Although Gloria Ramirez’s stomach churned when her high school guidance counselor called her in for a meeting about her rebellious behavior, she now remembers that winter day as the day she found relief.
She left the office feeling as though it might be possible to survive another day — and then maybe a few more — as she found help for her depression, which stemmed from abuse at home.
“I walked in there and she said, ‘We’re going to have a meeting about your bad behavior,’ ” Ramirez recalled, “and I said, ‘I’m really embarrassed about it, but my mom will not come in.’ I just broke down then and I said, ‘She’s pretty much given up on me. She doesn’t care. She has no faith.’ ”
Ramirez, whose name has been changed to protect her privacy because she is a victim of abuse, said she might still be in the throes of depression or, grimly, not here at all — having contemplated taking her own life — if it weren’t for the help she found that day and in the months that followed.
Even though she felt completely alone in her struggles at her East County high school, Ramirez was actually roaming the halls with dozens of other teens plagued with mental illness, said Kevin Cox, medical director of the youth and family division at Ventura County Behavioral Health.
“The likelihood of depression clearly increases (during the teen years), and I think a lot of that is just that the brain is changing and kids are possibly being exposed to more abuse, trauma and neglect, or just poor parenting,” he said.
Ramirez, who is now 20, working as a clerk in East County and — most importantly — happy, shared her story to give other teens hope. There is light at the end of what can sometimes seem like the long dark tunnel of high school, and there are plenty of community members waiting to help teens, she said.
“I would just go to them and tell them, ‘You know what, there’s help out there for anybody,’ ” she said. “ ‘However old you are, it really doesn’t matter. You could be 13 or 14 and someone’s out there to help you. There is help.’”
Kevin K. Cox, M.D., Medical Director of the Youth and Family Division at Ventura County Behavioral Health, which offers a variety of services on mental wellness.
A shape-shifting illness
Studies have shown that almost five percent of adolescents nationwide struggle with clinical depression, compared with approximately 15 percent of adults, Cox said.
Although many people with depression have a history of trauma, childhood abuse or neglect, not all do — there is a genetic component to the illness as well, Cox said.
“There are a lot of factors involved,” he said. “There’s clearly some genetics and a large amount of environment influence.”
Cox, a child psychiatrist, said his department saw 3,666 teen patients last year, and 767 of them were depressed, or roughly one-fifth.
The percentage of teens with depression has stayed about the same in the past few years, but the number of patients the clinics see continues to increase, he said. In 2010, VCBH treated 3,363 adolescent patients, 703 of whom were depressed.
Depression is about twice as common in adult females as in males, and that gap begins to appear in adolescence, perhaps due to the hormonal changes of puberty, Cox said. He notes that although women face a doubly high risk of depression, rates of incarceration among men are much higher, perhaps suggesting that men and women typically deal with mental illness differently.
Depression can take many forms and is different than “teen angst,” or feeling down for a few days, said Marcela Becerra, a marriage and family therapist intern at City Impact, a nonprofit that provides counseling to at-risk teens.
“Sometimes we just don’t see it because of the way teenagers manifest their depression,” she said. “It might be through self-destructive behaviors or defiant behavior. They also withdraw from positive family and friends, and stop doing activities they once enjoyed, like exercising or going to the gym. Something that’s much more common than we think is cutting, or self-mutilation, to release the pain or negative feelings they’re going through.”
Drinking or drug use is also common and can cause depression on its own, she said.
Ramirez had started drinking to try to ease the pain of her family abuse, causing her grades to plummet, Becerra said.
Becerra was Ramirez’s therapist during her senior year in high school. After Ramirez told her guidance counselor that her mother was verbally abusive and blamed her for her father leaving them a few years earlier, the school official contacted City Impact.
Becerra and Ramirez began meeting for an hour during the school day in the teacher’s break room, and, amid the paper plates and plastic utensils, Ramirez began to unwrap her sadness.
“I just felt so down and real, real bad,” she said. “But as soon as I started therapy, halfway through my senior year, I just started feeling a lot better and I was going to school more happy and confident and excited.”
But Becerra remembers the therapy sessions slightly differently — she said the change was as real as Ramirez recalls, but it wasn’t as fast.
“It took her about four months to actually open up and express all her feelings,” she said. “Teenagers will sometimes give an ‘I don’t care’ attitude, but once you get them to open up, you see that they are hurting.”
It’s not uncommon for depressed youths to start drinking or using drugs before their teen years, particularly if there is substance abuse or other forms of abuse in the home, said Linda Gertson, behavioral health manager with Ventura County Alcohol and Drug programs.
