Ten years ago this disease was for adults only. But as teen depression comes out of the closet, it's getting easier to spot - and sufferers can hope for a brighter future

Brianne Camilleri had it all: two involved parents, a caring older brother and a comfortable home near Boston. But that didn't stop the overwhelming sense of hopelessness that enveloped her in ninth grade. "It was like a cloud that followed me everywhere," she says. "I couldn't get away from it."

BRIANNE STARTED DRINKING and experimenting with drugs. One Sunday she was caught shoplifting at a local store and her mother, Linda, drove her home in what Brianne describes as a "piercing silence." With the clouds in her head so dark she believed she would never see light again, Brianne went straight for the bathroom and swallowed every Tylenol and Advil she could find-a total of 74 pills. She was only 14, and she wanted to die.

A few hours later Linda Camilleri found her daughter vomiting all over the floor. Brianne was rushed to the hospital, where she convinced a psychiatrist (and even herself) that it had been a one-time impulse. The psychiatrist urged her parents to keep the episode a secret to avoid any stigma. Brianne's father, Alan, shudders when he remembers that advice. "Mental illness is a closet problem in this country, and it's got to come out," he says. With a schizophrenic brother and a cousin who committed suicide, Alan thinks he should have known better. Instead, Brianne's cloud just got darker. After another aborted suicide attempt a few months later, she finally ended up at McLean Hospital in Belmont, Mass., one of the best mental-health facilities in the country. Now, after three years of therapy and antidepressant medication, Brianne, 19, thinks she's on track. A sophomore at James Madison University in Virginia, she's on the dean's list, has a boyfriend and hopes to spend a semester in Australia -a plan that makes her mother nervous, but also proud.

IS TEEN DEPRESSION AN 'EPIDEMIC'?

Brianne is one of the lucky ones. Most of the nearly 3 million adolescents struggling with depression never get the help they need because of prejudice about mental illness, inadequate mental-health resources and widespread ignorance about how emotional problems can wreck young lives. The National Institutes of Mental Health (NIMH) estimates that 8 percent of adolescents and 2 percent of children (some as young as 4) have symptoms of depression. Scientists also say that early onset of depression in children and teenagers has become increasingly common; some even use the word "epidemic." No one knows whether there are actually more depressed kids today or just greater awareness of the problem, but some researchers think that the stress of a high divorce rate, rising academic expectations and social pressure may be pushing more kids over the edge.

This is a huge change from a decade ago, when many doctors considered depression strictly an adult disease. Teenage irritability and rebelliousness was "just a phase" kids would outgrow. But scientists now believe that if this behavior is chronic, it may signal serious problems. New brain research is also beginning to explain why teenagers may be particularly vulnerable to mood disorders. Psychiatrists who treat adolescents say parents should seek help if they notice a troubling change in eating, sleeping, grades or social life that lasts more than a few weeks. And public awareness of the need for help does seem to be increasing. One case in point: HBO's hit series "The Sopranos." In a recent episode, college student Meadow Soprano saw a therapist who recommended antidepressants to help her work through her feelings after the murder of her former boyfriend.

Without treatment, depressed adolescents are at high risk for school failure, social isolation, promiscuity, "self-medication" with drugs or alcohol, and suicide-now the third leading cause of death among 10- to 24-year-olds. "The earlier the onset, the more people tend to fall away developmentally from their peers," says Dr. David Brent, professor of child psychiatry at the University of Pittsburgh. "If you become depressed at 25, chances are you've already completed your education and you have more resources and coping skills. If it happens at 11, there's still a lot you need to learn, and you may never learn it." Early untreated depression also increases a youngster's chance of developing more severe depression as an adult as well as bipolar disease and personality disorders.

NEW APPROACHES TO TREATING DEPRESSION IN TEENS

For kids who do get help, like Brianne, the prognosis is increasingly hopeful. Both antidepressant medication and cognitive-behavior therapy (talk therapy that helps patients identify and deal with sources of stress) have enabled many teenagers to focus on school and resume their lives. And more effective treatment may be available in the next few years. The NIMH recently launched a major 12-city initiative called the Treatment for Adolescents With Depression Studyto help determine which regimens-Prozac, talk therapy or some combination-work best on 12- to 18-year-olds. Brent is conducting another NIMH study looking at newer medications, including Effexor and Paxil, that may help kids whose depression is resistant to Prozac. He is trying to identify genetic markers that indicate which patients are likely to respond to particular drugs.

Doctors hope that the new research will ultimately result in specific guidelines for adolescents, since there's not much evidence about the effects of the long-term use of these medications on developing brains. Most antidepressants are not approved by the FDA for children under 18, although doctors routinely prescribe these medications to their young patients. (This practice, called "off-label" use, is not uncommon for many illnesses.) Many of the drugs being tested-like Prozac and Paxil-are known as SSRIs, or selective serotonin reuptake inhibitors. They regulate how the brain uses the neurotransmitter serotonin, which has been connected to mood disorders.

continue: Finding Help for Depressed Teens