMART ENOUGH IN 2013 TO DO A TEST THAT'S OBJECTIVE, LIKE A BLOOD SUGAR OR AN ULTRASOUND FOR THE ABDOMEN TO TELL WHAT MEDICINE IS THE RIGHT ONE. SO IT'S A PROCESS. AND SO WHEN WE GET IT RIGHT THE FIRST TIME, WE HAVE GOOD WAYS TO THINK ABOUT THIS, BUT THE SHARE AND THE PROCESS, WHEN WE GET IT RIGHT THE FIRST TIME, THAT'S GREAT, BUT OFTEN WE DON'T, AND WE NEED TO -- THE THING WE'RE BEST AT IS RECOGNIZING WHEN SOMETHING IS POORLY TOLERATED AND TO TAKE AWAY SOMETHING THAT'S POORLY TOLERATED.

 

PETER SALGO:

 

NOW, WHEN OLIVIA WAS AT HER WORST, AFTER COMING HOME FROM THE HOSPITAL, AND THIS CHAOS, THIS DAILY EXPERIMENT WITH MEDICATIONS, WAS GOING ON, WHAT WERE YOUR WORRIES?

 

ELLEN REARDON:

 

THAT SHE WOULD HARM HERSELF SIGNIFICANTLY.

 

PETER SALGO:

 

YOU WERE WORRIED ABOUT SUICIDE.

 

ELLEN REARDON:

 

I WAS WORRIED ABOUT SUICIDE, YES. I WAS WORRIED ABOUT SUICIDE.

 

PETER SALGO:

 

I WAS TAUGHT --

 

ELLEN REARDON:

 

AND IT WAS THE ONLY TIME IN THE WHOLE SORT OF YEAR LEADING UP TO IT THAT I THOUGHT ABOUT IT, AND I THOUGHT ABOUT IT DAILY.

 

PETER SALGO:

 

I WAS TAUGHT, IF YOU'RE WORRIED ABOUT SUICIDE, SOMEBODY BELONGS IN THE HOSPITAL. BUT SHE WAS MANAGING THIS OUTSIDE THE HOSPITAL.

 

JEFF PRINCE:

 

WELL, MOST PEOPLE WHO FEEL SUICIDAL -- FEELING SUICIDAL SHOULD ALWAYS BE TAKEN SERIOUSLY, AND IN FACT, IT'S VERY IMPORTANT, AS YOU WERE SAYING, LOU, SUICIDE IS THE THIRD LEADING CAUSE OF DEATH IN ADOLESCENTS AND OUR 15- TO 24-YEAR-OLD AGE GROUP. SO WE ALWAYS WANT TO TAKE IT VERY SERIOUSLY. IT'S A SYMPTOM AND A SIGN THAT SOMEONE'S OVERWHELMED, AND WE NEED TO BOTH ACKNOWLEDGE TO THEM WHAT'S GOING ON, WE NEED TO

EXPRESS THAT WE CARE AND WE'RE CONCERNED AND THAT WE SEE WHAT'S GOING ON -- OFTEN WHEN PEOPLE FEEL THAT WAY, THEY FEEL SO ISOLATED AND ALONE, THEY FEEL LIKE THEY'RE SCREAMING OUT FOR HELP AND NO ONE'S SEEING. AND THEN WE NEED TO TELL OR GET THEM CONNECTED WITH SOME PROFESSIONAL ASSESSMENT.

 

PETER SALGO:

 

SHE WAS WORRIED ABOUT IT. ARE THERE SPECIFIC WARNING SIGNS YOU LOOK FOR IN TEENS THAT SAY, "WHOA, CHECK BOX HERE, CHECK BOX THERE, SUICIDE IS REALLY ON THE AGENDA HERE"?

