Family grapples with teen’s suicide; ‘There’s not a day we don’t cry’ — (The Atlanta Journal-Constitution)

SSRI Ed note: Boy, 13, diagnosed with depression given Lexapro, attempts suicide, gets bipolar diagnosis, more psych meds added. Lexapro dose increased, he dies by suicide.

Original article no longer available

The Atlanta Journal-Constitution


Published on: 04/03/05

Kandy Kim was beyond worried about Alex, her 13-year-old son.

The seventh-grader, her baby, had just finished a difficult school year, with strife between him, his parents and his homeroom teacher.  Jean Shifrin/AJC

Kandy Kim and her husband, Lynne, lost their 13-year-old son, Alex to suicide in June 2004. They question whether the usage of antidepressants adversely affected their son.

He’d been diagnosed with depression in March 2004. He had attempted suicide the following month by swallowing a handful of sleeping pills.

Yet, with the school year finally over, a few rays of light seemed to stream into Alex’s darkness. He was happy with his summer schedule of football camp and visits to see family.

On June 8, though, Alex had a disagreement with his much-loved football trainer. When Kandy picked Alex up, he silently climbed into the car and tore up a list of things he had wanted to work on during the summer. He stuffed the shredded paper into the side compartment of his door.

Once home, Alex went to his room.

Kandy decided to make Alex’s favorite dinner. Maybe shrimp tempura would cheer him up.

Alex, still quiet, went downstairs with a load of clothes to wash. She saw him go back upstairs.

Dusk fell, and Kandy noticed that three of her kitchen lights were out. She called for Alex to come downstairs to help change light bulbs.

He did not answer.

With dinner on the table, Kandy called Alex again.

No answer.

Kandy went upstairs. She checked his bedroom. His bathroom. The hall. The computer room. His sister Sarah’s room.

She couldn’t find him.

She went back to his room. No Alex.

Maybe, she thought, Alex was playing hide-and-seek.

Kandy turned the knob of his closet door.

Alex, at 5 feet 3 inches and 125 pounds, was hanging from the clothes rack with a belt around his neck.

No, no, Alex, no, no, Alex, no.

He’s dead, he’s dead, oh God, he’s dead.

Kandy tried to unleash Alex from the belt. Crying and screaming, she heaved with all her might to try to release the tension. Maybe she could save him, she thought.

She couldn’t free him. She ran downstairs into the kitchen. She grabbed a butcher knife and ran back upstairs to cut the belt. At the same time, she begged a 911 dispatcher to send an ambulance.

She sawed through the belt.

After he fell to the floor, she gave CPR  – 1, 2, 3, 4, breathe – trying over and over again to save her youngest child.

Alex, at 13, was gone.

Journey of ‘what ifs’

His death blasted through his family of five, this family that used to go to movies and on rafting trips together but now can’t even cook a meal in their home. In less than nine months, they’ve moved twice trying to escape memories.

It is still a raw experience endured by his mother, his older sisters  –  Amanda, 24, and Sarah, 22  – and his father, who left for Ohio in the early morning of the day Alex died.

“When I left at 5, I woke him up and told him, ‘I love you,’ and he said, ‘Dad, I love you, too.’ ” his father, Lynne, said. “That was the last thing I said to him.”

Their grief is solitary. Few people outside the family are willing to talk about it.

Even so, the Kims have decided to reach past their pain and talk about how Alex’s death shows the gaps in the treatment of teenagers with depression.

They question if he was adversely affected by the antidepressants, whose usage in children and teens has been under scrutiny for nearly two years. The Kims hail a September Food and Drug Administration ruling that the drugs must carry a black box warning ? the FDA’s most stringent ? after dozens of children ended their lives while taking antidepressants. The labeling states that antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and teens with psychiatric disorders.

But perhaps more importantly, Alex’s death ? and his parents’ willingness to talk about their journey of “what ifs” ? provides a jagged window into the world of teenage depression and the ignorance and stigma that surround it. It’s about how depression can ravage a previously happy, beloved child and the challenges of getting good health care and support for the youngest of the mentally ill, experts said.

‘Treated like criminals’

“This is unbelievable. It’s tragic –  there were a whole bunch of episodes that put this kid at risk,” said Dr. Harold S. Koplewicz, director of the Child Study Center at New York University, when he heard Alex’s story.

While physically ill children and their families often stir a culture’s collective heart, children who are mentally ill and their families often get little to no support, psychiatric experts say. Questions are raised: Why is this child acting this way? What have the parents done wrong? And most importantly, how can I keep my child away from this family?

