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DEPRESSION: Out of the Shadows
Take One Step: A PBS Health Campaign
DEPRESSION: Out of the Shadows + TAKE ONE STEP: Caring for Depression, with Jane Pauley  

Faces of Depression: Josh Lipton and Wendy Clough
< Faces of Depression

Josh Lipton and Wendy Clough

Eighteen-year-old Hart Lipton's struggle with depression began in the sixth grade. Initially diagnosed with a combination of depression and ADHD, Hart's treatments proved ineffective. Ultimately, his depression deepened to the point that suicidal feelings began to overwhelm him, and he requested hospitalization for his own safety.

Several years and several diagnoses later, Hart was diagnosed with Bipolar II. This disorder is often confused with depression, but is treated differently. Hart and his family found a treatment regimen that has virtually eliminated his depression.

Throughout Hart's experience, his parents Josh Lipton and Wendy Clough worked with mental health professionals and trusted their own insights to select therapies that would help their son. Hart, an accomplished artist, is now graduating from high school, and will begin college at the San Francisco Art Institute. His parents share their family's story, and discuss how the family supported Hart in finding effective treatment.

Interview

Hart has shared that his depression developed about the time he entered junior high school. Can you talk about Hart as a young child in contrast to Hart after he developed the disorder? In other words, what changed about Hart, and what remained the same?
When Hart was a young child, he was cheerful, calm, serene, and shockingly sweet and kind. He was always very comfortable with himself, and adopted a role of peacemaker in any dispute at home or school. He was a very good student - careful, hardworking, and interested. He enjoyed team sports, and took pride in being a "hard worker" at sports and at school.

As he entered his depression, he became withdrawn, and was often angry and oppositional. He lost all interest in school and became incredibly disorganized. In addition to his belongings and schoolwork, his messiness extended to his person. He displayed a lack of self-confidence and had very few interests other than skateboarding. He avoided high-performing kids, lost interest in sports or exercising, and preferred to either be alone or with other disturbed kids.

But throughout his dark period, Hart held onto many of his core personality traits. Even when times were bad, Hart remained the caring, kind, and thoughtful person he had been before. He also - thankfully - remained very open and warm with his family. At no point did Hart, the person, ever change. It's just that his dark and defiant moods would get in the way of his being himself.

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Some parents describe their child's descent into depression as "happening overnight," while others witness more gradual changes. Would you say Hart's symptoms appeared over a period of time, or very rapidly? Was there a defining moment in which you determined that Hart was seriously ill?
Hart's changes were both sudden and gradual. When Hart entered sixth grade, he went through a pretty sudden mood shift. It was the first time we had ever seen him unhappy in school. After that initial instance, however, his slide into serious depression was fairly gradual. We experienced a three-year period of general decline until he started ninth grade, when we tried talk therapy and antidepressants.

However, when Hart started high school, he experienced another precipitous decline into severe depression. At that point, we needed more serious intervention; it was really Hart who communicated that need to us.

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Many parents and mental health experts describe how easy it is to confuse depression with normal adolescent behavior (including melancholy, questioning, defiance, etc.). Can you offer readers some insight into some key differences between the "growing pains" and depressive symptoms?
It seems as though there's a continuum of behaviors that can range from obviously "normal" to obviously "ill." The behaviors along that continuum are really hard to sort out. In Hart's case, things reached such an extreme situation that we had no doubt about his condition's severity. However, until we reached that point, we probably sometimes tried to convince ourselves that his extreme moods were just normal. In addition to wanting to avoid difficult issues, our denial was also sometimes due to the fact that it's a really painful and difficult process to find effective help!

The only guidance that we can offer is that there were certain behaviors that clearly indicated that Hart was in pain. These behaviors prevented him from being the person that we knew him to be. When a person can't be himself, something's wrong.

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We know that you were very proactive in seeking help for Hart, and played a key role in tracking and defining his symptoms, behavior, and feelings. Describe your experience seeking professional help for Hart, and offer your advice on how parents can partner with experts to best serve their child.
It's really, really hard finding the right kind of help. You have to hunker down for the long-run, and be prepared to accept that there are no quick solutions. That's really hard to accept when you are trying so hard to help a much loved child, and you want to "fix" the problem quickly. But there is a certain amount of trial and error. Therapists, therapies, and medications work differently for every individual. So you have to be prepared to slog through some different trials to find the solution to your individual child's circumstances.

