Teen Depression!!! by swethareddytaduru


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The Gazette                                                                                                                                                                     Wednesday, February 3, 2010            B1

                         Health & Fitness
 Meet                                                                     Teen Depression - Part 1 of 4
 Dr. Rakesh Ranjan...                                                          How to Recognize the Red Flags
                                                                                      By Dr. Rakesh Ranjan

                                                                            Teenage years are the most tumultuous
                                                                          period of our lives. Yet teenage years are
                                                                          perhaps the most formative period in
                                                                          most people's lives. Given children are
                                                                          the future of our communities, it seems,
                                                                          as a society, we should strive to guide,
                                                                          support, nurture and monitor our teens
                                                                          in the best possible manners. It is espe-
                                                                          cially relevant since 'teenage troubles'
                                                                          have gotten worse in recent years. This is
                                                                          generally attributed to negative changes
                                                                          in our culture, family structure and

    The Medina-Gazette is pleased to welcome Dr. Rakesh                      Teenage depression, for instance,
  Ranjan as a weekly columnist to our Health & Fitness fea-               seems to have become more prevalent.
  ture. Each Wednesday he will be discussing a wide range                 One in four young women and one in
  of mental health issues.                                                seven young men have had a bout of
    Dr. Rakesh Ranjan is a practicing psychiatrist and a                  depression by the time they enter adult-
  researcher. He is a recipient of several research awards                hood. One in six high school students
  and has authored several peer-reviewed journal articles                 report they have seriously thought about
  and book chapters on psychiatric illnesses and their treat-             suicide and one in twelve report having
  ments. He is a national speaker for several organizations               attempted suicide in the preceding year.
  and serves on the medical advisory board for the NAMI of                The incidence of depression in teenage
  Greater Cleveland.                                                      boys, especially, is increasing and is           It seems Johnny had exhibited a DRASTIC            EYES OPEN, BUT OUR EARS TOO. So
    In 2009, he was awarded the National NAMI Exemplary                   expected to equal that in teenage girls. In      CHANGE in his MOOD, PERSONALITY,                   please be available to talk to a teenager if
  Psychiatrist Award and the Ohio NAMI Psychiatrist of the                light of enormous importance of this             AND BEHAVIOR over the past several                 one brings up any of the relevant topics
  Year Award.                                                             matter, I have decided this column will          weeks. This change consisted of some               even during most inconvenient times,
    Finally Dr. Ranjan has taken a leadership role in the                 dedicate the month of February 2010 to           common symptoms of teenage depres-                 since that may be your last opportunity to
  Northeast Ohio mental healthcare community by utiliz-                   the topic of teenage depression, an              sion such as irritability, academic prob-          recognize a red flag. This is especially
  ing his media appearances to dispel myths associated                    important aspect of which will be dis-           lems, withdrawal from some friends, drug           important for boys since the age old 'boy
  with mental illness. His TV appearances include the                     cussed each week. This week is dedicated         abuse, preoccupation with death and vio-           code' teaches them to not show or
  Robin Swoboda Show (Channel 8), In Good Company                         to recognition of red flags.                     lence, poor energy, change in sleep pat-           express emotions and not admit feelings
  (Channel 3), panel discussion on mental health issues in                                                                 terns, diminished interest in pleasurable          of depression as these could be seen as a
  Cuyahoga County (Channel 19/43), several morning news                      The red flags of teen depression are all      activities, etc.                                   sign of weakness or lack of toughness.
  segments on Channel 5 and Channel 3 etc. Additionally,                  around us, but the majority of society
  he has co-hosted two different weekly one hour radio talk               seems to completely miss them. For                  Other symptoms of teen depression                  Once you recognize a red flag, PLEASE
  shows on mental illness at WMMS and Q104.                               example, let us consider the tale of             include self-loathing, feelings of despair,        DO NOT TRY TO DIAGNOSE - this is
    Dr. Ranjan welcomes your questions your at                            Johnny, a seventeen year old who took an         unexplained aches and pains, increased             potentially very dangerous and confus-
  askthedoctor@charakresearch.com. He will be choosing                    overdose of cocaine in an apparent               sensitivity to criticism, changes in eating        ing. PLEASE DO NOT WASTE TIME, AND
  reader-submitted topics to be discussed in future                       attempt to 'feel good' and had to be taken       pattern, crying jags (often inexplicable),         SEEK PROFESSIONAL HELP IMMEDI-
  columns.                                                                to the emergency room due to cardiac             thoughts of suicide or homicide, etc.              ATELY. Please always err on the side of
                                                                          complications. Everybody around                  Other behaviors resulting from teen                caution - a good professional will tell you
                                                                          Johnny was taken by surprise. His par-           depression include running away, skip-             if your teen has clinical depression or just
                                                                          ents, who are successful professionals,          ping school, reckless or risk-taking               situational blues.

