Stanford Medicine Newsletter Updates For the Local Community

Second-generation depression

Studies focus on identifying teens most at risk


Peggy finished her last final of her first college semester, walked off the UC Berkeley campus, headed down Telegraph Avenue and bought a bottle of sleeping pills from the nearest pharmacy.

“I was going to wait until my grandmother went out shopping,” said Peggy, “and take the pills with a bottle of whiskey that she kept hidden in the linen closet. I couldn’t see any other way out.”

She had flirted with depression from the age of 5, and the stress of her first year of college had sent her into her blackest downward spiral yet. At 19, she felt helpless and utterly drained. Suicide seemed like her only option.

Today Peggy is a mother of two living in Danville and, along with her 15-year-old daughter, is a participant in one of a wave of scientific studies that could help prevent depression in adolescents. Scientists are examining brain scans, measuring stress hormone levels and testing prevention programs. The hope is that by understanding the interplay between human biology and environmental stressors, which together increase vulnerability for depression, researchers can better define those most at risk and get them treatment before it escalates.

A pervasive problem

All people feel some degree of sadness at times, but clinical depression is something else entirely. It destroys the ability to feel pleasure. It exhausts both mentally and physically. It makes it impossible to get out of bed and impossible to fall asleep. It takes away appetite or causes overeating. It creates obsessive guilt and overwhelming grief.

With clinical depression now affecting 20 million Americans, there’s a growing need to stop the disorder. Young people who have experienced a major depressive episode are at a greater risk of cycling through depression again within the next five years and are at a higher risk of suicide and other mental health problems.

About 4,400 Americans between the ages of 10 and 24 commit suicide each year, making it the third most common cause of death in that age group, according to the Centers for Disease Control and Prevention. Between 60 and 70 percent of these individuals had a history of a mental health disorder, most commonly depression.

Stanford mental health experts, in particular, have been focusing on the need for early and ef-fective treatment of mood disorders during adolescence in the wake of the suicides of five teens in the past year—a pattern that stunned the community (see "On track to deter teen suicides" below).

Signs of trouble

Peggy’s teenage daughter is among those participating in studies at the Stanford Mood and Anxiety Disorders Laboratory, directed by Ian Gotlib, PhD, a professor of psychology. Gotlib and his colleagues are comparing the stress responses of 100 girls who have depressed mothers with the responses of a control group of girls whose mothers have not suffered from depression.

In the lab, the girls undergo tests that can detect high cortisol levels, reduced hippocampus size (the brain structure that stores and retrieves memories), brain responses to various stimuli and susceptibility to negative moods—all of which have been linked to depression.

Initially, researchers thought they’d have to wait for the at-risk girls to become depressed before they saw physiological or psychological differences between the groups. But even before experiencing depression, the at-risk girls are more reactive to stress than the control girls. They have higher levels of the stress hormone cortisol; they perceive more stress day to day; and they have smaller hippocampi than the control group, the researchers found.

Gotlib believes this finding provides evidence that a certain response to stress may push these girls over the edge into depression.

“Reducing reactivity to stress should be a critical target for prevention efforts,” he said. “We could assess stress reactivity within a sample of children at risk for depression (for example, those who have a depressed parent) and offer prevention programs to those with the highest levels of reactivity.”

Breaking the cycle

In theory, stress reduction programs such as yoga, meditation, self-hypnosis or exercise could help prevent depression in adolescents. That’s what researchers like Judy Garber, PhD, a professor of psychology and human development at Vanderbilt University, are exploring. She published a study last summer showing that relatively modest intervention—fewer than a dozen sessions of cognitive behavioral intervention—goes a long way toward preventing episodes of depression in high-risk teens.

“Basically, you’re trying to teach kids to evaluate the way they view the world,” said Garber. “For example, when something bad happens, like you lose your job, a person at risk for depression might think, ‘My God, my life is over. I’m never going to get another job. It’s my fault I lost the job.’ Someone else might see this as an opportunity to try something new.”

For people with chronic depression, like Peggy, preventing depression in young people before it has the chance to spiral out of control makes the most sense. She’s hoping for any tips that would help her own children avoid the lifetime of depression that she’s cycled through most of her life.

Peggy never took those sleeping pills when she was a freshman at Berkeley. She went on to graduate. She worked many years as a magazine editor. She’s successfully raising a family now, and going back to college.

“It’s hard for kids,” she said. “All they think is, ‘I want my pain to stop. I’m miserable,’ and sometimes they don’t see any way out. I have gotten better, and I think what helps me the most is to have somebody to talk to. They don’t realize that life does get better.”

On track to deter teen suicides

Twice an hour, red warning lights flash at the Meadow Drive train crossing in Palo Alto. The gates lower to stop cars, a whistle blares and a silver commuter train blasts past. Sitting nearby is a security guard. In the afternoon, when streams of kids cross the tracks on the way home from school, nobody talks to him but everybody knows he’s there. Posted on a small sign next to him is a suicide hotline number.

Since May of last year, five Palo Alto teens traveled to this spot to end their lives. Spurred by a group of parents who began patrolling the tracks as part of a coordinated effort to stop future suicides, the city hired a private security firm to help.

“At first people thought we were crazy, but it just seemed to be common sense,” said Caroline Camhy, the mother of two small children who helped to start Track Watch by recruiting volunteers to stand guard at the train crossing. “If suicide wasn’t so easy to do, it seemed like fewer people would do it.”

Following months of collaboration among mental health experts and city and school personnel, a plan is in place to conduct routine screening of students at risk for mental health disorders, maintain a database of mental health services, and conduct psychological and circumstantial reviews of the suicides, looking for possible patterns, trends or causes. And patrols will continue at the Meadow Drive crossing, as well as other nearby sites.

“It’s important to know this is not completely out of our control,” said Shashank Joshi, MD, a pediatric psychiatrist at Lucile Packard Children’s Hospital and director of the hospital’s school mental health team, which provides support to the Palo Alto Unified School District. “We’re trying hard to spot at-risk kids. We’re keeping watch. We’re helping kids and families by teaching coping skills and resiliency.”

“Ninety percent of people who die by suicide are suffering a psychiatric illness such as depression,” said Frances Wren, MD, an assistant professor of psychiatry and of pediatrics, who directs the Child and Adolescent Depression Clinic at Packard Children’s. Wren was instrumental in organizing an alliance of mental health, medical and educational professionals that began meeting last summer. “Effective treatments are available. The key is getting treatment to the kids who need it, quickly.”

Volunteers are needed to patrol the tracks. For information, e-mail

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