The following observations by a mother of the gradual onset of her daughter's depression during adolescence are important for several reasons:
One of them is that it is a clear and moving description of what happened to Faith during her adolescent years. The second is that it painfully reminds us that adolescent depression impacts not only the teenager but also all the members of the family. This is important not only for parents and family members. It is equally important for pediatricians to keep in mind that childhood depression can affect every family member.
~Dr. Howard King
Although Faith began treatment during her freshman year at high school, in hindsight, her problems began much earlier. I sought counseling for her back in the 4th grade because she developed irrational fears. She would come into our room many nights, afraid someone would break in to our house that something was going to happen to me, or her father. I tied to reassure her but I felt overwhelmed. I sought counseling through my pediatrician's office. She met with a counselor for four months. But when we went to the office, she was embarrassed and worried she might see someone she knew. She didn't want anyone to know she was in counseling. (The therapist was affiliated with the doctor's office so we waited in the waiting room like every other patient until the therapist came to get her!)
In contrast, her middle school years were rather uneventful. There were some ups and downs but nothing seemed very different from a typical adolescent. She was very self-conscious but that too didn't seem unusual for the age.
The high school years
However, when she started her freshman year, problems began immediately. She was difficult to get along with. I would ask about school and she was closed-mouth about everything. She had friendship issues. Still, I thought she was just going through a 'typical teenage angst'. Faith has a brother who is a year older than her and he did not behave this way towards me. I thought, she's a girl and I know girls can be difficult going through the teenage years. I've always read books so I could understand my children better. One was, "Get out of My Life, But First Can You Drive Cheryl and Me to the Mall?"
"Maybe my family would be better off without me"
In the late winter of her freshman year, one day, we had wood delivered to our home. It was dropped off in the front of the house and we needed to move it around back. Everyone was outside helping except Faith. I went in to get Faith and asked her to help out. We exchanged angry words; she stormed upstairs and said, "Maybe this family would be better off without me." I tried to talk to her at such times but her response was that everyone was always mad at her. I found an article that I had cut out of a magazine, "When a Teenager is Sad'. I read through it again and felt my heart racing. It said too many too many parents are afraid to ask their kids if they have ever thought about killing themselves. They think it will give kids ideas.
I picked my daughter up that afternoon, was alone with her in the car and asked her if she had ever thought of hurting herself. Her response was, "I don't know". I told Faith we really needed to see someone about this. I contracted with her that if she was ever considered hurting herself, she should let me know immediately. I went home, called the pediatrician and met with her, and was referred to outside counseling. Faith began counseling in the spring of her freshman year but wasn't enthusiastic about it. She was never very communicative with me. I'm sure it wasn't easy for the counselor. Medications were suggested but I wasn't ready to hear that. The school year was ending and I didn't think medication was necessary. Faith met with the counselor a few more times but didn't want to continue. I agreed to let her stop counseling.
"I'll never be good enough for you"
During that summer, she was 'training' to get ready for soccer. In the past, she had had no problems with running but for whatever reason, she was really struggling with her breathing. In hindsight, it was probably anxiety related. I tried to help her but she once said, "I'll never be good enough for you."
My husband surprised me with a 40th birthday trip to Bermuda, which happened to take place during her soccer tryouts. My mother came to stay with our children. Upon returning from Bermuda, I was told that Faith had been taken by ambulance from her tryouts. During the 2 mile run, she had difficulty breathing. It was a hot day and they had been concerned about dehydration. But she wasn't admitted and the reports from the ER showed that it had been a hyperventilation issue. That concerned me a great deal.
In November, we went for her yearly check up and we talked to her pediatrician about the ER visit. The pediatrician talked to Faith alone and when I came back in, she said that Faith would like to go on medication for anxiety. I was now ready to hear the need for med, especially coming from her pediatrician. She prescribed Lexapro but I said I would only agree if Faith was willing to resume counseling, but Faith didn't want to go back to the same counselor so we found another counselor. In addition, Faith wanted to see her at her home in Concord, because she didn't want anyone to know she was in counseling.