Of course, do as much of your own research as you can. There is no shortage of people, including many highly qualified people, who can offer their opinions. But always remember that it's your child. Nobody knows your kid as well as you do. So while it's very important to listen to and accept what experts are telling you, it's equally important to calibrate that input against what you know about your child.

We've met a number of caring, educated, and competent professionals when seeking help for Hart. But the "fit" wasn't always right, or their observations didn't jibe with our sense of Hart as a person. It's important to listen to your child and listen your "inner voice" when weighing recommendations. And if the first (or second, or third) recommendation or approach doesn't help, try another. And another. Never give up hope.

Another thing for parents to consider is that it's so important to children's mental health that they perceive themselves as good at something. That's sometimes difficult in a school setting where a depressed child is consistently acting out or failing. We really urge parents to find their child's unique strengths, and encourage them in a positive way.

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How can parents work to "tailor" therapy for their individual children?
Consider children's individual personalities, their likes and dislikes, their strengths. For example, since children need to experience success, it's helpful for parents to consider a wide spectrum of educational settings for their kids. One of the problems with teenage depression is the way it is often read as "bad" behavior. At a parent/teacher conference, there is a good chance you will be told that your depressed child doesn't do his homework, is disruptive, doesn't care, or doesn't try. And if the conference includes your child, the teen is sitting there and listening to a lot of negative information about him or herself. And that's really discouraging for everyone.

Of course it's hard for teachers to make the extra effort to help a "sullen" or withdrawn kid, and not all teachers are up to the challenge. Even the most alternative public schools may not be able to help you and your family; depending on the school, the combination of behavioral and academic expectations can be counterproductive to helping the child cope with depression. Seek out a school where your child can thrive.

This same concept of finding the right environment for your child extends to his or her therapist. Sometimes even mental health professionals can demonstrate a disciplinarian attitude try to "correct" a behavior that is really more of a symptom of depression, or a reflection of how the child feels inside. In Hart's case, there were a couple of therapists whose stern approach was actually the antithesis of what we felt Hart needed. This perception was a "gut reaction" about the situation, and is difficult to articulate. Again, you know your son or daughter. So in addition to doing your research, trust your intuition about the best kinds of environments, treatments, and therapists for your child.

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What does Hart need to consistently do to manage his mental health?
Hart takes several different daily medications, which can be hard for him to remember. He has gone through periods when he wishes he didn't have to take medication. When he thinks about the alternative, though, it doesn't seem like such a big deal. As he's gotten older, he's become much better about remembering his medications, and realizing how much they really do help.

The other parts of Hart's mental health management plan are similar to the rest of us: forging and enjoying friendships, enjoying the love of his family, playing with his dogs, and visualizing and pursuing his future.

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What do you think that schools, pediatricians, and youth organizations can do to help or educate families about adolescent depression?
Schools, pediatricians, youth organizations, religious organizations, parenting groups, and anyone who deals with children really need to learn more about depression. We should all be as alert to depression as we are to any other physical disorder. People need to be willing to discuss depression and bipolar disorder. People need to be open to talking about medication, and accept that it's no different than taking medication for any other illness. Education, communication, acceptance, and openness could improve - and save - a lot of lives.

To start helping people who are suffering, we need to eliminate the stigma associated with depression and mood disorders. This stigma just makes people avoid seeking help. They withdraw further into themselves, and feel like outsiders in society. We'd like to see depression discussed openly and regularly in school meetings, with guidance counselors, with doctors, with coaches, in youth organizations. Wherever kids gather, that discussion needs to happen.

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What are positive outcomes Hart and/or your family has experienced as a result of this journey?
It's true that there have been times when the journey has been pretty rough, particularly for Hart. On the other hand, we feel very lucky to have such a close, warm, and open relationship with Hart, and are so happy to see him continue to grow into such a wonderful young man. And the light at the end of this tunnel is that by living with depression, your child can develop incredible compassion for others, and a self-awareness and knowledge that many adults lack.

Learn more about teen depression

The Jed Foundation: www.jedfoundation.org

The National Mental Health Information Center's Child, Adolescent, and Family section: mentalhealth.samhsa.gov/ cmhs/ ChildrensCampaign/

The Federation of Families for Children's Mental Health: www.ffcmh.org

Your child's pediatrician, school counselor or social worker, or local public health agency may offer insight into your community's youth mental health resources; speak with them to learn more.

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