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Myth Breaking

Karen Swartz, M.D.

Drs. Swartz and Kastelic

Stopping a simple misperception could save the lives of thousands of young adults on the cusp of life. 

That thought entered Karen Swartz’s mind and took hold. “The idea out there,” she says, “is that teenage suicide is a response to extreme stress or pressure and could happen to anyone.” But that’s so far from the truth as to be shocking, she says. A multitude of studies show that roughly 90 percent of teenagers who die that way had a treatable psychiatric illness. Worse, some of the very programs high schools use to prevent suicide—about three-fourths of U.S. schools have a curriculum—inadvertently drain the act of its taboo status and may even romanticize it.

But Swartz is a resourceful woman with the right background—she’s a psychiatrist specializing in mood disorders. She has public health training. And the word “can’t” bounces off her.

In 1999, Swartz drew together a group of concerned Hopkins psychiatric nurses and clinicians, prompting creation of ADAP, the Adolescent Depression Awareness Program, which she now heads.

ADAP’s aim is to increase basic depression literacy, starting with high schoolers. Now a national program, it teaches the symptoms of depressive and bipolar illness, distinguishing them from normal adolescent ups and downs. Students—and, in separate programs, their parents and teachers—learn how clinicians diagnose and treat depression and why ignoring it courts danger.

 “Our mantra,” says Swartz, “is that depression is a treatable medical illness.”

From the first, Swartz decided not to make suicide prevention the focus, but to take a public health approach, to cut a wider swath. “Many more teenagers will experience depression throughout their lives than will ever try to commit suicide,” she says. “We focus on the mood disorders themselves and what to do.”

Reliability marks the program. Using her research background, Swartz has been dogged in testing each phase of ADAP. She’s seen, for example, that medical students or high school teachers can instruct as well as the core group who began it. She’s analyzed which techniques work best. And it’s paying off. Student pre- and post-tests show they’re learning the truths. “Collaborators wanted to expand faster than I thought we were ready to."

“No. No,” I said. “We have to do it right.”

A Rare, Healing Place

You wouldn’t offer a teenager with cancer the same therapy as someone elderly, reasons psychiatrist Liza Kastelic, “so why mix ages within a hospital unit just because they’re struggling with a psychiatric disease?”

Kastelic, who directs what’s likely the only U.S. psychiatric inpatient service for young adults—teens through the early 20s—has specialized in their mood disorders for more than a decade.

The approach she and staff use hinges on an exquisite awareness of that stage of human development, on an ability to sort pathology from teenage angst, for example, or to use peer pressure to advantage to push medicine-taking. And with home environment crucial to therapy for teenagers, educating parents becomes part of it.

Kastelic’s clinical questions clearly guide her research. The shortage of information on mania in adolescence has prompted her to follow its appearance in children whose parents have bipolar disorder.

And she’s part of a national quest for better drugs for them.

Click here for Faculty Profile of Dr. Swartz

Click here for Faculty Profile of Dr. Kastelic