Young girls & body image:                                                 felt Johnny was involved in so many aca-
                                                                          demic and extra-curricular activities that
                                                                                                                           behaviors, internet addiction, tormenting
                                                                                                                           animals or children, etc. Teens with these       Early recognition of teen depression is
                                                                          he "hardly had any time to feel down.'
  Help form a healthy mindset                                             Parents were too busy themselves to
                                                                                                                           behaviors are often labeled 'bad kids' or
                                                                                                                           some of these behaviors are written off as
                                                                                                                                                                         vital in not only ensuring the safety of the
                                                                                                                                                                         teenager and others, but is also essential
                                                                          hardly ever have any 'downtime' with             'typical teen behaviors.' In fact, however,   for a better long term outcome for the
                                                                          Johnny. His teachers were shocked as he          any or all of these symptoms experienced      teen. Now, we are increasingly aware of
   By Rebecca Williams             is a normal part of develop-
                                                                          was a 'straight A' student, and did not          by Johnny and those listed above could        the 'kindling effect' whereby the earlier
   The Orlando Sentinel            ment, especially during
                                                                          think that recent drop of his grades to Cs,      be red flags for teen depression.             the depression manifests in a child and
                                                                          and Ds in a couple of subjects were more                                                       the longer depression remains untreated,
  I was hanging out with my           —Avoid negative state-              than a 'blip.' His basketball coach did not         So, what strategy should we employ to      greater the likelihood of more severe,
12-year-old niece the other        ments about food, weight,              make much of it when Johnny missed two           'catch 'em early' and intervene in a timely more frequent, more prolonged, and
night when she suddenly            and body size and shape.               practices in the past few weeks and              manner? Well there are certain 'gatekeep- more difficult-to-treat episodes of depres-
pinched her inner thigh and           —Allow the child to make            seemed 'disinterested' in a school tourna-       ers' who are in the best position to recog- sion in adulthood.
declared she hated her legs.       decisions about food, while            ment game recently. His friends failed to        nize teen suffering. They include parents,
  I was incredulous.               making sure that plenty of             attach any significance to the observation       teachers, coaches, school counselors,            NEXT WEEK’S TOPIC: Teen Suicide
                                   healthy and nutritious meals           that Johnny had been rather irritable            clergy, police officers, judges, and pri-
   Not only is my niece a          and snacks are available.              lately and was uncharacteristically more         mary care physicians. As I emphasized in         If you or a loved on is experiencing any
twig, blessed with skinny             —Compliment the child               interested in video games with themes of         my last article, there is a great need to     symptoms that would lead you to believe
genes that she definitely did-     on her or his efforts, talents,        death and violence. In the past few              educate these 'gatekeepers' about mental that there could be a mental imbalance,
n’t get from my side of the        accomplishments and per-               weeks, his girlfriend had left him several       illness in general, but especially among      please e-mail your questions to me at ask-
family, but she’s 12 years old.    sonal values.                          messages on his cell phone inviting him          teens.                                        thedoctor@charakresearch.com. Each
Certainly, a young girl               —Restrict television view-          to go see his favorite 'Spiderman" movie                                                       Wednesday, I will address some of these
shouldn’t be preoccupied           ing, and watch television              and Johnny, again unlike him, declined              These 'gatekeepers' should also be         questions in this column. All contact info
with a dislike for her body,       with the child and discuss             saying he had been feeling quite tired and       made aware of common risk and precipi- will be kept confidential. Help me bring
right?                             the media images you see.              needed more sleep. So, for everybody             tating factors for teen depression since      these issues to the forefront with Medina
   As I assured my niece that         —Encourage schools to               around Johnny, his overdose incident             we tend not to look for something we do       County residents.
she’s beautiful and has            enact policies against size            came 'right out of the blue.'                    not know about. These factors include a
amazingly toned and thin           and sexual discrimination,                                                              family history of depression (perhaps the        EDITOR’S NOTE: Last week’s column
legs (I admit I’m somewhat         harassment, teasing and                  What was happening to Johnny hap-              most important risk factor), parental         was misedited to read that Electroconvul-
jealous of them), I couldn’t       name-calling; support the              pens to millions of teenagers in this            divorce or separation, absence of a par-      sive therapy (ECT) was painful and dam-
help but wonder if my nega-        elimination of public weigh-           country, however only 20% of depressed           ent(s), changes of puberty, pressure for      aging. ECT is actually the most effective
tive comments about myself         ins and fat measurements.              teenagers receive any treatment. Almost          sexual activity, death of a loved one,        and safest treatment for depression; it is
when she’s around have any-           —Keep the communica-                everybody who touched Johnny's life had          break-ups, feelings of 'not fitting in,' etc. certainly painless when properly adminis-
thing to do with her claim         tion lines with the child              some red flags of depression in front of         Remember, in order to recognize red           tered. I apologize for any confusion this
that her legs are fat.             open.                                  them, but they could not recognize them.         flags, we need to keep NOT ONLY OUR           may have caused.

   I like to keep communica-
tion lines open with my
niece. Though she knows I’m
                                          In an emergency, you should always dial 911 or go to the closest ER for evaluation. For other times when you need to visit an emergency room, now you can first
the adult in our relationship,
we approach each other in                 go to akrongeneral.org/er for estimated wait times to see an ER doctor at any of our four emergency rooms. Akron General is the only area hospital to offer this
more of a sisterly way. Per-
                                          service. For more reasons to make Akron General your first choice in healthcare, including waiting less in our ERs, please visit akrongeneral.org/er.
haps because of this, I’ve felt
more free to express my con-
cerns to her when I’m having
a “fat day.”

   But that may be more
destructive than I think.

