Differentiating Depression vs. Suicide Risk in Teens


By Shauna Summers
with resources from The StayWell Company, LLC ©2018 and the National Institute Institute of Mental Health and Suicide Awareness Voices for Education (SAVE)with resources from The StayWell Company, LLC ©2018 and the National Institute Institute of Mental Health and Suicide Awareness Voices for Education (SAVE)

Depression is a serious disorder, with many sub-types) that can cause significant problems in mood, thinking, and behavior at home, in school, and with peers. It is estimated (because teens underreport) that major depressive disorder (MDD) affects about 5 percent of adolescents.
"Suicidal thoughts are very common in adolescents," says David Fassler, M.D., a child psychiatrist who teaches at the University of Vermont. "At least one in six thinks about it, and about half of all kids with depression will attempt suicide." Luckily, few succeed. "Usually, they won't tell anybody about it, and that's what we worry about."
A clinical trial involving about 440 adolescents with major depression showed that about 70 percent responded well to a combination of Prozac and talk therapy. That was double the rate for youngsters on placebos. The warning that medication for depression might increase suicidal thoughts came from studies with roughly 4,400 depressed kids which found that in this sample 4% of depressed teens on medication expressed suicidal thoughts versus 2% of depressed teens those who took the placebo (sugar pill). There were no actual suicides. This suggests medication for depressed teens is helpful in 96% of teens who take it and that especially for the first four weeks, any teen medicated for depression needs to be watched closely by the adults in their lives (including CLERGY) for increased (in severity/hopelessness) signs of suicidal ideation:

  • Talking about wanting to die or to kill oneself
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious, agitated, or reckless
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings
  • Giving away their treasured possessions that they would never give away
 Studies involving about 4,400 depressed kids led to the new warning. Those who took antidepressants were twice as likely to express suicidal thoughts as those who took placebos (sugar pills). The numbers were small -- 4 percent for those on the drugs versus 2 percent on placebos. There were no actual suicides, Dr. Fassler says.
"The key is, if you think your child might have depression, don't worry about trying to define what it is, just get it checked out," says Dr. Fassler. "Get to a mental health professional and get a comprehensive evaluation. The good news is that if it is depression, we really can help most of these kids."
How parents and community leaders (ie: CLERGY) can help.  Here are some suggestions from the National Institute on Mental Health:
  • Realize that depression in (your) a child or teen is a serious condition that should be treated ASAP and monitored. Getting the affected child evaluated is a #1 priority.
  • A child should be thoroughly evaluated by a health care provider to determine if medication is appropriate. If an SSRI (Effective type of medication for depression, even in teens) is prescribed, the child should be closely monitored, particularly during the first four weeks.
  • Many times psychotherapy is given as the first treatment for mild forms of depression. For severe forms of depression, medication may be given in combination with psychotherapy.
  • If your child has suicidal thoughts or behavior, nervousness, agitation, irritability, sleeplessness or easily changeable moods, have him or her evaluated without delay.
  • If your child is already taking an SSRI, he or she should not stop taking the medication without discussing it with a health care provider. The child also should continue to be monitored to see that the medication is helping.
  • Realize that any medication may have side effects. Talk to your health care provider if you have concerns about side effects.