Instead of compassion, Alex got handcuffed by police. Instead of patience, Alex got disciplinary referrals. Instead of a community of support, Alex and his family struggled with loneliness and shame.

Teenage depression not only robs some youngsters of their joy, but their very lives, claiming as many as 3,000 teens each year from suicide. It’s also increasingly cited by criminal experts as a cause for homicides.

Dylan Klebold was diagnosed with depression before he and Eric Harris killed 13 people in Littleton, Colo., in 1999. So was Heritage High student T.J. Solomon, who fired shots at the Rockdale County school one month after the Columbine massacre.

But unlike adults, depressed teens are often discounted as angry, with critical warning signs missed. Instead of appearing sad and lethargic, they often act hostile, experts said.

And even when they are diagnosed, the medical system has a shortage of mental health professionals trained to work with children. About 6,400 child psychiatrists are in practice around the country, for example, for an average of 128 per state, clustered mostly in cities. Pediatricians ? not counselors, psychologists and psychiatrists ? provide almost 75 percent of mental health care for children, according to the American Academy of Pediatrics.

And then there’s the stigma.

“None of it makes any sense,” said Ellyn Jeager, director of public policy and advocacy for the National Mental Health Association of Georgia. “Kids are being treated like criminals when in fact they are sick.”

Alex’s case could be a textbook example.

Middle school trouble

Life had been good for Alex until he hit his middle school years, his parents said.

The third child, and the first son, Alex was doted on by his parents and his two sisters.

He would often call and leave messages on his parents’ phones, tellin
g them he loved them, sometimes in a goofy voice.

“He was always making jokes and laughing,” said his sister Sarah, who loved to watch movies with her little brother.

The day before he died, his family was coming home from a rafting trip in Tennessee. On the way back to Atlanta, Alex rode with his friends, and his parents followed in their car. At one point, Alex ? acting his age ? mooned his family.

“That was just so Alex,” Lynne said.

He had been an A student at Berkeley Lake Elementary in Gwinnett County. He rode with Kandy, who taught third grade there.

Yet middle school brought a cascade of changes. First, his father moved to Ohio for a sales job.

Alex was deeply unhappy about that. “Oh, he definitely missed me,” Lynne said. “But I tried to stay in touch. We talked on the phone at least once a week.”

But Lynne second-guesses his decision. What if. What if he hadn’t taken the job and stayed?

At school, things weren’t good either, the Kims said. Alex got into trouble for slouching in his seat, talking out, being disrespectful.

“It was more of an attitude thing,” Kandy said.

Alex was pushing limits, his father said. “He was definitely out there, no question, but it was never in a bad way.”

Allowed to bring a few soft drinks to school for a special party, Alex overdid it and brought a six-pack of Coke. His teachers were angry, conference minutes show.

“He got into trouble a lot, but it was nothing serious,” said Brian Grenier, one of Alex’s friends and a classmate at Dacula Middle School. “He always did his homework.”

In March 2004, tension at school became more pitched when Alex kicked his sneaker onto the top of a classroom trailer. Alex had to walk around the rest of the day in the rain without a shoe, his mother said.

Kandy and Lynne asked for a teacher conference.

Three teachers, the vice principal and counselor were there. Alex and his parents joined them. The school officials were on one side, Alex and his parents on the other.

“They said he needed some help with his anger problem,” Kandy said. Alex felt “ganged up on,” Kandy said.

“By the end of the meeting, he was slouched over and turned around. He wouldn’t even make eye contact with anybody.”

Officials from both Dacula Middle School and Gwinnett County Public Schools would not comment on Alex’s case. Minutes from the meeting show that five school officials were in attendance. The minutes note that “Alex thinks [the teacher] did not do enough to get his shoe and was mad about it.”

Overdose crisis

Not long after the shoe incident, Alex was found behind the bleachers at his church with a girl his age engaged in some petting, Kandy said.

A religious woman, she was infuriated that her son had violated some deeply held values, she said.

She and her pastor let Alex know about it ? and Alex became embarrassed.

Kandy second-guesses this decision. What if. What if she hadn’t gotten so angry?

“I wish I hadn’t acted quite as bad. I got really mad.”

On the recommendations of his teachers, Kandy took Alex to a child psychiatrist on her HMO list. The doctor prescribed Lexapro and gave Alex a sample sack of sleeping pills, Kandy said. The doctor told Kandy that she was prescribing Lexapro because it was not one of the antidepressants implicated in the suicides in teens, Kandy said.

