A Jewish teenager starts spending every night in her bedroom with the door closed and music blaring. She's moody and easily irritated. Her journal is filled with morbid poetry.
Is this a standard version of teenage blues, or a red flag for a suicide risk?
It's a tricky diagnosis. That's why a group of 20 parents attended a panel discussion on teen suicide last Monday night at Temple Beth Torah in Fremont. Milpitas High School teacher Jack Weinstein, Fremont pediatrician Bennett Coplan, counselor Lisa Gioia and hospital community relations director Deborah Gene Brostoff detailed the symptoms of teen depression and manic depression, the major causes of suicide in young people of all religious and ethnic groups.
Suicide is the third leading cause of death among people 15 to 24 years old, according to the National Institute of Mental Health. While the NIMH does not track the number of Jewish teens who commit suicide, the panelists pointed out that the Jewish community is far from immune to the problem.
In fact, among Jews, there may even be "an added pressure to succeed," said Gioia, who works with families and young people at the Youth and Family Counseling Center in Fremont. Because of this pressure, some Jewish kids "may be devastated by an A-minus."
As a physician at Kaiser Permanente, Coplan doesn't take many chances when it comes to teens at risk. If he notices any warning signs for adolescent depression, he takes action immediately.
"Teenagers aren't like adults [with depression]. They often don't look or act sad, but are acting out in other ways," he said. That's why any mention by a teen of suicidal or depressive feelings warrants an "immediate referral" for a psychiatric evaluation.
Other panelists voiced similar concern. Before kids kill themselves, they almost always express what experts call a "gesture," some way of voicing their thoughts of suicide to others. Any such sign, any mention of death or suicide, should be taken extremely seriously, speakers said.
To help parents differentiate between normal teen angst and dangerous depression, the panelists detailed some classic signs of the mental illness.
Unlike grief or a passing sadness, depression is a persistent illness, said Brostoff, of Washington Hospital Healthcare System in Fremont.
"It's an illness, not a weakness. It can't be willed or wished away," she said.
According to Brostoff, more than 15 million American adults suffer from clinical depression each year. Depressed teens are harder to track, however, because they often don't seek help.
Gioia added that teens often lack the skills to deal with the problems adults might handle more easily.
"It's easy to look at what teens are depressed about, and not take it seriously. It could be failing a test, having bad skin, not getting into their first-choice college," said Gioia. "For them, these can be very serious and complex issues, and they have no breadth of coping skills to deal with them."
The speakers warned parents about specific changes to look for in their kids.
First, parents should be aware of common suicide triggers, which include the suicide of a close friend, a divorce or death in the family, a breakup of a romantic relationship, or a failure in athletics or school.
Danger signs include verbal threats like "You'd be better off without me," social withdrawal, excessive risk-taking, giving away possessions, changes in sleeping and eating habits, loss of interest in usual activities, themes of death in artwork, depressive poetry and notes to friends, drug and alcohol abuse, increased self-criticism, hopelessness and problems in school.
The teen's body might even show some signs of suicidal tendencies, said Coplan, who worries about patients with pierces or tattoos.
"They're deforming their body; it's like they want a different body," he said. More alarming than that, Coplan has seen teen patients with scratches on their wrists, which he said is common among kids who are testing their veins, flirting with the idea of slicing them open.
Teens suffering from bipolar disorder or manic depression, a far less common depressive illness, may experience periods of mania as well. Symptoms include severe insomnia, increased talking, grandiose notions, disconnected and racing thoughts, poor judgment and inappropriate social behavior.
The good news, the experts said, is that many of these symptoms can be treated and ameliorated with a combination of medication and individual, family or peer counseling.
What is crucial is that anyone who observes a problem, from a rabbi to a teacher to a friend, should not remain silent, said panelists. Speaking up could save a life.
Some parents wondered how they could be sure whether theyshould intervene with their children. In addition to looking for warning signals, Gioia suggested that parents talk over their concerns with their children, pointing out the symptoms they've noticed and asking what's wrong.
"Just go in and try to get a flavor of what's going on. And trust your gut," she said. And if teens resist? "Don't give up."