Coping with the complexities of teen depression and anxiety

“Depression is what we call the common cold of mental disorders,” Carmel High AP Psychology teacher Nora Ward says. “At some point in their lives, one in three Americans will have a depressive episode.”

According to the National Institute of Mental Health in 2015, 12.5 percent of the population of the U.S. aged 12 to 17 had at least one depressive episode in the past year, characterized as major depression. Although depression and anxiety alike are prevalent issues among American adolescents, recognition, awareness and acceptance have proven to be elusive.

“There’s been such a stigma throughout the ages about mental illness,” Carmel High School in-house nurse Susan Pierszalowski says. “It’s nothing to be ashamed about, it’s a medical illness. It’s real.”

Pierszalowski, a registered nurse and credentialed school nurse with a primary background in psychiatric mental health nursing, goes on to add that chronic stress often seen in students can physically alter brain chemistry, which can lead to clinical depression.

“That’s why it’s so important that teenagers have good health habits,” Pierszalowski notes. “Of course, treatment depends on the severity of the depression or anxiety, but your prefrontal cortex which governs decision-making is not fully formed, so it’s so important to get rest, to eat, to have a support system.”

According to Pierszalowski, depression and anxiety are the most common mental illnesses in adolescents, and she, along with student stress counselor Lauren Capano, assists Carmel High students suffering from these conditions on a daily basis. Capano, a licensed clinical social worker, explains that many CHS students are under the influence of a number of stressors, including family, personal life and especially academics.

“Because I’m in a school setting, I’m limited in what I can do,” Capano adds. “I don’t do full-out therapy with students, with treatment plans and assessments and evaluations and diagnoses. What I focus on with many students is maintenance, stabilization and getting back to class, helping with coping strategies to continue functioning throughout the day.”

Pierszalowski and Capano are part of Carmel High’s support system for students with mental illnesses, but students within CHS have reported different experiences with how the school has handled their situations.

One Carmel High senior girl was diagnosed with depression her freshmen year and hospitalized after attempting suicide when a culmination of family stress, eating disorders and bullying in school became too much for her to handle. Upon returning to home and school, this student used a series of coping mechanisms to get back into her old routines.

“I’m definitely better now,” she says. “I saw how what I did affected my family, and I knew that no matter how I felt, to act on those things wasn’t fair to everyone else. Coming back, my deal with my parents was that I had to take medication, go to therapy, communicate more, but for me, the thing that really did help was that I couldn’t just do whatever I wanted. It wasn’t about me.”

Other Carmel students have gone through similar experiences in coping with mental illnesses on a day-to-day basis.

“Just getting out of bed is very difficult,” says one CHS junior boy who has suffered with symptoms of clinical depression since seventh grade and was diagnosed in his sophomore year. “Going about everything can be outrageously hard. Getting motivation to do anything on top of the lack of motivation everyone has, it just kind of keeps building up. All the little things seem so huge. One little thing can send you down into this deep abyss of worry.”

Pierszalowski cites a lack of motivation and a drop in grades as common symptoms of depression in adolescents, accompanied by fatigue, lack of energy, difficulty concentrating, sadness and hopefulness, tearfulness and crying, withdrawal from friends and family and loss of interest in activities.

Senior Rachael Schroeder was diagnosed with depression and general anxiety in December of 2014 after an attempt on her own life.

“I had tried a couple times before to overdose,” Schroeder explains. “It was the week before finals and I had been in a really toxic relationship for six months and I just lost all my motivation to live. I ended up going to the hospital, and they put me on a 5150 hold.”

A 5150 involuntary psychiatric hold is placed on a patient whom a doctor or other qualified individual deems to be a danger to herself or others. Typically, the hold will last 72 hours, but after less than a day in the Community Hospital of the Monterey Peninsula, Schroeder was allowed to return home, where she underwent psychotherapy and was prescribed Ativan, an anti-anxiety medication.

“When I came back, the teachers that I told were really understanding,” Schroeder adds, “but I definitely ended up with some C’s sophomore year because of all the school I missed.”

Although Schroeder was prescribed Ativan, she explains that most of the time, she avoids taking the medication, preferring to go without except for extreme circumstances.

Like Schroeder, the previously mentioned senior girl believes that medication is not the most useful tool for her in coping with depression and anxiety.

“I started on medication when I was diagnosed,” she says.  “I had a really hard time finding one that actually helped. It seems like all the medications for me were just there for the placebo effect. So I would find other outlets. Like running. I would get so tired I wouldn’t have to think about things anymore, and then I would have to turn around and run back.”

The same CHS junior boy was prescribed a 10-milligram dosage of Prozac his sophomore year. After a slight change, he explains that medication seemed to lose its effect. His doctor upped the dosage to 20 milligrams, and the same process occurred. According to this student, medication works in combatting depression only “on and off.”

The Center for Disease Control and Prevention characterizes depression as “persistent sadness and sometimes irritability (particularly in children).” Although it’s often seen as something that occurs in the mind, it’s important to note the physical aspect of the illness, which can be broken down to one chemical: serotonin.

“Serotonin is the chemical that our brain releases to keep our mood up and stable,” Ward explains. “Typically, people with depression don’t have enough serotonin available in their brain. Their brain still produces serotonin, but it doesn’t get used the way it does in a normal brain. That’s why they take antidepressants, called selective serotonin reuptake inhibitors.”

According to Ward, these SSRIs change the way the brain interacts with serotonin, making it more available to regulate mood and emotion. Ward goes on to add that while medication typically will solve the chemical imbalance, antidepressants come with a series of side effects that have caused a movement in psychology away from medication and toward a more “holistic approach.”

“People become so reliant on medication that they never want to do the cognitive work that it takes to fix it,” the psychology teacher continues. “Little things like getting proper sleep and exercise are all ways that therapists tell people can actually work better than medication because your body will naturally regulate itself if you treat it right, even with a genetic predisposition to depression. Most mental disorders are something chemically imbalanced in the brain, and just like with physical illnesses, our bodies can heal themselves over time with proper diet, nutrition and exercise. A lot of people with severe depression will still need medication, but that’s only one tool.”

Ward adds that, despite the prevalence of mental illness in adolescents, Monterey County is particularly inhospitable to teens with depression.

“I had a student one year who was suicidal, and she had to get sent up to Oakland. Her family had to drive up to Oakland to visit her every day because there was no place in all of Monterey County that she could go. There just aren’t many beds allotted to adolescents in Monterey County.”

Having dealt with the illness itself as well as some of the effects that accompany it, Schroeder explains that one of the most important things to her is visibility: “I know a lot of people say this, and it’s cliche, but depression is a real thing. It often isn’t treated like it’s a real problem because you can’t see it, but it’s real. It makes it hard to get up in the morning, makes it hard to function, and it’s a real problem.

-Anna Gumberg