Her first drug overdose
In the following January, my husband and I went to a church workshop. Faith was home alone with our youngest son who was 8 at the time. I was also aware that Faith had had a fight with a friend. At church, we were in the middle of a prayer service when my phone rang. I didn't answer it because my children often called me for minor things. Fifteen minutes later, I received a phone call in the church office. It was the local police saying that they were at my home and my daughter had just overdosed on the Lexapro. They were transporting her to the hospital. We raced home to find my younger son all excited about the ambulance and fire engine that had been at our home and his older sister, hysterical. She had been dropped off and found an ambulance in the driveway. She thought that my husband had had a heart attack. We decided my husband would stay home with the children and I would go to the local hospital. I found out that the call to my cell phone while I was at church was from Faith. She said she tried to call me before she took the pills. When she couldn't reach me, she took the pills and then called my neighbor, who called 911. (We told my younger son it was an accidental overdose.)
We were discharged with instruction to follow up with an MD. Faith promised that she would never do it again but never really talked to us about the overdose itself.
The beginnings of treatment
After the overdose, we got an appointment with a psychiatrist. Fortunately, we already had a counselor. Different meds and different combinations were tried. After the overdose, the Lexapro was discontinued and she started on Wellbutrin and Prozac. She experienced different side effects but ultimately she remained just on the Prozac. We met with her psychiatrist on a regular basis and she had weekly counseling sessions. There were times that her therapist got frustrated with her because it was like pulling teeth to get her to say anything.
Is she bipolar?
I shared with her psychiatrist and her therapist that my sister is bipolar and wondered if Faith might be as well. We ended up paying for outside psychological testing to see if she was. The testing did not indicate that that was so.
As a school nurse, I routinely receive fliers about class days related to mental health issues. I go to many things to prepare for my role as a nurse but also to educate myself in order to help my daughter. I was involved in a discussion group in Concord. I met someone who gave me books to read to help me understand what it was like for Faith. I have also attended workshops including Suicide Prevention and on self-injury. In the meantime, Faith continued with her therapist and we made another trip to the ER in her sophomore year because her therapist was concerned with "comments" she was making.
In the beginning of her junior year, she again had trouble with anxiety at the soccer tryouts and Ativan was prescribed as needed. A plan was put into place where her teachers were made aware of her depression/anxiety issues because of the panic attack she previously had. I discovered she had been cutting because one of her friend's mothers told me. That was addressed in counseling. She developed a new group of friends and seemed to thrive with the boy/girl friendships. Most of them were unaware of her history. At the end of her junior year, she went off medications and stopped seeing her therapist. I didn't want her to go off of her meds but she chose to do so.
"The summer from hell"
That summer was the summer from hell for my husband and me. Faith would say it was the best summer of her life. She was very social and spent all her free time hanging out by the pool with a circle of friends but she was very unkind to us. She was always angry and would say how happy she was, but just not with us. We clashed constantly about curfews. I became depressed and ended up on medications. Our marriage went through a difficult time.
When school resumed in the fall, my husband and I met with her psychiatrist. I felt somewhat desperate because I felt Faith was not well. She said she was fine and accused me of being the problem. The psychiatrist told us that we couldn't force her to be in counseling or take meds.
What to do about college?
We had begun the college search in the spring of her junior year, continuing it into the fall. On the Columbus Day weekend, I took a college trip with her and she didn't say 2 words to me in the car or while we were walking around the campuses. We were only looking at schools nearby because I told her she needed to be within driving distance because we were concerned there might be recurrences of anxiety related issues and/or panic attacks. She wrote her college essay and showed it to me. It was the first time she revealed what happened on the day she had overdosed with the lexapro. It was a beautifully written essay but I was worried that the colleges she was sending it to would judge her negatively. I spoke with her guidance counselor about this but Faith wanted to do this. I was proud of her for 'speaking' so publicly about this.
Faith got into the college she really wanted to go to in mid December but was not overly enthusiastic about it. Christmas that year was very difficult. She didn't like one thing we got her. We were both miserable. After Christmas, I gave her an over the counter remedy for depression. I asked her to take the meds for one month. I told her I was concerned about her unhappiness. But three days later she took the whole bottle! We had a nightmarish experience at a hospital ER. She was treated as an overdose, not as a depressed child who in a desperate act, took a bottle of pills. In the meantime, I was treated as a difficult mother. The good that came out of this was that for the first time she really accepted the fact that she had serious mental health issues and needed help. She got back under psychiatric care, went on her meds and met with her counselor, but there continued to be ups and downs. Faith had a full-blown catatonic panic attack the spring of her senior year. She had some wonderfully supportive friends but some just didn't get it.