 

JEFF PRINCE:

 

SO, IN PEOPLE WITH MODERATE TO MARKED OR SEVERE MOOD DISTURBANCES, EITHER DEPRESSIONS OR MANIAS, OR OFTEN, WHEN THEY COME TOGETHER, WHEN PEOPLE HAVE PRIOR HISTORIES OF FEELING THAT WAY OR PRIOR ATTEMPTS, WHEN THERE'S A FAMILY HISTORY, AND IT'S VERY, VERY IMPORTANT, AND THIS IS AS A PUBLIC HEALTH PIECE, IF THERE ARE GUNS IN THE HOUSE, THEY NEED TO BE SECURED, AND THEY NEED TO BE PUT IN A WAY THAT THERE IS NOT ACCESS TO THEM. THAT'S A VERY STRAIGHTFORWARD THING PEOPLE CAN DO.

 

PETER SALGO:

 

YOU WOULD ASK OLIVIA ONE QUESTION EVERY MORNING DURING THIS TIME.

 

ELLEN REARDON:

 

RIGHT BEFORE I LEFT TO GO TO WORK, I WOULD LOOK HER IN THE EYES, AND I WOULD SAY, "OLIVIA, I'M LEAVING TO GO TO WORK NOW. IT'S 8:00. I WILL BE BACK AT WHATEVER TIME. WHILE I'M GONE, WILL YOU BE SAFE?"

 

PETER SALGO:

 

AND YOU ASKED HER TO PROMISE YOU SOMETHING.

 

ELLEN REARDON:

 

AND I SAID, "AND YOU PROMISE ME THAT YOU WON'T DO ANYTHING TO HURT YOURSELF."

 

PETER SALGO:

 

DID YOU TAKE THAT PROMISE SERIOUSLY?

 

OLIVIA REARDON:

 

I DID, 'CAUSE SHE MADE ME FEEL REALLY GUILTY, AND I DIDN'T WANT TO --

 

PETER SALGO:

 

MOMS ARE GOOD AT THAT.

 

ELLEN REARDON:

 

THAT WAS THE ONLY TOOL I HAD, THOUGH.

 

PETER SALGO:

 

WELL, THAT'S WONDERFUL, IN THE SENSE THAT IT WORKED AND YOU'RE HERE. AND THINGS BEGAN TO STABILIZE.SO NOW YOU'RE ON MEDS, YOU'RE IN TALK THERAPY, AND HOW'S ALL OF THAT GOING?

 

OLIVIA REARDON:

 

IT'S GREAT, BECAUSE THE THING WITH TALK THERAPY IS THAT I DON'T HAVE TO GO EVERY WEEK, DEPENDING ON HOW WELL I'M DOING. I CAN DO IT EVERY TWO WEEKS OR SOMETHING LIKE THAT.

 

PETER SALGO:

 

DO YOU FEEL THERE'S ANY STIGMA TO THE FACT THAT YOU HAVE DEPRESSION?

 

OLIVIA REARDON:

 

YES. I AM ALWAYS REALLY, LIKE, AFRAID TO TELL PEOPLE AND FEEL EMBARRASSED, BUT I LIKE TO TALK OPENLY ABOUT IT.

 

PETER SALGO:

 

WE'RE THRILLED THAT YOU SHARED THAT WITH US. THIS TOOK A LOT OF COURAGE ON YOUR PART. IT'S TIME FOR US TO PAY YOU BACK, WHICH IS, THIS IS "SECOND OPINION." WE'VE GOT THESE GREAT GUYS HERE. ANY QUESTION YOU WANT, ANY SECOND OPINION YOU WANT, ASK AWAY.

 

OLIVIA REARDON:

 

WHAT DO YOU THINK ABOUT, LIKE, HOLISTIC, NATURAL REMEDIES FOR THIS? BECAUSE I AM VERY MUCH AGAINST IT AND THINK THAT YOU SHOULD BE SEEING, LIKE, ACTUAL DOCTORS.

 

LOU PAPA:

 

YOU'RE VERY BRIGHT. THE PROBLEM I HAVE WITH HOLISTIC--

 

PETER SALGO:

 

TRUST LOU TO CUT TO THE CHASE.