                                                               Introducing the region’s
explains that girls pay more
attention to what we do and
say than we realize. My niece
is hearing me say things like
“I wish I could lose this” or “I
wish I could tone that,” and
those comments are shaping
                                                              newest emergency service.
her body image.
   Feelings that may seem
harmless are, in fact, creat-
ing a potentially unhealthy
expectation of what a nor-
mal and healthy body should
                                                                           Our ER Wait Times
be. She’s already dealing with                 Akron                                           Montrose                                            Stow                                              Lodi
the pressure of media and

                                                22                                               08                                                  11                                             03
social expectations, and my
apparent dislike of my body
feeds into the idea that she’s
just not skinny enough.
                                               MINUTES                                          MINUTES                                          MINUTES                                          MINUTES
  Womenshealth.gov offers
the following for building
young girls’ body image:
                                          For current wait times, visit akrongeneral.org/er.
  —Make sure the child
understands that weight gain

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The Gazette                                                                                                                                                                     Wednesday, February 10, 2010                                B1

                          Health & Fitness
Teen Depression - Part 2 of 4
             Risk Factors and Warning Signs of Suicide
    By Dr. Rakesh Ranjan            pattern of aggressive or anti-     may be fully complete. In             long, but it could be longer

   Many of us know or know of
                                    social behavior, a recent but
                                    profound loss (e.g., death,
                                                                       essence, 'gatekeepers' and
                                                                       professionals should be
                                                                                                             since teens, like adults,
                                                                                                             express their feelings of             Meet
a teenager who has attempted
suicide. The number of
teenagers who attempt and
                                    breakup, etc), frequently
                                    impulsive behavior and strong
                                    feelings of hopelessness, help-
                                                                       alarmed by any significant but
                                                                       especially marked changes in
                                                                       a teen's mood, personality and
                                                                                                             despair in very individual
                                                                                                             manners.                              Dr. Rakesh Ranjan...
succeed at suicide is alarm-        lessness, and worthlessness        behaviors.                               WHAT TO DO WHEN YOU
ingly increasing. In this coun-     are at a much higher risk as                                             SPOT A TEEN WITH WARN-
try, suicide is the third leading   well.                                 The following is a list of         ING SIGNS OF SUICIDE?
cause of death for 15 - to 24 -                                        commonly known warning                   First of all, 'gatekeepers'
year olds. Additionally, as I         The 'gatekeepers'                signs of teen suicide that all        should never take things in
pointed out in last week's arti-  (described in last week's arti-      'gatekeepers' should be famil-        ‘their own hands.’Unfortu-
cle, one in six high school stu-  cle) and mental health profes-       iar with:                             nately, this happens often
dents report having had seri-     sionals should also consider         • Joking about suicide                which leads to tragic conse-
ous suicidal thoughts and one     other risk factors such as a         • Talking about death, dying          quences. If a teen is express-
in twelve report having actu-     broken home, a history of or           and suicide                         ing thoughts of suicide or
ally attempted suicide in the     current abuse (physical, emo-        • Making statements like 'I           threatening suicide, you have
preceding year.                   tional, or sexual), severe aca-        wish I were dead,' 'I would         no time to waste. Please
                                  demic failure, alienation              be better off dead,' 'I wish I      immediately have the teen
   Needless to say, teen suicide among peers etc. I must                 was never born,' 'I wish I          escorted to the nearest Emer-
is a very serious and surpris-    emphasize that each teen is            could just disappear' etc.          gency Room or mental health
ingly common problem. In          individually unique and              • Feeling trapped in a situation      specialist. If you suspect teen
light of the finality of an act   his/her psychosocial situation         ('There is no way out for           may be violent, please call
like suicide, it is especially    is singular; therefore the 'gate-      me')                                paramedics and/or police.                 The Medina-Gazette is pleased to welcome Dr. Rakesh
imperative to promptly recog- keepers' and professionals               • Talking positively about            The teenager should be under            Ranjan as a weekly columnist to our Health & Fitness fea-
nize the risk factors and warn- should pay attention to every            death ('My family would be          constant vigil until he or she is       ture. Each Wednesday he will be discussing a wide range
ing signs of teen suicide and to facet of a depressed teen’s life        better off without me,' 'Peo-       under the supervision of a              of mental health issues.
institute treatment immedi-       in order not to overlook a risk        ple might love me more after        health professional or facility.          Dr. Rakesh Ranjan is a practicing psychiatrist and a