Four weeks later, Kandy rushed Alex to the Gwinnett Medical Center. He had overdosed on the sleeping pills.

(The Kims gave written permission to the psychiatrist to talk about Alex, but she did not return several phone calls from The Atlanta Journal-Constitution.)

Alex was at Gwinnett Medical Center for about four hours. Like many Georgia teens who attempt suicide, he was handcuffed and put into the back seat of a police car for transport to SummitRidge, a mental health facility.

“I was stunned, but they told me this was standard practice,” Kandy said. She asked if she could ride with him, but doctors and police told her no.

At SummitRidge, a doctor diagnosed Alex not with depression, but bipolar disorder, according to his parents.

The doctor there added Risperdal, an anti-psychotic drug, and Depakote, which is used to treat bipolar disorder, Lynne said. Alex also was to take Benadryl, an over-the-counter antihistamine. He stayed on Lexapro, his parents said. SummitRidge officials would not comment on Alex’s case, citing privacy laws.

But after four days, the Kims pulled Alex from SummitRidge against the hospital’s advice, the Kims said. They thought he was taking too many medications.

“I went to visit him there,” Sarah said. “He was solemn, stone-faced. He wasn’t even my brother.”

‘Some anger issues’

The Kims were very confused about what to do next.

“He was really stressed out about his grades,” Kandy said, “and he wanted to go see his friends.”

Alex went back to school. The Kims did not tell anyone about their son’s illness and hospitalization.

Alex held his secret tight.

“I think he was embarrassed,” said friend Brian Grenier. “He didn’t want to talk about it.”

Alex started seeing the psychiatrist every two weeks, Kandy said. “The nurse would come in and ask him how he was feeling. Then the doctor would come in and say, ‘I see you have some anger issues.’ ”

The psychiatrist disagreed with the diagnosis of bipolar disorder, Kandy said, and weaned Alex from the Risperdal, Benadryl and Depakote. In late May, the doctor doubled his Lexapro dosage and suggested counseling for Alex’s anger.

Kandy made an appointment with a psychologist for June 16.

Alex did not live to keep it.

A family in pain

On June 8, Alex was excited to see his football trainer, Mark Clark, with whom he had worked for more than a year. They worked out three days a week at 6:30 at night.

Kandy dropped Alex off at Clark’s home. “He was just so happy when he ran in there,” Kandy recalled.

Clark said Alex confided many things to him during their sessions ? pain about his father working in Ohio, the embarrassment and shame he felt about the bleacher incident, getting in trouble at school.

The antidepressants also seemed to have changed Alex’s personality, Clark said.

Alex had made some videotapes of himself that he wanted to review with Clark and to pinpoint some things to work on. He made a list of all the things he wanted to do. That day, Alex wanted to put on his pads and uniform and go outside.

But Clark disagreed with Alex, saying that he should work indoors instead.

“He got really angry with me, and he never got angry at me,” Clark said. “He thought I wasn’t listening to him.”

Alex was dead within two hours.

And Clark has struggled with his own what ifs.

“He was such a beautiful child,” Clark said, starting to cry. “I loved him like my fourth son.”

A few months shy of the first anniversary of Alex’s death, the Kims are barely hanging on. They have tried grief counselors, but Kandy wonders whether most would even be able to comprehend her sorrow.

“No one has seen their son hanging from a clothes rack in their closet,” she said simply.

Such feelings of isolation are understandable and normal after such a horrendous loss, said grief therapist Karen McCarty.

“It’s so hard, particularly when it&
#39;s a young child,” said McCarty, of the Link Counseling Center in Sandy Springs.

While seeking support might sound helpful, McCarty said, “it isn’t easy to enter one of those groups.”

Work has been Kandy’s escape.

Lynne, who has since left his Ohio sales job and moved back with his family, has fought depression and has been diagnosed with Bell’s palsy. He finds an escape in sleeping. Sarah sobs every time she talks about her brother. Amanda doesn’t want to talk about it at all.

“There’s not a day we don’t cry,” Lynne said. “Our life is just empty. If it weren’t for our other two kids, it wouldn’t even be worth living.”

They used to have a curio filled with photos, his football helmet and jersey. But in recent months, they’ve taken it down. Two photos of him remain on the mantel.

“When someone asks and says, ‘Is that your son?’ we break down,” Lynne said. “If we see someone in public who knows Alex, it’s the same thing. I just have to turn my back. They just feel so bad, they just start apologizing. They know our life is ruined.”