 

LOU PAPA:

 

I THINK PART OF THE PROBLEMS WITH THAT IS, THERE'S NO QUANTIFIABLE WAY TO MEASURE THEIR EFFECT, RIGHT, BECAUSE THE HOLISTIC MEDICINES ARE "NATURAL," SO THE ACTIVE COMPONENT, WHATEVER IT'S TOUTED TO BE, VARIES, AND THAT'S BEEN SHOWN FROM ONE BOTTLE TO ANOTHER. AND YOU WANT THE MOST EFFECTIVE DRUG. YOU WANT THE DRUG THAT'S EFFECTIVE, THAT'S GOING TO WORK RELIABLY AND QUICKLY. AND YOU'RE NOT GOING TO GET THAT WITH A HOLISTIC TREATMENT. THIS IS A SERIOUS DISEASE.

 

PETER SALGO:

 

JEFF, THE LAST WORD IS YOURS.

 

JEFF PRINCE:

 

EXCELLENT. I WOULD THINK OF THEM AS EITHER COMPLEMENTARY OR ALTERNATIVE. AND I THINK THE MOST EFFECTIVE TREATMENT IS THE ONE THAT YOU'LL DO, AND SO I THINK THAT DEPENDS. THERE ARE A NUMBER OF THEM -- THINGS LIKE FORMS OF FOLATE, OMEGA-3 FATTY ACIDS, AND CERTAINLY LIGHT THERAPY AND PERHAPS VITAMIN D, THAT MAY ALL CONTRIBUTE TO REGULAR MEDICINES, AND I USE THEM AS A COMPLEMENT TO REGULAR TREATMENTS.

 

PETER SALGO:

 

IS THERE ANYTHING ELSE YOU WANT TO ASK?

 

OLIVIA REARDON:

 

NO, JUST THANK YOU FOR HAVING ME.

 

ELLEN REARDON:

 

I WANT TO KNOW WHY SO MUCH OF THE MEDICATION THAT'S USED TO TREAT ADOLESCENTS IS OFF-LABEL MEDICATION THAT'S USED TO TREAT ADULTS -- WHY THERE ISN'T MORE RESEARCH BEING DONE INTO ADOLESCENTS. THEIR BODIES ARE, YOU KNOW, THIS MESS OF HORMONES, AND, YOU KNOW, THE PSYCHOPHARMACOLOGIST THAT WE HAVE -- WHOM WE LOVE -- WILL SAY -- IN THE BEGINNING -- NOT NOW, WE DON'T REALLY NEED IT, BUT IN THE BEGINNING, SHE WOULD SAY, "THIS IS A MEDICATION THAT'S ACTUALLY USED FOR SEIZURES, BUT WE WILL TRY AND USE THIS NOW FOR THAT."

 

PETER SALGO:

 

SHORT ANSWER?

 

JEFF PRINCE:

 

SO, UNTIL RECENTLY, NOTHING WAS APPROVED FOR DEPRESSION FOR  ADOLESCENTS. IT WAS ACTUALLY IN 2003 THAT PROZAC GOT THE FIRST INDICATION. SO FOR MANY, MANY YEARS, THERE WAS NO INCENTIVE FOR THE PHARMACEUTICAL INDUSTRY TO REALLY STUDY THIS OR FOR DOCTORS OR ACADEMIC INSTITUTIONS TO STUDY IT. THERE'S AN INCENTIVE NOW, AND WE HAVE TO STUDY THEM CAUTIOUSLY, BUT IT BRINGS UP A LOT OF ETHICAL ISSUES AS WELL. WE CERTAINLY NEED MORE DATA ABOUT THE SAFETY, THE TOLERABILITY, AND THE EFFICACY IN ADOLESCENTS.

 

PETER SALGO:

 

I WANT TO THANK BOTH OF YOU VERY, VERY MUCH FOR BEING HERE. YOU TWO, OF COURSE, AND YOU IN PARTICULAR FOR SHARING THIS WITH US.THERE IS A STIGMA, AS YOU POINTED OUT, AND YOU WERE VERY BRAVE TO COME AND SHARE IT WITH US AND OUR AUDIENCE, AND THANK YOU SO MUCH FOR BEING WITH US. AND NOW IT'S TIME FOR THIS WEEK'S "SECOND OPINION 5."