ately. However, the stigma of     factor for suicide.                    I die.')                                                                    researcher. He is a recipient of several research awards
mental illness and a lack of full                                      • Expressing thoughts about              'Gatekeepers' should never           and has authored several peer-reviewed journal articles
understanding about feelings            Depressed Teens and              death, dying and suicide            play an ‘arm chair’ therapist           and book chapters on psychiatric illnesses and their treat-
of despair, etc, on teens' part        Antidepressant Drugs              through story - writing,            or psychiatrist, since this cre-        ments. He is a national speaker for several organizations
make these tasks very difficult.     On October 15, 2004, the US         poems/songs, drawings, or           ates a false sense of security          and serves on the medical advisory board for the NAMI of
A sense of invincibility among Federal Drug Administration               paintings etc.                      which could be lethally dan-            Greater Cleveland.
teens and a somewhat incom- (FDA) issued a warning that                • Giving away personal and            gerous. Please let the mental             In 2009, he was awarded the National NAMI Exemplary
plete understanding of the        there is an increased risk of          prized possessions.                 health professionals properly           Psychiatrist Award and the Ohio NAMI Psychiatrist of the
irreversible nature of death,     suicide and suicidal thoughts        • Exposing self to physically         evaluate the teen and make              Year Award.
especially in some younger        in children and teens who are          reckless situations or sus-         treatment decisions, which                Finally Dr. Ranjan has taken a leadership role in the
teens, also may contribute to     on antidepressant drugs. I will        taining a lot of accidental         may include a hospital admis-           Northeast Ohio mental healthcare community by utiliz-
this difficulty.                  discuss the issue in greater           injuries.                           sion. Please act as a resource          ing his media appearances to dispel myths associated
                                  detail in the fourth and final       • Saying 'goodbye' to friends         not an adversary to the mental          with mental illness. His TV appearances include the
  Risk Factors of Teen Suicide    segment of the 'Teen Depres-           and family                          health professional treating            Robin Swoboda Show (Channel 8), In Good Company
   For an overwhelming num-       sion' series. However, it suf-       • Seeking means to kill them-         your teen. Even when you                (Channel 3), panel discussion on mental health issues in
ber of suicidal teens, depres-    fices to say that any teen on          selves, for example, firearms,      spot warning signs which are            Cuyahoga County (Channel 19/43), several morning news
sion or another neurobiologi-     antidepressant drugs should            pills, etc.                         less impending than the overt           segments on Channel 5 and Channel 3 etc. Additionally,
cal disorder is the main cul-     be monitored very, very              • Threatening to hurt or kill         threat of suicide, the more             he has co-hosted two different weekly one hour radio talk
prit. After depression, bipolar closely for any signs of suici-          oneself.                            helpful step is to have your            shows on mental illness at WMMS and Q104.
disorder is perhaps the most      dality by the 'gatekeepers' and      • Expressing feelings of hope-        teen evaluated by a mental                Dr. Ranjan welcomes your questions at...
common diagnosis in teens         professionals. On the other            lessness, helplessness, or          health specialist at the earliest       askthedoctor@charakresearch.com. He will be choosing
who attempt or commit sui-        hand, this warning should not          worthlessness.                      possible occasion.                      reader-submitted topics to be discussed in future
cide. A teenager who has first stop parents, teens, or profes-         • Expressing feelings of a lack                                               columns.
degree relatives with mood        sionals from utilizing these           of purpose in life.                    Please remember suicide is
disorders or a history of         drugs when clearly needed.           • Feelings of rage or need for        irreversible, so you, as a ‘Gate-
attempted or completed sui-                                              revenge.                            keeper’, will not get a second       or treat any medical or psychi-               ance, please e-mail your ques-
cide is at high risk for suicide. Warning Signs of Teen Suicide        • Recently increasing use of          chance if you do not take the        atric issue.                                  tions to me at
This risk is even higher if these    As with risk factors for teen       alcohol/drugs.                      right step. If you are not sure                                                    askthedoctor@charakresearch.c
first-degree relatives include a suicide, the 'gatekeepers' and        • Withdrawing from others.            where to turn, please call The        NEXT WEEK’S TOPIC: Teen                      om. Each Wednesday, I will
parent. If both parents are       professionals should look for        • Any dramatic change in              National Suicide Prevention          Depression: Violence                          address some of these questions
afflicted with any of the above warning signs in the full con-           sleep/appetite/energy.              Lifeline at 1-800-273-TALK.                                                        in this column. All contact info
conditions, risk is generally     text of a teen's life, since every   • Showing increasing, inexpli-                                               If you or a loved on is experi-             will be kept confidential. Help
believed to be even greater.      teen's life experience is              cable agitation.                       The purpose of this article is    encing any symptoms that                      me bring these issues to the
Teens with a history of or cur- unique. Therefore, no list of                                                for educational purposes only.       would lead you to believe that                forefront with Medina County
rent drug/alcohol abuse, a        warning signs of teen suicide          As you notice, the list is          It is not intended to diagnose       there could be a mental imbal-                residents.