In her summer before college, Faith was now 18 and I wasn't privy to what was going on unless she allowed me to know. Faith signed release forms so I could speak to counselors at her school. (She was always agreeable to signing release forms so that doctors could talk to each other and/or therapists.) She had a big falling out at the end of the summer with a best friend. I was devastated for her. I was so worried about her going off to college with this 'sadness' hanging over her. I wanted to throttle these friends. We left Faith at college and I was so overwhelmed by the enormity of how far we had come but how far we still had to go.
Time off from college
In November 2007, I received a phone call from her college counselor. Faith revealed that she had resumed cutting and her therapist wanted her evaluated at home. We met with the psychiatrist and the therapist and Faith said her older brother and younger sister were aware of the cutting. I was upset that no one had told me. Her brother was worried about her but was afraid that if he said anything to me, she might not talk to anyone. He further revealed that Faith had made disturbing comments including, "I don't see myself being here a year from now." He was crying when he told me this. I was grateful for his help with Faith but I told him that he should never keep information like this in confidence. I told him there are things that I can do like calling doctors and looking into programs that he is not able to do. I also told him that if anything ever happened to Faith and he didn't say anything to anyone, how would he live with himself for the rest of his life?
A new therapeutic approach
An intervention was done with Faith at home and she agreed to put off going back to college for a few weeks and entered an outpatient program at the Faulkner. It was a 4-day outpatient program. Faith was now 18 so the program was an adult one. I had some reservations because everyone was older than her. But she willingly went every day and came home with plenty of stories. She met with a psychologist and a psychiatrist and was in various groups. One of the groups she was in was Dialectical Behavior Therapy). It helps people like Faith with impulsive behavior and those who experience their emotions intensely. They work on finding strategies to soothe oneself, and also work on negotiating appropriately through relationships. I was given the two places that offer these groups close to her college. A few weeks ago, we received a call that there was an opening and she is now in a DBT group, which meets Wednesday evenings. It is a little overwhelming for all of us because it is a yearlong group. But she needs to needs to learn skills so she can safely and successfully navigate through these years and into adulthood.
The impact of depression on the entire family
Faith is a physically beautiful young lady who when she smiles, lights up the room. She laughs heartily and enjoys enjoy simple pleasures like reading in bed and watching the Gilmore Girls over and over again! She is very intelligent, creative, artistic and athletic. She loves her little brother unconditionally. She has always showered him with attention. Recently her younger brother got a cell phone for Christmas. When I see him talking and texting Faith and her older brother, I know I did the right thing.
Faith and her younger sister have had a volatile relationship over the years. Faith wasn't very nice to her for many years. She had a hard time through early adolescence when people would question who was older. (Faith is 2 years older but her sister is taller than Faith.) When her sister entered high school, their relationship significantly improved. They became friends and are still to this day. Faith and her older brother have also had their ups and downs. But this past year, he has become her confidante. I am grateful that other children have grown in understanding and caring for Faith.
Her illness has affected everyone in different ways. The overdoses have caused emotions ranging from sadness to anger towards Faith. At times, we felt Faith was manipulating us. Last January was particularly difficult. Her brother was home from college when the overdose occurred and when the phone call came in. He gave his younger brother guarded information. When we returned the next day there were many questions to answer and questions about what was appropriate to share, particularly with our 10 year old. For the first time, Faith was genuinely remorseful for what she had done. That was a relief for my oldest son. The first time she had taken too many pills, she hasn't seemed phased by it. At least that was his perception. This time, Faith was tearful and expressed how sorry she was for putting us through it again.
In the meantime, her younger sister had closed up completely. She wouldn't talk to anyone about it. She was angry and hurt that her sister, whom she had grown close with, made the decision to swallow a bottle of pills instead of talking to someone. She had a big track meet, which I had planned to attend but was unable to because we were looking into hospitalizing Faith. At the track event her younger sister set the school record in high jump. I cried when I heard the news. I was happy for her but sad for her that I wasn't there to celebrate with her. I told her that there would be times in families when one child would get more attention that the others. Her response was that Faith was always that child in our family.
Explaining depression to the youngest child
One of the most difficult things we had to deal with was how much information to give our youngest child. We did tell him in very simple terms what Faith had done. He wanted to talk to his friends about it. We told him that he could not. He didn't think it was fair that the rest of us could talk to our friends but he couldn't talk to his. I tried to explain to him that is a difficult thing for anyone to understand, especially young children. I also said that Faith deserved her privacy in this matter. I did talk to several of his friend's parents to let them know what had happened in case he did say anything. We ultimately let him tell one friend after we talked with the mother first. I also let the school nurse know as well as the guidance counselor.
