Suicide is every parent’s nightmare. On an ongoing basis, there are pressures in teenager’s lives that we know about, and we don’t know about. It’s never simple. In the case of 13 year-old Cayman Naib who was found near his home with a self-inflicted gunshot wound last week, I am sure there are a lot of questions that friends, teachers, and family are asking themselves.

According to the CNN story, Naib left shortly after receiving an email from the school about overdue homework. Most likely that was not the trigger for his suicide. As an adolescent psychiatrist, I know that these stories are usually far from complete. I believe there might have been signs of pre-suicidality that were missed. A suicide rarely happens out of the blue after an email about homework, although sometimes a suicide does appear to come out of nowhere. More often some social rejection or another stressor is present.

Psychological testing of all students is not practical, but the good education of teachers (see our recent blog) and parents to signs of depression or other mental disorders is best.

I think it needs to be pointed out that suicide does not discriminate. The best defense against these situations is knowledge, and the courage of parents to ask the right questions. Here is a list of warning signs that I posted for parents in an earlier blog.

I want to make it clear that knowing the warning signs of suicide can save lives, but it certainly is no guarantee. Hopefully, families that are faced with the suicide of a loved one can eventually find peace, and they need to know that this is not their fault.

Click here for more on Cayman Naib’s story.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

If you suspect that your teen might be depressed or contemplating suicide then you need to act right away. Here is a quick list of things to look for:

• Always take seriously any mention or discussion of death, dying, suicide, self destruction or other evidence of morbid thinking that your teenager may manifest
• Talk to your teen, listen, don’t lecture, express love and reassurance, and realize that suicidal ideation and depression are usually temporary and treatable states but probably need immediate professional intervention.
• If you are worried that your teenager may be contemplating suicide, remove any weapons, pills, or other objects of substances in the house to which he or she may have access to achieving the act.
• Get professional help immediately. Remember that depression is almost always indicated in suicidal teenagers and that a combination of “talk therapy” and medication can turn things around.
• Get the numbers and/or websites of suicide hotlines both to report any fears or concerns you may have and to learn more about the likelihood of your teen carrying through any suicide attempt if you remain unsure.
• Note changes in behavior mentioned previously (including dressing in black) and take them seriously. Engage your teen in conversation about what’s going on with him or her in his or her life and what he or she intends by the changes in dress or behavior you have noticed.
• Don’t Judge. Family supportiveness is crucial. The point is always to get your teen to talk, not to lecture or try to persuade him or her out of feelings.
• Be especially alert if your family has had a history of suicide or suicide attempts.
• Understand that in a minority of cases, if the depression or other underlying reasons for your teen’s suicidal thoughts and/or behavior indicate it, your teen may need hospitalization and a combination of therapy and medication.
•  The most important thing you can do if you think your child is suicidal is to explore the situation openly. If your child states that he has suicidal ideas or intentions or plans then an immediate mental health evaluation is necessary. Go to the nearest hospital emergency room or mental health crisis unit.

Check my February blogs on Suicide for more information, and certainly feel free to contact me.

Statistics of Suicide
The Warning Signs of Suicide
What to Do If You Feel Your Child Might Be Suicidally Depressed

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

The most important thing you can do if you think your child is suicidal is to explore the situation openly.  If your child states that he has suicidal ideas or intentions or plans then an immediate mental health evaluation is necessary.

Unfortunately, things are not always that clear, so first ask yourself is my child or teenager depressed? If after a week or two, a sad mood does not budge or gets worse and signs of depression are present, be concerned.   Talk to your child openly about how he or she is feeling.  Include direct questions about suicide. Many parents mistakenly feel that by asking about suicide they will put it in a child’s mind.  This does not happen. It is important to know what your child is thinking and direct questioning is the best way to find out. You can ask directly about suicidal ideas, rehearsals, preparations, and the like. This can also be done by asking something like: Sometimes when we feel like this, thoughts of dying or wanting to take your own life can pop up. Has that ever happened to you? Further probing can include other questions like:

•     Do you think about death?
•     Do you feel like you want to disappear?
•     Do you feel hopeless?
•     Do you think about the afterlife?

