Depression Factors Can Hit in Concert

"My parents were fist fighting, again. There was bloodeverywhere.

"I just wanted out. I went into the bathroom. My mom had thismedicine cabinet that was like stuffed with all kinds of pills. So Ipopped a lot of pills and I just went to sleep.

"It didn't work."

Lisa, now 15, was 9 when she first attempted suicide. Herparents went through a "nasty divorce" when she was 11, and Lisamoved from Florida to Maryland. At 12, Lisa tried to slash herwrists, but it hurt too much and she stopped. She started drinkingalcohol that year, and began using narcotics at 14.

Last year she was diagnosed with major depression and drugdependency. She began treatment, which failed. She started another,longer, program. It worked.

"Now I'm clean, I'm happy," said Lisa, who asked that her namebe changed. "I have good friends and a good support group. I'mdoing alright."

Lisa is now in counseling and regularly takes medication tohelp counter her depression. She is among as many as 2.5 percent ofall American children with depressive illness. The disease,characterized by symptoms such as prolonged sadness, unexplainedcrying spells, significant changes in appetite and sleep patterns,irritability, worry and social withdrawal, affects both sexes equallyuntil adolescence, when the incidence doubles for girls, according tothe National Institute of Mental Health in Bethesda, Md.

Although it's virtually impossible to determine the cause of thegender discrepancy in depressive illness, many mental health expertsbelieve the disease stems from multiple causes that often work inconcert.

Socialization differences are often cited as a chief cause ofdepression, particularly in girls. "It starts early. Many girls areencouraged to play with dolls and help take care of other kids in thefamily, and later, on the playground," said Dr. Nancy Molitor,assistant professor at Northwestern University and clinicalpsychologist at Evanston Hospital. "Girls are taught to be nice, toplacate, and to deal with conflict by stamping it out," she said.

Boys are socialized to be individuals, to speak up, raise theirhands more in class, Molitor said. "They `put themselves out there'as autonomous individuals," she said, whereas girls tend to applylessons learned early on, and retreat into the world of themselves,away from individual expression and questioning.

Girls become more concerned about fitting in and backing downin the face of conflict. "They learn to stifle their ambitions andtalents in hopes of conforming," Molitor said. Gradually, many girlsbegin to question their talent and worth. "It chips away at selfesteem," she said.

Biological and genetic factors may also contribute todepression, according to recent research. Studies have shown thatsome families appear predisposed to the illness, though it's notclear whether the effect is biological, environmental or both.

Hormones also seem to play a role in the illness. Estrogen andprogesterone levels drop in the last week of the menstrual cycle,noted Linda Holt, an obstetrician; gynecologist at Evanston Hospitaland assistant professor at Northwestern University Medical School.Although no research has yet pinpointed a precise link, mooddisorders, suicide attempts and psychotic breakdowns in females tendto peak in that same span, Holt said.

"Male hormones, (present in both sexes, but at lower levels infemales), tend to turn frustration into anger and `acting out'behavior, which tends to be a release for most individuals," Holtsaid.

Culture may also set up conditions for depression in youngAmerican girls, especially white girls, according to a recent studyby the American Association of University Women. The study found asignificant drop in self-esteem in girls ages 11 to 13. "You get nosuch drop in boys," said Judy Jordan, associate professor ofpsychology at Harvard University Medical School and a director oftraining at the Stone Center for women's research at WellesleyCollege, Wellesley, Mass.

Compared to white girls, self-esteem in black girls droppedless, Jordan said. "In the African-American subculture, there may bemore esteeming of the mother and more valuing of mother and mother'srole," she said. "Also, the mother may hold more power in thosefamilies than in the average white family," she said. Black girlsmight then infer, " `If mom can be an authentic, strong person, thenso can I,' " Jordan said.

Fortunately, societal influences and adolescent stress can bemitigated, particularly by a warm, nurturing relationship between agirl and her mother. In fact, a four-year study reported inNovember, 1994, by the National Institute of Mental Health found thatgirls were measurably buffered against depression if their mothersshowed them warmth, listened carefully and made a real effort to talkand socialize with them.

Mental health experts also highly recommend exercise to combatdepression. In general, people with depression tend to have lowbrain levels of serotonin, a substance that helps control mood."Activities that help raise serotonin levels will help counteractdepression," Holt said. "One of those activities is exercise. Ithink of it as being nature's Prozac," she said.

Physical activity also takes some aggressive impulses and turnsthem outward instead of inward, Holt said. Whether competitive ormore individually focused, "spports can put a healthy twist onaggression," she said.