Reader’s Question

I am a 16-year-old girl living a normal life. For the past three years or so I’ve always thought something could be wrong with me. I’m constantly thinking about suicide and have even made a list of eleven possible ways I’d be willing to kill myself. However, I’m not sure if I’d follow through. It’s a selfish action, and I don’t think I could hurt my friends and family like that. I always hope to get into some sort of freak accident or something. I don’t necessarily want to die, but I’d certainly be fine with it. However, I’m not sure if it’s depression since I don’t have the normal symptoms (feeling like a failure, feeling sad all the time, loss of appetite, loss of sleep, etc.). In fact, most people think I’m a happy, friendly person. I just want to know if something is wrong with me.

Our Clinical Psychologist’s Reply

You are reporting symptoms of depression. You probably don’t have all the symptoms of depression at this time as over the past three years, your personality and even lifestyle have made some changes to accept those early symptoms. At your current age of 16, I would guess that your depression and puberty arrived near the same time — a very common experience. The changes in hormones, body, and even brain chemistry at that time probably started the depression.

Depression is a disorder of both mood and — in moderate to severe depression — brain chemistry. Depression has been linked to low levels of the neurotransmitter Serotonin which is also linked to Obsessive-Compulsive Disorder (OCD), eating disorders, body image disorders, and several other mental health conditions. How do we know brain chemistry is involved? When we want to determine if a thought or behavior is a mental health symptom related to changes in our chemistry, we need to ask if we have any control over it. A student might be tired due to late hours of studying — something they had and have control over. In depression, the individual can’t sleep or has early-morning awakening — no matter what they do. The fact that you “constantly” think about suicide tells me low Serotonin and depression are involved. You are unable to control the number, frequency, or intensity of your suicide thoughts. That’s low Serotonin.

I’d recommend taking a few of the depression screening tests on this website. Read the articles on depression and approach the subject with your parents or a trusted adult. You might want to read my article on Understanding Depression.

We can also develop depression in unexpected ways. For example:

• Your depressive symptoms may be linked to your monthly cycle. Body hormones are also body regulators and can influence neurotransmitter levels in the brain. There is a well-known link between menses and depression.
• Depression can be a side effect of many medications used by teenagers. Medications for acne and birth control can often have depression as a side effect. Review your past four years for changes in medications, adding medications, etc.
• Teenagers are as intellectually capable as adults, but they don’t have much life experience. Teens often don’t recognize mental health symptoms when they appear and instead develop a strategy that actually accepts the symptoms. A parent who suddenly can’t sleep quickly recognizes something is wrong. For a teenager, when they can’t sleep they often change their sleep-wake cycle and spend many hours in the middle of the night text messaging. When their appetite changes, they use the opportunity to lose weight for example. This type of flexibility can actually lead them deeper into depression as in your case, when you constantly think of suicide but don’t feel you have symptoms of depression.

If you have difficulty discussing the symptoms with adults in your life, you may want to print my depression article and hand it to them, along with a comment such as “I think I’ve got this. Can we see a professional to evaluate it?” We have very effective treatments for depression. They are available in your community.