It is also essential that you look for possible signs of preparation:  a note or other writing, a weapon, or hoarded medication.  Increased drug use is also a high risk sign

If, after open, kind, and compassionate questioning of your sad child, without lecturing or criticizing, you see no progress in the depression, and have little or no handle on understanding the situation, and see any signs of possible suicidal intent, then a mental health assessment is needed. No time should be wasted in getting professional attention.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

Potentially suicidal young people frequently show warning signs. What follows is a list of some of the thoughts, feelings, and actions that could indicate that a young person is contemplating suicide. They range from internal, unexpressed thoughts, like wanting to die, to overt actions, like writing a note or collecting drugs or weapons.

• Thoughts of death
• Wanting to die
• Prior suicide attempts/gestures
• Feeling that the world would be better off if they were dead
• Feeling useless and hopeless
• Giving verbal hints about not being able to take it anymore
• Writing about death
• Getting absorbed in music, video sites, or activities stressing death or suicide
• Talking of the afterlife
• Dressing in black
• Becoming absorbed in morbid subjects
• Having an inappropriate burst of enthusiasm or cheerfulness after being depressed (this sometimes indicates that a person has decided to commit suicide)
• Cleaning house and putting his/her things in order
• Writing a suicide note
• Buying books or researching modes of suicide
• Idealizing celebrities who have committed suicide or died in other ways
• Engaging in drunken driving
• Accumulating weapons

If you see any of these signs you should be immediately concerned and contact a medical health professional right away.  In my next blog I will discuss having an open conversation with your sad/depressed child if you suspect that he or she might be contemplating suicide, but is not showing any clear signs like those listed above.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

Of course, suicide is always a worry when there is talk about depression.  While suicide is quite uncommon for younger children, we do see an increase starting at about nine years old.  By 13 to 14 years old, the rate of suicide increases and becomes the third highest cause of death for 10 to 24 year-olds. The rate of suicide under ten years old is about .8/100,000 children, it doubles in the 10 to 14 year old group but then increases to about 8/100,000 by 15 to 19 years old. Suicide attempts are often reported as accidents and are not reflected in the statistics — like the depressed teenager who crashes the car into a tree. About two thousand suicides in youngsters occur in the United States each year. There are about one hundred thousand world-wide. While depression is the main risk factor associated with youth suicide, other conditions also raise the risk:

·         Behavior disorders

·         Physical/sexual abuser

·         Severe anxiety

·         Eating disorders

·         Suicide in the family

·         Substance abuse

·         Being bullied

·         Family disruption

There are many triggers for suicide including being rejected socially or in a love relationship, school failure or expulsion, being caught by the police doing an antisocial act, feeling humiliated, being intoxicated, and experiencing family stress.  Hopelessness, often found in depressed youngsters, is one of the most indicative signs of a possible suicide attempt.

So where do antidepressants fit into adolescent/teen suicide? After some preliminary studies had come out from the FDA in 2003 and 2005 saying that there was an increased risk in suicidal thoughts in children, adolescents and young adults, parents became scared to have their child on any of these medications.  There was, and still is, a lot of information on the Internet to dissuade parents from using antidepressants, so I understand the fear.

Here’s how I see it.  When the studies came out, many psychiatrists, me included, spoke out nationally emphasizing that if, in fact, this was a risk, it was so rare that most of us had never seen it and that proper monitoring by the prescribing physician would, in all probability, be enough to ward off any tragedy.   Despite this, the new prescribing of antidepressants dropped markedly.  Tragically the suicide rate increased in teenagers.  No scientific correlation was made, but it seems that this was related to less use of the antidepressants which could have treated the depression and prevented the suicide.

The reality is that, if prescribed correctly under the guidance of an experienced psychiatrist, I do not think there is an increased risk of suicide.  Further studies about particular drugs with proper control groups will clarify this.   What I recommend is that parents do not withhold antidepressants on what we know so far, but parents should be cautious and make sure that their child is being monitored for every possible side effect.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.