What is the Most Important Component of Your Diet?
 By Clifford M Sonnie, M.D.      outer wall of every cell in your      to generate and repair every          eventually reach a state where       easy?). The problem is that                   means that they contain all
                                 body contains an incredibly           tissue in the body, and mus-          you cannot even support the          eight of those amino acids are                eight of the essential amino
   Last week, a patient asked    high concentration of fats.           cle, most tissue and hormones         weight of your own arm and           called "essential" amino acids.               acids. Vegetable proteins such
me what is the most important Ninety-five plus percent of              are composed of proteins. As I        legs. Research done on con-          And the only way your body                    as grain, seeds, nuts, etc are
component of your diet? Pro- your brain is also fat. Protein           mentioned before, since you           centration camp survivors in         can get them is through diet.                 essentially incomplete
tein, Fats or Carbohydrates?     is the main component of              cannot store proteins, it is vital    literally every war we've            Now here is where I may incur                 because they are missing 1 or
Well, I was taken aback.         muscle. It is also the main           that you continuously replen-         fought in has proven this the-       the wrath of some of my vege-                 more of the eight. Therefore
Nobody had ever asked me         component of almost every             ish them through your diet.           ory. Areas in the world              tarian friends. All eight of                  it's vital that vegetarians be
that before, and to be truthful  other tissue that supports our           When you eat any food that         wracked with starvation due to       these essential amino acids                   very cognizant of what they
I had never thought about it.    skeleton in the body. You             contains protein, and I will get      lack of food, have also shown        come from animal sources                      eat. But it isn't impossible, it's
Everybody knows that I have      would not be able to contract         into those foods in a bit, diges-     this to be the case.                 such as meat, milk, eggs, etc.                just a little more difficult. For
always supported the notion      muscles or grow new muscle            tive enzymes and acids break             All protein is composed of        and are known as "complete
that, in a perfect world we      with out it. Wow!! So, which is       down the protein into the             amino acids. In fact your body       sources of protein". This                                               See DIET, B2
should get one third of our      most important? Well, I really        building blocks called amino          makes most of these amino
calories from fats, one third    don't want to say that one is         acids. They can be used any-          acids and you don't even
from protein and ( you           more important than the               where in the body and if you          know it. We just need to eat
guessed it) one third from car- other, but I think the one that        don't consume enough pro-             the appropriate vitamins, min-
bohydrates. Of course you        is most vital that we should          teins your body will begin to         erals and nutrients and our
have to eat the proper types of make sure we get daily in our
carbohydrates and fats. If you diet is protein. The reason I
wanted to lose weight or you     say this is quite simple. We
                                                                       break down itself. It becomes
                                                                       incredibly weak and you will
                                                                                                             body does the rest (don't you
                                                                                                             wish more things were this               OUR FOCUS IS
had blood sugar issues, you
decreased the carbs and
increase the fats and proteins
                                 can store fat and carbohy-
                                 drate, (some of us have stored
                                                                                         Ladies, Suspect                                               YOUR CARE
                                 more fats and carbohydrates
proportionately. I have always than others) but none the less
                                                                                       That Your Hormones
advocated this but when my       it can be stored for later use.                       Are Out of Balance?
patient asked me this I figured You cannot store protein. If
it was about time to do a little you don't use it you lose it. So         IN HONOR OF VALENTINES DAY
more research into the sub-      I think today's article will be              Consultations for women’s hormone
ject.                            on proteins.
   Ok gang, a "little" science.
                                                                          replacement will be half off the normal price.
                                    The word protein is from
It's not bad, don't worry.       the Latin word proteus. It
When you ask the question        means "that which comes
                                                                                 This offer is good from
which of the three compo-        first". Proteins are the build-              February 15 to 26, 2010 ONLY
nents is the most important      ing blocks of the body. They
it's hard to answer. Carbohy-    are composed of amino acids.                          Schedule a consultation with
drates are vital for not only    Amino acids are found in                               our consultant pharmacist
stored but also immediate        every single tissue and com-                        Jeff Potter to develop your plan.
energy. Fats are important for ponent of the body. It's used in
                                                                               We will work with you and your doctor to come up
tissue regeneration, and the     muscle contraction, it's used                with a customized plan using Bioidentical Hormones.