About one week after the overdose, he and I were in the car and he was asking me what was going on. He said he felt like no one tells him anything. I asked him what he wanted to know. He said he wanted to know everything. I told him that his sister suffers from something called depression. I explained that it is an illness, a chemical imbalance in her brain. It was because of the depression that she made the decision to take too many pills. It was not a healthy Faith that made that decision but a sick one. I told him that she was under doctor's care for her illness and she was on medication. I told him she was seeing a counselor on a regular basis to talk though a lot of things. He wanted to know how long she had this illness. I told him that she had been suffering from this illness for several years.
When I said this, he became angry that I was just telling him now. I explained to him that depression is difficult enough for the rest of us to understand. I didn't think there was any reason to talk to a young child about this very misunderstood illness. But I felt like now it was time. I went on to tell him that I have always found comfort in how much Faith loves him. Even in testing, the one thing, which came out was how much she loved her little brother. When I told him this, he cried and said if he had known over the years, he wouldn't have pushed her away when she was hugging him. I told Faith about this conversation and she talked to him individually. There were several times during this period when he was having a lot of stomachaches. I got calls to pick him up a few times and/or I had to talk to him to encourage him to get through and stay in school.
The impact upon the parents
Faith's illness deeply affected our marriage. There have been many peaks and valleys over the years.
I had to a lot of the legwork with Faith. I was the one who had to make the phone calls or take them when Faith had a panic attack or a difficult situation that needed to be addressed. I had to drop everything when she needed me. Several times my husband was away on business when a call came in that affected plans that I had made. I resented the fact that his life was going on as always and my life became on hold any time any place. I also resented my husband when he would become angry with Faith for putting me through everything. I know he thought he was protecting me but it stressed me out even more. I gave him articles over the years about teenage depression, trying to educate him. I tried to tell him that it was not her fault.
I also had to deal with my own depression. I have always been a runner and a faith filled individual and that had been my 'therapy.'
But I found myself spinning somewhat out of control. I was very unhappy in my marriage. I wanted freedom and fun. I was drinking too much and going out. I wasn't acting like a married woman. I blamed my husband for all my problems. I had been in counseling myself during this period of time and I asked him to go to individual counseling as well. He did. I knew we would need marriage counseling. I talked to my counselor about what I was going through. She referred me to a psychiatrist who prescribed medications. I told my husband I was going to start on meds. He told me he believed I was so strong. I told him that I was strong for admitting I needed help but I believed that the problems in our marriage were related to my state of mind. I started on meds and was amazed how much better I felt so quickly. I hadn't realized that my poor decision-making was also related to depression.
I ultimately told him the painful truth about some poor choices I had made. He was wonderfully loving and supportive. We started marriage counseling. We addressed a lot of parenting issues and misconceptions. We talked about our upbringings and why we each bring such different approaches to raising our children based on our own childhood. We talked at great length about Faith's illness and how it had affected us individually and together. We talked about the importance of communicating our needs to one another. We came away from all this empowered and our marriage is now stronger than ever.
The importance of family and friends
I am grateful to the many people in my life and Faith's. My older sister and my mother have always been my confidantes. My other sisters have been very supportive as well. I have wonderful friends who have always been there for me along with countless others in my faith community, at work, and in my running community. And Faith has been blessed by having wonderful friends, who have been there for her during so many difficulties. It does take a community to raise a child! She has an incredibly loving and supportive immediate and extended family, an unbelievable pediatrician, an excellent psychiatrist and therapist…and God. There have been so many very painful moments on this journey, but there has been so much good as well.
Reducing the mystery of depression
I am so proud that Faith is willing to share her story and willing to let me be so open with others. I believe putting a 'face' on this illness makes it less mysterious and hopefully will enable others to understand how depression or any mental illness affects a person and their family. We have to stop concealing the realities of this illness if we want to help others recognize signs in themselves or those they love.
That is how they will get the help they need before it is too late.
I feel hopeful.
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I would like to thank the following for their generous support, without whom this web site and training program would not exist: The Sidney R. Baer, Jr. Foundation, The Alden Trust, the Commonwealth of Massachusetts Department of Mental Health, Project INTERFACE (Newton Public Schools and the U.S. Department of Education), the Locke Educational Fund at Newton- Wellesley Hospital, Aetna Health Plan, the Kenneth B. Schwartz Center, and the families of my medical practice.
I hope you find this site useful and encourage any comments.
- Dr. Howard King, M.D.