Kay Jamison, PhD, is Professor of Psychiatry and Behavioral Sciences and Co-Director of the Mood Disorders Center at The Johns Hopkins University School of Medicine. She is also author of the book An Unquiet Mind: Memoirs of Mood and Madness, which chronicles her own struggle with bipolar disorder. Here Digging Deep talks with Dr. Jamison about recognizing, diagnosing and supporting young people with psychiatric illness, specifically depression and bipolar disorder.
Digging Deep: You’re a professor at a medical school where, for the most part, students are training to treat physical diseases. What do you say to your students to help them appreciate the severity of less visible conditions, like depression and bipolar disorder?
Jamison: Actually, I spoke at a meeting yesterday for all the med students at Hopkins and we talked about all the things that kids can get – cancer, infectious illnesses, etc. – but what kids are really going to die from is suicide. Outside of accidents, the overwhelming number of people who die when they are young is from suicide. Mood disorders underlie most suicides, and, in fact, we know an incredible amount about these illnesses – they were described even before Hippocrates. And we know that like many other medical conditions, they are very treatable.
Digging Deep: And treating mental illness and mood disorders in young people comes with its own set of challenges?
Jamison: Psychiatric illnesses are unique in that they tend to first appear in youth, which distinguishes them from age-associated conditions like cancer, heart disease, or other medical problems. And yet diagnosing psychiatric illness in young people can be especially challenging. Kids, especially, can be irritable, have rage attacks and other symptoms for many reasons other than something like bipolar illness. The younger you are, the less definable are the episodes, the more mood cycling there is naturally, and the less obvious the condition can be. It’s also doubly important to get it right, because the wrong treatment can be especially detrimental to the developing brain. And families may resist the idea that their child is ill. I find that kids can generally accept that they have depression, but parents say, “My child isn’t depressed; it’s just a moody, broody time, just a patch.”
Digging Deep: So, in this process of diagnosis, what is the difference between a “moody, broody time” and true psychiatric concern?
Jamison: I’ve heard people ask, “What’s the difference between bipolar illness and being an adolescent?” One is that in the case of bipolar illness, it’s very heavily genetic. Another sign is significant change from the way a child has been in the past – withdrawing from friends, not enjoying the things they used to, sleeping less well. Then there is the manic side of bipolar disorder. Kids may lack the articulate nature of adults, but they describe a need for a ‘red light’ in their head, because their thoughts are running around so fast. Again, some kids are naturally sped up. What a parent should watch for is change – seeing kids suddenly talking very fast, being more irritable, grandiosity, expansiveness, thinking they’re superman and really believing it, high mood, giggling, and high energy – being driven.
Digging Deep: In addition to specific challenges in diagnosing psychiatric illness in young people are challenges in treating these conditions, right?
Jamison: My sense, dealing with a lot of young people, is that it’s about persuasion. It’s like alcoholism: By the time an adult has been in the hospital six or seven times and has lost relationships and sanity, it may take less convincing to help them believe in the necessity of treatment. What you’d like to do is prevent people from having to get to that point. Young people have to know how bad this illness can be. You don’t want to terrorize patients – I tell them that bipolar is a really interesting illness and many interesting people have had it – but people are going to die unless they get treated; too many parents are going to bury their kids.
Digging Deep: Once a young person is in treatment for a psychiatric illness, does treatment tend to progress in the same way that it does with adults?
Jamison: Adherence is a problem in medical conditions of all kinds. It’s hard to keep people on medications, especially young people. Once they feel well, they say they don’t need it anymore. Fifty percent of people prescribed medication don’t take it like they should. Young people can respond well to many different kinds of interventions, but it’s a question of access, staying in it, persuading them to do it.
Digging Deep: You mentioned access…
Jamison: Most people can’t afford a first professional opinion, let alone a second opinion. Every academic department is overwhelmed. It’s one thing to find an expert, another is to get access. It breaks your heart to see access to care eroding even more. For example, psychotherapy can be enormously important and effective, but if it’s hard to get in to see a doctor for 20 minutes to get medication, it’s even more challenging in terms of time and access and cost to see a therapist for an hour or hours every week.
Digging Deep: Are there recommendations that you would give to parents or professionals working with young people who have mental health concerns?
Jamison: If you have a family history of bipolar illness or severe, recurrent depression or suicide, you want to be talking with your kids about it before they go off to college. Have a matter of fact talk. Tell them the odds are you aren’t going to get this, but you should know that it runs in the family, and that it’s treatable. If young people are educated about psychiatric illness and the symptoms of illness, if it happens to them, they may recognize it and be more inclined to seek help. With an illness like this, education goes a long way.