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 Balance Of Life Clinic                                                                 APPOINTMENT!
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 Supporting Your Commitment To Better Health                                                                                                                                                                                MEDINA COUNTY

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 www.BalanceofLifeClinic.com                                                                    Medina, OH 44256
3985 Medina Road Suite 250, Medina, OH 44256 (330) 764-4242
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The Gazette                                                                                                                                                         Wednesday, February 17, 2010              B1

                         Health & Fitness
Teen Depression - Part 3 of 4

                     By Dr. Rakesh Ranjan                                                                                                     • Detached or absent parents
                                                                                                                                              • Substance abuse and/or criminality in parents
   Columbine! A word that still reverberates in the minds of                                                                                  • Gang involvement
most Americans, especially teenagers and their parents. A                                                                                     • Rejection by peers/family
decade after the ill-fated high school massacre, most facts show                                                                              • Being a victim of bullying
that both Harris and Klebold, the perpetrators, suffered from                                                                                 • Academic failure
significant depressive symptoms. Klebold described his life, in                                                                               • History of problems with authority figures
his journal, as "the most miserable existence in the history of
time," Harrison referred to himself in his writings as "a god of                                                                              Warning Signs of Impending Violence in Depressed Teens
sadness." Shortly after the incident, the U.S. Secret Service and                                                                             These are the signs which, when spotted by you as a 'gate-
U.S. Education Department launched a study examining school                                                                                 keeper', should alert you to seek professional help immediately.
shooters. The main finding was that, while shooters had no set                                                                              This includes having the teen escorted to the nearest emer-
profiles, most were depressed. Other studies have also found                                                                                gency room or mental health specialist:
that a vast majority of school shooters suffered from depression                                                                              • Recent history of violent or aggressive behavior
and suicidal thoughts.                                                                                                                        • Drastically increasing use of alcohol/drugs
                                                                                                                                              • Increasing or uncharacteristic fascination with weapons,
   Let us ponder over a few relevant facts. Homicide is the sec-                                                                            especially guns
ond leading cause of death among young people ages 10-24.                                                                                     • Overt threats towards others
For African-Americans, in this age group, it is the leading cause.                                                                            • Increasing or uncharacteristically new feelings of anger
According to the CDC (Center for Disease Control) 2004 data, in                                                                               • Expressing preoccupation with themes of death and vio-
the same age group, an average of 15 get murdered each day,                                                                                 lence through writings, drawings, paintings, movies, video
and almost 80% of these victims are killed with firearms. In                                                                                games etc.
another 2004 nationwide survey of high school students it was                                                                                 • Increasing withdrawal from peers/family
found that about 17% carried a weapon to school on one or                                                                                     • Increasing feelings of alienation from peers/family
more days in the preceding 30 days; 33% were in a physical fight                                                                              • Joking or bragging about committing violence/suicide
one or more times in the preceding 12 months and 9% were hit,                                                                                 • Recent, profound loss (e.g. significant break-up, death, etc)
slapped, or physically hurt on purpose by their boyfriend or                                                                                  • Recent history of abuse or either severe trauma
girlfriend in the preceding 12 months.                                                                                                        • Any warning signs of suicide (as described in the second
                                                                                                                                            article of this series)
  Why violence is so prevalent among teens?                                                                                                   It is important to realize that a suicidal teen is more likely to
  I believe that the increasing incidence of depression among                                                                               engage in violence since he/she has 'nothing to lose.'
teens is definitely a contributor. This issue was discussed in the
                                                                                                                                              How can We Prevent Violence among Teens in General?
                                                                                                                                              As a 'gatekeeper' and society at large, we should do every-
 Meet                                                                                                                                       thing we possibly can to prevent violence among teens. The fol-
                                                                                                                                            lowing is a list of things we can do:
 Dr. Rakesh Ranjan...                                                first article of this series on teen depression. Currently, about
                                                                                                                                              • Seek professional mental health help at the FIRST SIGN of
                                                                                                                                            emotional distress which is unduly prolonged
                                                                     8% of American adolescents suffer from depression.                       • Help change societal attitude towards violence which, in
                                                                        Another main contributor is a cultural shift, over the last few     any form should not be tolerated or glorified
                                                                     decades, in societal attitudes towards and acceptance of vio-            • Help change home environment to be supportive,
                                                                     lence. Our modern culture often views expression of violence           empathic, and loving
                                                                     as glamorous and 'manly.' These attitudes especially put boys            • Help change school environment to be more supportive and
                                                                     at a higher risk of committing violent acts as a means to 'right       sensitive. Crack down on bullying
                                                                     the wrong.' Increasing acceptance by our society of violence as          • Help improve neighborhood environments by encouraging
                                                                     a noble act through certain movies and video games is also             social activities. Crack down on gangs.
                                                                     problematic.                                                             • Monitor teens' use of internet, video games, and TV with
                                                                        In my clinical practice, I have noticed that schools and teach-     regards to violent themes.
                                                                     ers have a somewhat lackadaisical attitude towards bullying,             • Be role models by way of resolving conflicts with non-vio-
                                                                     which, when not properly addressed, may lead to violence by            lent means.
                                                                     the victim.                                                              • Know warning signs of teen suicide
                                                                         Adults, in our modern American society, are often violent            • Keep firearms out of the home or absolutely out of reach of
                                                                     towards children and each other, thus creating poor role mod-          teens.
                                                                     els. As the U.S. surgeon general mental health report on youth
     The Medina-Gazette is pleased to welcome Dr. Rakesh
                                                                     and violence observed, by the time they reach adolescence, 16            I must emphasize that the above lists may serve as general
   Ranjan as a weekly columnist to our Health & Fitness fea-
   ture. Each Wednesday he will be discussing a wide range           million teens in this country have witnessed some form of vio-         guidelines for the 'gatekeepers' and do not represent an
   of mental health issues.                                          lent assault, including robbery, stabbing, stealing, murder, or        absolute number of factors we should consider when assess-
     Dr. Rakesh Ranjan is a practicing psychiatrist and a            domestic abuse.                                                        ing/monitoring risk of violence in a teen. This is because, as I
   researcher. He is a recipient of several research awards                                                                                 have stated earlier, each teen's life experiences and perceptions
   and has authored several peer-reviewed journal articles             Risk Factors of Violence in Depressed Teens                          thereof are uniquely individual.
   and book chapters on psychiatric illnesses and their treat-         You, as a 'gatekeeper', should be aware of these risk factors so
   ments. He is a national speaker for several organizations         you can keep your guard up when dealing with these teens:
   and serves on the medical advisory board for the NAMI of                                                                                    The purpose of this article is for educational purposes only. It is
                                                                       • Males are at a higher risk since boys tend to express their        not intended to diagnose or treat any medical or psychiatric
   Greater Cleveland.                                                feelings of depression through bravado or 'action'
     In 2009, he was awarded the National NAMI Exemplary                                                                                    issue.
                                                                       • Co-occurrence of ADHD (attention deficit hyperactivity dis-
   Psychiatrist Award and the Ohio NAMI Psychiatrist of the
   Year Award.                                                       order) or anxiety disorders.                                             NEXT WEEK’S TOPIC: Teen Depression: Prevention
     Finally Dr. Ranjan has taken a leadership role in the             • Depressed or mixed manic phase of bipolar disorder
   Northeast Ohio mental healthcare community by utiliz-               • Antisocial beliefs                                                    If you or a loved on is experiencing any symptoms that would
   ing his media appearances to dispel myths associated                • History of aggressive behavior, especially in early childhood      lead you to believe that there could be a mental imbalance,
   with mental illness. His TV appearances include the                 • Drugs/alcohol abuse                                                please e-mail your questions to me at askthedoctor@charakre-
   Robin Swoboda Show (Channel 8), In Good Company                     • Early involvement with legal system                                search.com. Each Wednesday, I will address some of these ques-
   (Channel 3), panel discussion on mental health issues in            • Learning disorder                                                  tions in this column. All contact info will be kept confidential.
   Cuyahoga County (Channel 19/43), several morning news               • Low IQ                                                             Help me bring these issues to the forefront with Medina County
   segments on Channel 5 and Channel 3 etc. Additionally,              • Conflicted/harsh/violent parenting or home life                    residents.
   he has co-hosted two different weekly one hour radio talk
   shows on mental illness at WMMS and Q104.
     Dr. Ranjan welcomes your questions at...
   askthedoctor@charakresearch.com. He will be choosing
   reader-submitted topics to be discussed in future
   columns.                                                                             FA M I LY P H YS I C I A N J O I N S M O N T R O S E P R I M A RY C A R E
                                                                                                   R E B ECCA A N DA LO R O, M D
    Enjoy a Gracious and Dignified
        Lifestyle at Elmcroft!
  Each day at Elmcroft,
  we bring our hearts to work.
  • Trained staff providing care                                                                                          REBECCA ANDALORO, MD
    24 hours a day                                                            Dr. Andaloro graduated from Northeast Ohio University College of Medicine and completed her residency at
  • Three restaurant-style meals daily                                        Summa Health System. She is Board Certified by the American Board of Family Medicine.

  • Specialized memory care program                                           Montrose Primary Care Physician Alexia Lishnevski, MD welcomes Dr. Andaloro to the practice.