 

DR. SUSAN McDANIEL

 

HELLO, I'M DR. SUSAN McDANIEL, AND I'M HERE TO TELL YOU ABOUT THE FIVE SIGNS OF TEEN DEPRESSION. THE FIRST SIGN IS SLEEPING OR EATING TOO MUCH OR TOO LITTLE. GROWING PATTERNS LEAD TEENS TO OFTEN SLEEP AND EAT WHAT SEEMS TO BE AN EXCESSIVE AMOUNT TO ADULTS. HOWEVER, IF THEY START TO GAIN OR LOSE A LOT OF WEIGHT, OR STAY UP AT NIGHT AND SLEEP DURING THE DAY, THESE CAN BE SIGNS OF DEPRESSION. TAKE YOUR TEEN TO THEIR PERSONAL PHYSICIAN. LOW MOOD AND A LACK OF INTEREST OR ENTHUSIASM IS ALSO A SIGN OF DEPRESSION -- FOR EXAMPLE, DROPPING OFF A SPORTS TEAM WHERE THEY EXCELLED. THE THIRD SIGN IS SOCIAL WITHDRAWAL. A TEEN MAY WITHDRAW FROM THEIR FRIENDS AND STAY IN HIS OR HER ROOM MOST OF THE TIME, OR THEY MAY BEGIN TO HANG OUT WITH A DIFFERENT GROUP WHERE SUBSTANCE USE IS COMMON. A SUDDEN DROP IN GRADES CAN BE A SIGN OF DEPRESSION. ANY OF THESE PROBLEMS MAY BENEFIT FROM EVALUATION BY A PSYCHOLOGIST, FAMILY THERAPIST, OR COUNSELOR. THE LAST SIGN IS SUICIDAL IDEATION. TEENS MAY THINK ABOUT DEATH AND EVEN TAKING THEIR OWN LIVES. IF THEY'RE SUICIDAL AND HAVE A PLAN, IT'S A SIGN OF VERY SERIOUS DEPRESSION. TAKE HIM OR HER TO THE PSYCHIATRIC EMERGENCY ROOM AT YOUR NEAREST HOSPITAL. IT'S IMPORTANT TO LOOK FOR THESE SIGNS, BUT TALKING WITH YOUR TEENAGER IS EVEN MORE IMPORTANT. IF YOUR TEEN JUST WON'T TALK TO YOU, ASK THEM IF THEY'D LIKE TO SEE A COUNSELOR OR THERAPIST. AND THAT'S YOUR "SECOND OPINION 5."

 

PETER SALGO:

 

THANK YOU SO MUCH FOR WATCHING "SECOND OPINION." WE HOPE YOU CONTINUE THIS CONVERSATION ON OUR WEBSITE, WHERE YOU CAN COMMENT ON THIS SHOW OR YOU CAN SEND US YOUR SHOW IDEAS OR SHARE YOUR HEALTH STORY WITH US. WE MAY EVEN INVITE YOU TO BE ON THE SHOW. THE WEB ADDRESS IS secondopinion-tv.org. I'M DR. PETER SALGO, AND I'LL SEE YOU NEXT TIME FOR ANOTHER "SECOND OPINION."

 

Child: THERE ONCE WAS A TIME WHEN WE WERE TRULY FREE -- FREE OF WORRY, FREE OF FEAR, FAR FROM DOUBT. THAT IS STRENGTH. THAT IS POWER. THAT IS FEARLESS. "SECOND OPINION" IS BROUGHT TO YOU BY BlueCross/BlueShield, ACCEPTED IN ALL 50 STATES. LIVE FEARLESS.

 

NARRATOR:

 

"SECOND OPINION" IS PRODUCED IN ASSOCIATION WITH THE UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.