“A lot of times kids start by just going into the medicine cabinet of their families,” she said.
County teens most commonly abuse alcohol and marijuana, but officials are seeing a growing number of youths hooked on prescription opiates, such as Vicodin and oxycodone, which can lead to heroin use, Gertson said.
“I think early intervention is extremely important,” she said. “We know that, particularly with substance abuse, if it’s not addressed as early as possible, in general, it will progress and get worse, especially if it’s linked with depression.”
A card of hope
If left untreated, depression can lead to suicide.
About 15 percent of people with depression commit suicide each year, Cox said.
“Depression is something that not only makes you feel bad or not want to go to school every day,” he said. “It’s something that can actually be deadly.”
Suicide rates have stayed about the same in the county, among teens and adults, for the last decade, said Janelle Payne, Ventura County medical examiner.
Oxnard resident Lisa Rubio knows how serious depression can be. Her daughter was diagnosed with bipolar disorder and depression when she was 15. Four years later, she went off her medication and relapsed, needing to be hospitalized seven times.
“It was very scary,” Rubio said. “This is not an illness to be taken lightly.”
Rubio found help through United Parents, a nonprofit that supports parents of children with mental illness. After seeing the difference community support could make, she decided to help launch a program locally to help youths like her daughter.
She and other parents launched the Ventura County Yellow Ribbon project and began distributing yellow business cards at schools and teen centers.
“The cards are designed for a student to be able to hand them to a counselor or teacher or nurse or pastor, or even another student, as a way to say they need help when they don’t have the words,” Rubio said.
Printed in English and Spanish, the cards offer pointers and resources to the recipients.
Although the group would like to do more community outreach and make sure the cards are in the hands of every student in Ventura County, so far the project hasn’t fully gotten off the ground, due to a lack of funding, Rubio said.
“We also want to be able to train teachers so they can talk to their students about this,” she said. “But the schools are so short on funds for getting substitute teachers during the training, we haven’t been able to do it.”
The bottom line is, if teachers, parents or adult caregivers think youths might be depressed or suicidal, they should talk with the teens about it, Cox said.
“Depending on the cultural background, the people in the family might say, ‘Just buck it up and snap out of it and get out of bed,’ and it’s not helpful to try to beat someone out of it like that,” he said. “We’re trying to educate parents to help them understand your kid’s not just lazy, he’s really sick. That is really important.”
“Don’t give up”
Although teen angst, bullying and depression have been chronicled with increased frequency in national news outlets, Cox isn’t sure they are in fact on the rise.
“Nationwide there has not been an increase, although in the sort of popular press I think people think there has been,” he said. “I think perhaps it’s getting diagnosed earlier and people are seeking help more than they used to. Also, given the extent of press and social media, anything that’s happening in society is much more public than it ever used to be.”
But that doesn’t mean it’s necessarily become easier for teens to find the help they need. Social media can connect youths with counselors and support groups, or it can lead to bullying and misinformation about mental illness, Cox said.
“I think education is really important and (so is) anything to help reduce the stigma,” he said. “If an adolescent had a broken leg, would they say no to a cast? Of course not. But when someone says, ‘You need some therapy or medicine,’ there’s high resistance to it.”
Slowly, the stigma against seeking help for mental illness is going away and being replaced by an understanding that treatment can relieve suffering, Becerra said.
“What I want everybody to know is that therapy’s not just for crazy people,” she said.
“Everybody goes through rough times and it doesn’t mean anything if you get the help.”
Ramirez, who credits Becerra with helping her find happiness, said she doesn’t want teens to give up, even if the halls ahead look bleak.
“Nobody should give up when they think everything’s going to go bad from here on out,” she said. “It gets different and it gets better. I know it doesn’t seem like it now, but please don’t give up.”
Teens do not need a parent’s consent to meet with a therapist or seek mental health help. There are free and low-cost services available to youths, as well as their families.
To contact the Ventura County Behavioral Health department, call (866) 998-2243 or visit well nesseveryday.org.
For information on Ventura County Alcohol and Drug programs, log on to venturacountylimits.org.
To learn more about the Yellow Ribbon project, see yellow ribbon.org.
Signs of depression
Symptoms of depression vary, but can include:
• Feeling sad or “empty”
• Feeling hopeless, irritable, anxious or guilty
• Loss of interest in favorite activities
• Feeling very tired
• Not being able to concentrate or remember details
• Not being able to sleep, or sleeping too much
• Overeating, or not wanting to eat at all
• Thoughts of suicide, suicide attempts
• Aches or pains, headaches, cramps or digestive problems
— From Ventura County Behavioral Health