  • Planned social activities each day                                        Rebecca Andaloro, MD
                                                                              Montrose Primary Care
   Contact Chrissy at 721-2000                                                4125 Medina Road, Suite 200B, Akron, Ohio 44333
   to schedule your personal tour                                             New patients welcome. Provides complete family care
     and complimentary lunch.                                                 from newborn to geriatric. Special interests include
                                                                              pediatric and female care.
                                                                              For an appointment, call 330-344-1255
                   ELMCROFT OF MEDINA
                   Assisted Living & Memory Care Hearts at work.                                      Member of Akron General Partners Physician Group
                   1046 N. Jefferson St., Medina, OH 44256
                   330-721-2000 www.ElmcroftAL.com                                                                                                                w w w. a k r o n g e n e ra l . o r g

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The Gazette                                                                                                                                                            Wednesday, February 24, 2010               B1

                         Health & Fitness
Part 4 of 4
              How Best to Manage Teen Depression
   "You were in my room                                               teens and their families tend       least once by a psychiatrist,        medication and/or counsel-           gradually over 2 months or
again!" Matt, normally a                                              to lapse into denial wishing        the most qualified mental            ing.                                 longer in order to avoid any
happy kid, glared at his                                              symptoms will just go away.         healthcare professional. An             Finally, attention should be      withdrawal symptoms (only in
mother, "I told you to stay out                                         • Stigma: Even when people        accurate diagnosis is para-          given to the well being of fam-      case of certain antidepres-
of there!"                                                            sense the need for some kind        mount to proper and efficient        ily as a whole as having a           sants) and spot return of
   "I just dropped off your                                           of intervention, they tend to       treatment. Parents and/or            depressed teen is very stressful     symptoms.
clean laundry," his mother                                            'drag their feet' because they      'gatekeepers' need to find a         to the family. Family therapy          • Psychotherapy should also
replied, "I wasn't snooping."                                         do not want to be labeled or        psychiatrist they feel comfort-      may be needed in some cases.         be continued for several
Matt stomped off to his room,                                         considered weak.                    able with. However, once that                                             months after resolution of
slamming the door behind                                                • Misconceptions: Most            is accomplished, the wise                     Pitfalls in use of          symptoms and/or stressors
him.                                                                  people still do not view clini-     option is to listen to and com-       antidepressant drugs in teens         • Neither medications nor
   His mother sat down shakily                                        cal depression as a medical ill-    ply with the recommendations            There are certain red flags       psychotherapy should be dis-
at the kitchen table. What was     DR. RAKESH RANJAN                  ness. Therefore, teens and          made by the psychiatrist. It is      'gatekeepers' should be              continued when a new stres-
happening to her son? Matt         "It'll turn me into a zombie,"     parents tend to try non-med-        perfectly alright to ask ques-       watching out for when a teen         sor is anticipated.
had been just like any other       he complained, "and my             ical options first. This often      tions about risk/benefits of all     is on antidepressant medica-
teenager until age fifteen.        friends will think I'm a freak!"   leads to a loss of valuable time    treatment options, but the           tions. The prescribing physi-          Do antidepressants have an
After breaking up with his girl-      And then more family mem-       and worsening of symptoms.          ultimate recommendation has          cian should be contacted if           long-term adverse effects on
friend, he had become              bers stepped in. Matt's Aunt       Also, there is a lot of misinfor-   to come from a psychiatrist.         any of the following appear:                    teen brain?
increasingly argumentative         Peggy decided 'there was           mation about antidepressants        Please do not get swayed by             • Increasing or new                  In spite of speculations,
with his parents and teachers.     nothing wrong with Matt' and       swirling around on the inter-       anecdotes or opinions of fam-        thoughts of suicide or a sui-        there is no conclusive evi-
A gifted student, Matt's grades    that he just needed to get out     net. As I have stated earlier,      ily members/friends who are          cide attempt                         dence that antidepressant
were plummeting. And he had        more. She gently suggested         some 'gatekeepers' are              not psychiatric professionals.          • Increasing symptoms of          medications cause any kind of
lost interest in his greatest      Matt start attending church        inclined to play 'armchair psy-        • Address co-morbid psy-          clinical depression                  damage to the evolving teen
passion - football. When he        and she set up a meeting for       chiatrists'; thus adding to mis-    chiatric conditions: Again, a           • Increasing or new anxiety       brain. On the other hand,
pulled the covers over his head    him to talk to the pastor. Matt    information.                        competent psychiatrist will be       symptoms                             there is some evidence that
and ignored a wake-up call for     was relieved that Aunt Peggy                                           able to both diagnose and               • Increasing or new agita-        these medications normalize
football practice, his mother      was 'on his side' and would        So, what is the best approach?      manage any co-morbid condi-          tion, or restlessness, or anger      levels of glutamate (a brain
began worrying. Her concern        save him from appearing               The best way to help a teen      tions such as anxiety disorders         • Physical aggression             chemical which has protective
grew when his homeroom             'weak' if he were to take pills.   with depression is for the          or substance abuse disorders,           • Impulsive behavior              effects on neurons) in brains
teacher called. Matt, she said,    In the meantime, Matt's inner      'gatekeepers' and mental            etc.                                    • Severe insomnia                 of depressed children and
had become increasingly sad        world was collapsing. He was       healthcare professionals to                                                 • Euphoric feelings               adolescents. A reduced level
and withdrawn. Were there          getting deeper into the black      work together so that teen gets       What are the best treatment                                             of glutamate in certain parts of
any problems at home, she          hole of despair.                   an unified message about                         options?                   If some of the above symp-        the brain has been linked to
wondered.                             One Friday night while his      managing his/her depression.           Despite conflicting and           toms appear after a teen is          depression.
   Later that evening, hearing     parents were out for dinner,       This could be accomplished          often scary information about        placed on antidepressant
Matt's muffled sobs behind         Matt looked in the mirror and      by doing the following:             antidepressant medication in         medication, the teen should             The purpose of this article is
the door of his room, his par-     saw no purpose in living any-         • Education: 'Gatekeepers'       popular literature, internet,        be re-evaluated by a psychia-        for educational purposes only.
ents decided it was time to        more. Fumbling through his         need to be educated about           and folklore, a preponderance        trist for the possibility of bipo-   It is not intended to diagnose
take Matt to a counselor. But      parents' medicine cabinet, he      teen depression. They should        of scientific evidence indicates     lar disorder. With regards to
                                                                                                                                                                                    or treat any medical or psychi-
Matt resisted, saying he was       downed a handful of pain           take the initiative and famil-      that antidepressant medica-          suicidal thoughts after the ini-
