As Kelsey Noe started her sophomore year of high school last fall, it became clear that she was more than just another sullen 15-year-old navigating adolescent hell. Like many of her peers, she was moody and often lashed out at her parents, James, 55, a barber, and Robin, 45, a data systems technician. But her tantrums and crying jags could be frighteningly intense, and she seemed to be suffering from a kind of emotional paralysis: "Not wanting to go to school," says her mother, "not wanting to go to bed, not wanting to get up in the mornings." Worse still, she was secretly self-mutilating—taking scissors to her ankles and peeling off skin.
In retrospect, says Robin, Kelsey may have shown signs of her condition early on: "I look back at videos when she was a baby. She was unhappy all the time. Nothing pleased her." But the crisis came soon after her family moved from a blue-collar area of Cincinnati to the affluent suburb of Loveland, Ohio, where their modest means set Kelsey apart. "It's all about looks and who you hang out with," she says. "I felt like nobody wanted me around. I didn't have any self-confidence." One day this past January, Robin recalls, "Kelsey came to me and said, 'I need help. I don't know what's wrong with me.' "
The school psychologist referred the Noes to Mercy Adolescent Center, a psychiatric facility near Cincinnati. Doctors there diagnosed Kelsey with depression and placed her as an outpatient in both individual and group therapy. They also prescribed a 20-mg. daily dose of Prozac—the brand name for fluoxetine, the first and most popular of the relatively new class of drugs known as SSRIs that boost the mood-regulating chemical serotonin.
Kelsey's case reflects a startling trend: The number of children on antidepressants has tripled in the past decade to as many as 1 million. Until recently pediatricians and child psychiatrists had to prescribe such drugs "off-label"—legally but without government approval—for patients under 18. But in January the Food and Drug Administration sanctioned Prozac for treating depression in kids as young as 7. The FDA cited child studies showing that the medication, introduced in 1987, was safe. "The chances of doing harm are very low," says Mercy director Dr. Rodney Vivian. "I've had 4-year-olds on Prozac."
The prescription boom coincides with a rising incidence of what the Department of Health and Human Services calls "serious emotional disturbances" among the under-18 set. According to HHS, one in five children and adolescents suffers from a mental disorder that interferes with functioning at home or in school, with the highest incidence among teenage girls. The real numbers may be far higher, studies suggest, given the prevalence of underreporting and misdiagnosis.
In part, says Dr. Peter Whybrow, head of the Neuropsychiatric Institute at UCLA, the epidemic may reflect the pressures of a "frenetic, stressful" culture that fragments family life while encouraging the Kelsey Noes of the world to grow up fast and dress like Britney. "We've defined for them what is the good life," he says. "Having the right pair of sneakers, wearing the right clothes, having the right friends. All of those things are so complicated in adolescents, who are trying to create themselves—and we've increased the pressure to do that by commercializing their lives more than ever before."
Nevertheless, many experts caution that Prozac and its cousins should not be given indiscriminately to kids. Although the average treatment lasts three years, some patients take SSRIs into adulthood, and the long-term side effects remain unclear. In June the FDA advised doctors against prescribing the serotonin-booster Paxil for children, because studies show the drug may increase the risk of suicidal thoughts in young people. (If parents choose to discontinue Paxil, they should do so gradually and under a doctor's supervision.) Lisa Van Syckel says her daughter Michelle became psychotic after taking Paxil three years ago, and grew worse after doctors prescribed a cocktail of other antidepressants. The girl, then 14, allegedly slashed herself with a razor and threatened her mother with an ax. "Just to keep her alive," says Lisa, a homemaker in Flemington, N.J., "took every ounce of my energy."
Critics also complain that insurance companies, eager for a quick fix, often pressure pediatricians to prescribe drugs alone when psychotherapy (with or without drugs) might be more appropriate. "When a kid throws a tantrum in a restaurant," says Dr. Julie Magno Zito, associate professor of pharmacy and medicine at the University of Maryland, "there are ways of managing it other than a pill."
Still, many families see those pills as a godsend. Five miles from the Noes, Ben and Paige Schlosser of Maineville, Ohio, once seemed to be living under their own black cloud. Ben, 12, was prone to rages that baffled—and sometimes terrified—his parents, Paul and Kristin. "My goodness, the outbursts," says Paul, 42, who owns a fence company. Adds Kristin, also 42, a kindergarten teacher who has taken antidepressants for years: "If we sent Ben to his room, he couldn't let go of whatever was making him mad. He would sit on his bed and scream at the top of his lungs for an hour." Paige, 7, was a nonstop whiner. "She'd start off in the morning," Kristin recalls. "I'd say, 'Would you like cereal or a bagel?' and she didn't want either of those. Then we'd move on to which shoes to wear. It went on and on and on."
Riding home from art class last December, Paige made a chilling confession. "She said to me out of the blue, 'Mom, this is the thing. I know you want me to be happy, but I can't be happy; I'm always sad,' " says Kristin. "She went on to describe all the symptoms of depression. I lived in that black hole for so long, and that's what she was describing to me."
The Schlossers consulted Dr. Arnold Shapiro, a Cincinnati psychiatrist who has treated 4,000 children for more than two decades. Along with therapy, he prescribed Paxil for both brother and sister. (He later switched them to Lexapro, which proved more effective.) Since then, they've made great strides. Ben "doesn't lose control as easily," observes Kristin's sister Robyn, 40. And Paige "is like a different child," says Dorothy Murray, a family friend. "She's much more easygoing and easier to get along with."
Shapiro is neither surprised nor overly concerned about the FDA's Paxil ruling. "I always warn parents that medicines usually make moods better, but there's always a slight chance it could get worse," he says. "Paxil is very helpful for a large percentage of patients." For Shapiro the issue strikes close to home: His now-grown daughter was put on Prozac at 12. "She went from being angry and cranky for 12 years," he says, "to the happiest, kindest human being."
The Noes have seen a similar transformation in Kelsey—though at first they had reservations about the diagnosis and recommended treatment. "I thought, 'There's no way she's depressed, she's just spoiled,' " says James. Robin says she "worried about my baby taking all this medicine. But the doctor put it to me that if your child had epilepsy and needed medication, you wouldn't hesitate. They convinced me that depression is a disease that needs to be treated."
After spending three weeks at the Mercy Center, Kelsey went home seemingly improved. But within a week she relapsed. "I would just sit around every day, watch TV," Kelsey says. "And I'd look at my pile of makeup schoolwork. It just got bigger and bigger." When she began having suicidal thoughts, doctors doubled up on her Prozac. The improvement was swift and dramatic. "Her mood is more stable on a daily basis," says Karen Mendenhall, her family therapist. "When you're so irritable and revved up, you can't hear what anybody has to say." Even James has been won over. "If your kid has a problem you can't handle," he says, "you can't just say, 'Buck up.' "
Now looking forward to her junior year, his daughter has beefed up her grades and begun to make plans—she's contemplating a future in fashion design. "One of my strongest points is being artistic and creative," says Kelsey. "I want to start over fresh."
Angela T. Koenig in Loveland and Maineville, Lauren Comander in Chicago, Vicki Sheff-Cahan in Los Angeles, Melody Simmons in Baltimore and Debbie Seaman and Michelle York in New York City
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