The problems started when she was just eight. By the time she turned 11 she was cutting herself. Rock bottom came in the spring of 2012, when she found herself at A&W in Humboldt, waiting for a ride from her mom and a chance for some help.
"I got in the car and just cried and cried and cried," she said. "I told her what was going on, that I hadn't been feeling well and I'd been cutting again."
"She" is Melissa, a Grade 12 student at Humboldt Collegiate Institute. Her real name isn't Melissa, but the Journal has opted to use an alias so she can tell her story freely. It's a story of depression, pills and resilience, and it's more common than you might think.
The number of young people in Saskatchewan (aged 0 to 19) being medicated with prescription antidepressants nearly tripled between 1983 and 2007, according to a new study by researchers from the University of Saskatchewan. Girls between the ages of 15 and 19, like Melissa, were most likely to use antidepressants, with a usage rate spiking nearly 16-fold over the study period.
The reason for the increase is unclear, but there are various theories, from greater awareness to a lack of alternative treatment options.
"There's more attention to mental health issues in the media, in popular culture, and that's a good thing," said Linda McMullen, a professor of psychology at the University of Saskatchewan.
"However, there are some issues with adolescents."
Those issues can largely be traced to a group of drugs called SSRIs - selective serotonin reuptake inhibitors. SSRIs work by changing levels of the neurotransmitter serotonin in the brain, which in turn affects mood. Despite their heavy use, SSRIs have never been approved by Health Canada for treatment of depression in children or teenagers. In the United States, the Food and Drug Administration has issued warnings about the effects of SSRIs on teenagers and many studies have found little to no benefit to their use. When the Journal reached out to Health Canada for comment, the organization declined to comment on the general issue, saying that it could only comment on specific drugs and not overall trends.
Still, the Canadian Paediatric Society endorsed the use of SSRIs for teenage depression in a position paper published last November.
"The potential benefits of SSRI use outweigh the potential harms for the treatment of depression in children and adolescents," summarized the report by Dr. Daphne Korczak.
In the case of Melissa, her first experience with antidepressants came after that awful day. She was prescribed a handful of medications after a visit to Royal University Hospital, including antidepressants, but she was allergic to some of them and began to resent the idea of having to take them.
"Every morning and every night I have to take meds and I hate it," she said. "I understand they're helping me cope and get through this but I just hate taking meds. Prior to my first hospitalization, I told every psychiatrist I met that I didn't want to go on meds."
In the end, the decision to prescribe SSRIs to teenagers most often rests with family doctors. Even if a particular drug is labeled as not being recommended for anyone under the age of 18, doctors are still able to prescribe it if they think it will help, a practice known as "off-labeling".
For McMullen, family doctors are being put in an untenable position because antidepressants are often viewed as a first treatment option.
"More resources need to be put into the mental health system so that family doctors have options," she said. "Too often they find themselves stuck."
Saskatchewan's College of Physicians and Surgeons is the province's regulatory body and includes more than 90 per cent of the province's doctors, yet the organization doesn't provide guidelines on the issue of antidepressants among teens.
"We will provide directives in cases where there's clear consensus, as in the case of marijuana" said Bryan Salte, the College's legal counsel. "However, judgment has to be used in places where there's no clear guidance.
"Some think the use of antidepressants is entirely inappropriate, some think it's entirely appropriate."
Melissa has been taking six pills a day for the last nine months and seems to have found the proper mix, though she said it took about 18 months to find the right combination of drugs. Though she's quick to point out that she's pursued a wide range of solutions, the medication has helped.
"The meds got me to a state of less panic where I didn't feel like I always had to cut or needed to try and kill myself," she said. "They got me to not be as hyped up, I guess. Counseling and seeing my psychiatrist regularly, we worked our way through cutting and I think the meds had a part in stabilizing me."
Melissa assigns a lot of the credit for her improvement to things other than her medications, including frequent visits with the school's guidance counselor and a psychiatrist. Representatives of the school board referred any questions on the topic to medical professionals, saying they were "better placed to respond to questions about prescribed medications as part of an individual's treatment."
Melissa's visits to guidance counselors and psychiatrists have helped her devise solutions to problems that in the past might have led to her cutting herself.
"I've put up coping mechanisms in place where if I am really frustrated or upset I can talk to my mom or take my dog for a walk or read a book or listen to music or just go have a nap instead of going to cutting or more extreme measures," she said.
As someone with a long personal history with antidepressants, Melissa wasn't surprised by the results of the University of Saskatchewan study, saying she knows many people at school who are on antidepressants, most of them girls.
"When I was at the hospital, 70 per cent of the inpatients were girls," she said, attributing the gender imbalance to the perception that girls are more encouraged to talk about their feelings and admit weaknesses or problems. Still, she couldn't shake the feeling that antidepressants have become a miracle cure, a catch-all solution for problems that demand more complex answers.
"I feel that a lot of doctors go right to antidepressants," she said.
McMullen agreed.
"In severe cases antidepressants can be a good first option, but so many mild to moderate cases can be treated in other ways," she said.
For Melissa, she is hoping to wean herself off most of her medications once she graduates in June. She's come a long way in the past 18 months and hopes she'll no longer need medication in the near future.
Note: Teens experiencing symptoms of depression are encouraged to contact the Humboldt branch of the Kids Help Line at 306-682-5333 if they need any assistance or someone to talk to.