                                                                                                                                                                                    atric issue.
just going through a rough         killers. When his parents came     iarize themselves with red          tions known as SSRIs (Selec-         tiation of antidepressants in a
                                                                                                                                                                                       Dr. Rakesh Ranjan is a prac-
patch and that he could han-       home, they found the sight         flags of teen depression as I       tive Serotonin Reuptake              teen, please refer to part 2 of
                                                                                                                                                                                    ticing psychiatrist and a
dle it himself. His parents        they had been dreading since       outlined in part 1 of this arti-    Inhibitor) are the single, most      this article. Clearly any teen
                                                                                                                                                                                    researcher. He is a recipient of
backed off.                        Matt's troubles began. He was      cle. For further information I      effective treatment for teen         on antidepressant medication
                                                                                                                                                                                    several research awards and
   After that, Matt put on a       unconscious on the bathroom        recommend only these two            depression.                          should be monitored and eval-
                                                                                                                                                                                    has authored several peer-
brave face but his symptoms        floor. They called 911.            websites: www.webmd.com,               However, it is also clear that    uated frequently and regularly
                                                                                                                                                                                    reviewed journal articles and
grew worse. Always optimistic,        Matt was admitted to a psy-     and www.nimh.nih.gov. For           the best treatment outcome is        by a psychiatrist even when
                                                                                                                                                                                    book chapters on psychiatric
he began wondering if the          chiatric hospital. The treating    the latest findings on efficacy     achieved by combining med-           the teen is apparently doing
                                                                                                                                                                                    illnesses and their treatments.
world would be better off          psychiatrist met with his par-     of antidepressant medications,      ication, therapy [especially         well.
                                                                                                                                                                                    He is a national speaker for
without him. He finally con-       ents, Aunt Peggy, and Matt,        cognitive-behavioral therapy,       Cognitive Behaved Therapy
                                                                                                                                                                                    several organizations and
fessed to his parents that he      and recommended a trial of         and a combination thereof, I        (CBT)] and targeted interven-              How long should the
                                                                                                                                                                                    serves on the medical advisory
was experiencing suicidal          antidepressant medications.        recommend this website:             tions for home, school or                     treatment last?
                                                                                                                                                                                    board for the NAMI of Greater
thoughts. After much cajol-        His family reluctantly agreed.     www.nimh.nih.gov/studies/in         social issues.                          • Antidepressant medica-
                                                                                                                                                                                    Cleveland. If you or a loved on
ing, Matt agreed to see a coun-    About ten days later, Matt was     dex.cfm for information on a           So, in essence, your              tions should be continued for
                                                                                                                                                                                    is experiencing any symptoms
selor who recommended he           discharged, feeling greatly        NIMH - sponsored study              depressed teen is best man-          at least several months after
                                                                                                                                                                                    that would lead you to believe
get evaluated by a psychiatrist.   improved and non-suicidal.         called the Treatment of Ado-        aged by a team of a competent        symptoms of the depression
                                                                                                                                                                                    that there could be a mental
"He will probably need med-           Challenges in treating teen     lescents with Depression            psychiatrist and a skilled ther-     have completely resolved. In
                                                                                                                                                                                    imbalance, please e-mail your
ication for clinical depres-       depression                         Study (TADS).                       apist. Support from parents,         my opinion, if a teen has a
                                                                                                                                                                                    questions to me at askthedoc-
sion," the counselor said. His        Matt's story is very emblem-       • Be proactive: 'Gatekeep-       other family members, school,        strong family history of
                                                                                                                                                                                    tor@charakresearch.com. Each
parents were terrified that        atic of the challenges faced by    ers' should ensure a teen with      clergy, etc, may also play an        depression and has had 2 or
                                                                                                                                                                                    Wednesday, I will address some
antidepressant medications         mental healthcare profession-      red flags of depression is          important role, when applica-        more episodes of depression
                                                                                                                                                                                    of these questions in this col-
might increase Matt's suicidal     als in treating teens with         promptly evaluated by a men-        ble.                                 in the past, the medication
                                                                                                                                                                                    umn. All contact info will be
thoughts as they had read          depression. I will outline         tal healthcare professional.           As stated earlier, for most       should be continued for sev-
                                                                                                                                                                                    kept confidential. Help me
something about the potential      them below:                           • Listen to professionals:       optimal treatment outcome,           eral years.
                                                                                                                                                                                    bring these issues to the fore-
risk on the internet. And Matt        • Denial: This is clearly the   Teens with depressive symp-         any and all co-morbid condi-            • Any discontinuation of
                                                                                                                                                                                    front with Medina County resi-
didn't want to take any pills.     number one challenge. Most         toms should be evaluated at         tions should be managed with         medication should be done

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