Wow! This Kid Looks Depressed!

I have a 16 year old patient named N who I saw today, after not seeing him for 6 months. N is a handsome adolescent, who normally has a wry sense of humor. I always enjoy seeing N. Trying to ring a smile from that tight lipped countenance feels like a contest. I’m flattered by the fact that I am one of the few adults with whom N feels comfortable.

I first saw N when he was 12 years old. At that time, N was exhibiting a little trouble with impulse control. He’s a terrific baseball player and his dad was friends with the baseball coaches in his school system. N would make sarcastic little jokes at baseball practice that bordered on disrespectful. He also had a bit of trouble focusing in school, as well as some mild depression. N has done great over the years, and in December we had a long talk about his mood and life in general.

N told me that he felt pretty good. He wasn’t depressed, but he was very disappointed in his parents and their relationship. He said that his parents rarely talked to each other, and never went out or socialized with other couples. Neither parent seemed to have friends, or to be particularly happy. N hoped that he could forge a better relationship for himself in the future. No, no, Dr. Altman, he clearly had no time for therapy. But, not to worry. He was feeling fine, and could we consider tapering him off his antidepressant?

“Sure!” I said, and completely forgot about self assured, wiser-than-his-years N, until I saw him today. N’s mom called for an emergency appointment, and luckily I had a cancellation, and could squeeze him in.

N looked like complete crap. There was no wry smile today. No twinkle in his eyes. I no more felt like making N laugh, than I felt like making an elephant shit tulips.

N was miserable. He hates his life, and “his teachers act like he’s a piece of shit”. (I thought this would be a poor choice of moments to tell him that yes, indeed, he did look a bit like shit.) He feels like there is nothing to look forward to in his life, except for eventually going to sleep at night. He can’t stand being around people. My dog could have told you that N is really depressed. A child psychiatrist was not really that necessary.

“N, you’re really depressed,” I said.

“No shit,” N replied.

“How long has this been going on?” I asked.

N shrugged. “A really long time.”

I looked at N’s mother, who also shrugged. “I called for an appointment a few months ago, but it was at a bad time,” she explained.

Bad time? What is it about mental illness that makes people think it can wait until baseball practices are over? If N had an abscessed tooth, I’ll bet he and his mom would have rushed his butt into my office. A hangnail would have been treated with more urgency. A 16 year old miserable and hating his life? No biggie. Thank god he wasn’t suicidal.

I felt defeated. Poor N. I gave mom and N another talk about childhood depression, stressed the hope and treatable nature of the illness, strong armed N into therapy, and put him on an antidepressant. I walked them to the door, encouraged N to “hang in there”, and proceeded to sit at my desk and wallow in self pity for 5 minutes. (I only had five minutes before my next patient was due.)

What the hell was wrong with people? I thought I had a good relationship with N and N’s mom, and had thoroughly educated them about childhood depression years ago. How could they let this go on for so long? Doesn’t anyone listen to the Altman-meister? Was there any birthday cake left in the staff kitchen? I needed birthday cake.

No birthday cake. Just more patients who might or might not be listening to me.