In depression's grasp

She didn't have a name for it, but it forced her into a game of pretend. At a private Catholic school in Wheaton, senior Paola Castro pretended to be happy, to love life just as her teachers told her to - until a school counselor saw through the disguise, and what she was feeling finally received a name.

In eighth grade, Castro was diagnosed with clinical depression, an illness shared by the approximately two million Americans aged 12 to 18 who suffered a major depressive episode in 2007, according to the National Survey on Drug Use and Health. Now diagnoses are becoming more common than ever. A 2004 study by the World Health Organization found depression - a mental illness characterized by persistent unhappiness, feelings of unworthiness or the inability to experience pleasure - to be the leading global cause of lost years of health, with the number of diagnoses increasing each year.

To some, it appears that the world is becoming more depressed. But Rudolph P. Savage, a neuropsychologist based in Silver Spring, says that the increasing prevalence of depression is more likely the result of greater willingness to confront the disease, or greater willingness to give it a name. Once associated with mental asylums and psychotic breakdowns, depression is becoming less confined to social stereotypes - meaning that as diagnoses increase, so, too, does an understanding of the diversity of the disease, a variety of experience that holds true within the very hallways of Blair.

Tough seasons, tough reasons

It hits senior Josh Cutick the worst in the winter. Cutick has been diagnosed with Seasonal Affective Disorder (SAD), a form of depression that is triggered by the change between seasons. As soon as the days become low in sunlight and lower in temperature, Cutick says he gets the "winter blues," constant exhaustion that won't go away no matter how long he sleeps. The condition simply aggravates the clinical depression he must cope with year round, in addition to mild cases of both Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder.

Cutick was first examined for mental illness around seventh grade, after his habit of skipping classes led his parents to temporarily transfer him from mainstream school to the Regional Institute for Children and Adolescents in Rockville, a center for emotionally-challenged students. He says his most telltale symptom was a lack of motivation, which remains the primary effect of his conditions and filters down into just about every aspect of his life. "I want to care, but I just don't," he says. "It's horrible."

Detachment is one of many symptoms of clinical depression, which also include feelings of sadness, withdrawal from socialization, a lack of enjoyment in previously fun activities and major changes in sleeping and eating habits, Savage explains. A person can be diagnosed with any combination of symptoms; the most important characteristic is that they last for at least two weeks. From there, the illness develops with differing levels of severity. Some patients may be able to go about with their daily lives, while others may repeatedly attempt suicide.

Savage says it all depends on both the genetic makeup and environment of the individual. Though someone with a family history of depression is generally more likely to have the disease, genes are not a requirement or even guarantee of the illness. One of the most frustrating questions for Cutick is why he experiences feelings of emptiness. "There doesn't have to be an actual cause. It just is," he says.

A more identifiable factor affects sophomore Sarah Botzer: stress. Botzer has been worrying about her future since middle school, when her teachers first started discussing career paths and emphasizing academics, she says. It seemed as if all her friends had a sense of direction in their lives, and the absence of one in hers, combined with her typically "pessimistic" outlook, led to full-on depression. "Life in general - it's scary," she says. "I've just had a lot of trouble dealing with it." Also a self-described perfectionist, Botzer says she spends a lot of her time moping, afraid of committing to tasks unless she knows she can perform them exceptionally.

Botzer self-criticism even extends to her social life, which, though active, is not immune to spurts of depression. Sometimes at parties or sleepovers, she feels moments of sharp loneliness and obsessively compares herself to other people. The moments pass, she says, but at other times she holds her feelings in and ends up releasing them in an explosion of stress. Although she considers much of this typical teenage frustration, she also questions the commonality of her experiences, saying, "I hope I'm not the only one who feels like this."

Filling the cup

She isn't. Castro used to feel habitually overwhelmed by her depression, which she would describe as a cup. Negative comments from others, unhappiness at home and other influences would "fill the cup" day after day, until finally, she says, it overflowed, pushing her to seek release.

Castro faced challenges throughout childhood: her parents' divorce, her mother's battle with breast cancer and her older brother's constant absence from home. When her brother had the first of two children, taking attention away from Castro's own care, things went downhill, she says. She kept a notebook in which she vented her anger, wrote poems and scribbled. At school, teachers noticed her mood swings, which she would sometimes cover up by hiding in a closet to cry. But the outlet she most depended on was more dangerous - the practice of cutting, or self-inflicting wounds. It got to the point where she would cut just because she felt bored or afraid to be by herself. "Sometimes," she says, "I wouldn't even wait for the cup to get full."

Not that there weren't plenty of external factors upsetting her, including people who she says took advantage of her sensitive nature. "I still have problems expressing things, because I'm worried about hurting people," she says, echoing similar sentiments expressed by both Cutick and Botzer.

Mimi Blasiak, director of the Adele Lebowitz Center for Youth and Families that focuses on adolescent mental health, says she has seen a fair amount of empathy among youths with depression. When faced with tragedy, she says, "these kids may be imagining what it was like to be there, feeling the outside pain."

For Castro, it was concern for her family that led to a breakthrough. Last year, her mother and brother broke down her bedroom door to find that her cup had been filled. In an attempt to stop the cutting, Castro's brother confronted her face-to-face and then urged his little sister to be strong for their family. "He walked me through it," she says. "[Before then], I didn't realize I had a choice."

Fading scars

The notion of choice seems unlikely to Cutick, who expects his depression to persist for the rest of his life. But he speaks positively about the effects of his treatment, a combination of medicine and therapy, and is determined to make a difference in the field of health. He hopes to pursue a career in medicine and educate people about his own conditions along the way.

Blasiak emphasizes the importance of nurturing personal interests as another aspect of treatment. "One thing I talk about a lot with patients is finding a passion - something in your life that matters," she says. "Empty hours lead to depressive hours and anxiety."

This is something Botzer says she knows too well, and something she plans to cure by exploring photography and magazine design. Currently a staffer for Silver Quill, Blair's literary magazine, Botzer says she has an active interest in layout and can see her future leaning in that direction - mostly because she enjoys it, but also because it is a source of self-esteem. "It makes me feel good," she says. "It's one thing I'm not terrible at."

As for Castro, she considers the most intense stages of her depression as already being behind her. Sometimes, she says, she vaguely thinks about cutting again - but then she remembers the example she wants to set for her brother's children, her niece and nephew, and hurting herself becomes entirely a thing of the past.

Or at least, almost entirely. Before describing her progress - better relationships with her brother and formerly estranged father, and more responsible behavior towards her family - Castro lifts her left sleeve, revealing a line going down her forearm lighter than the skin surrounding it. "I've grown up from this," she says. Then she continues to speak of her blessings, looking away from a fading scar.