Warning: This story contains accounts of teenage mental health issues, self-harm and suicidal behaviour.
Eden Waugh had been looking forward to dissecting a cow’s heart in his year eight science class.
But when the experiment was postponed, his mother Jodie was already waiting in the car outside his school to bring home the crestfallen 13-year-old at lunchtime, as she often does.
The shift-working maternity nurse and mother of five is still watchful of Eden’s small daily ups and downs after his tumultuous first year of high school last year.
“He tried to kill himself the day before my birthday last year,” Ms Waugh said.
“He [had] a horrible meltdown. He was hysterical. He tried to hurt himself. I ended up pinning him to the floor.”
Ms Waugh took Eden to the emergency department of a public hospital.
“And I won’t ever do it again. The mental health system in Australia is shit. They don’t know what they are doing,” she said.
“[The psych registrar] said to him, ‘You’re really upsetting your mum by coming here … go home, have a Milo and be a good boy from now on.”
“The first time I went through there, I rang the crisis assessment team because he was trying to strangle himself and had multiple self-harm attempts when he was eight … they took six weeks to get back to me with a self-harming eight-year-old.”
Eden’s memory of his episodes is fuzzy.
“I did try and use a knife,” he said quietly.
“I was definitely intending to kill myself. But I dunno, I just kind of thought … if I do actually kill myself, will I just be gone? Will there be an afterlife or something?
“You kind of realise [you] don’t really want to take that chance to find out.”
Eden has been taking antidepressants for almost half his short life.
He is one of more than 100,000 Australian children and teenagers who have been prescribed them, a number which has shot up by almost 60 per cent in the past five years.
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Dr Ian Hicke from the Sydney University Brain and Mind Centre broadly supports intervention, case by case.
“The issues about prescribing are quite different depending on whether you are talking under-five preschool, primary-school-age groups or post-pubertal secondary age groups. It’s really the last group, the 12 to 18 group … where most of the increased treatment is going on,” he told 7.30.
“It’s important to say, for adolescents the same as children, in most situations the optimal first-line treatment would be psychological behaviour and not medical.”
“It’s usually the last resort,” Professor Harriet Hiscock from the Murdoch Children’s Research Institute said.
“Best practice is certainly not to start with that, but to start with psychology and other therapies [such as] support around parenting.
“For some children, that’s not enough and certainly in teenagers, you need a combination of both, often, to lift them out of their anxiety or out of their depression.”
“It kinda just makes it so that you’re more relaxed. Maybe if I’m feeling like I’m getting annoyed, without it I’d be a lot more annoyed than I would be with it,” Eden said.
In Eden’s home state of Victoria, teenage mental health presentations to emergency departments have risen three times faster than physical presentations, such as illness or injury.
It means the very nature of teenagers’ risky behaviour is changing away from the traditional teenage rite of passage risks, like being hurt climbing trees, to the all-together more worrying trend of self-harm.
Eden is quiet and intensely intelligent. His flirting fascination with the paleolithic era has now faded and his latest love is his new dog, Jack.
His disinterest in competitive sport is difficult for his father John to understand, given John’s role with the Greensborough Junior Football Club.
“I have probably learnt a lot of things through being Eden’s father. I mean, I am very old school,” Mr Waugh said.
“So I wasn’t really keen on Eden taking medication.
“Your senses are always alert, tuning into conversations with his brothers, when he’s starting to get heightened.”
The youngest of five, in many ways Eden is not unlike any other teenager, facing the ups and downs of the early years of high school.
That’s why it’s difficult to imagine how, not long ago, this sweet young kid was violently hurting himself, his mother, and even other kids at school.
“He attacked them, all three of them, a few times at school,” Ms Waugh said.
“He got suspended. He did hurt them, which isn’t ever OK. But he was in such distress.
“His brain doesn’t work like everyone else’s. He doesn’t have some of the impulse control and the thinking things through and if his emotions go up, that’s it. He has a meltdown.
“He’s not even there anymore. It’s not Eden anymore. It’s just something else.”
“You don’t really realise how much you need friends until you don’t have any,” Eden said.
Treating Eden’s mental health is complicated by his underlying autism spectrum disorder. He has seen a psychologist for years, but his paediatrician, Dr Lionel Lubitz, first prescribed his antidepressants.
“Actually, he’s a beautiful, lovely boy and easy to get to relate to,” Dr Lubitz said.
“He talks very easily when he has a consultation. He is healthy and yet he suffers very severe anxiety. So much so that when I initially saw him, he couldn’t get to sleep, he couldn’t get up stairs, couldn’t leave his parents, because he felt so anxious about that separation, couldn’t get to school.”
The vast majority of antidepressants are prescribed to Australian adolescents and teenagers by GPs and paediatricians, not mental health specialists.
“I’m under-qualified, because it wasn’t really in my training,” Dr Lubitz said.
“I’ve learned them along the way. And I suppose in the early days, even with Eden … by then I was becoming a bit more skilled, but even then I was a little uneasy about it.
“So I do feel that most of the paediatricians would give you the same answer. They would say, yes, I do prescribe it, I feel a little uneasy about it.”
However, he said the change he saw in Eden was dramatic.
“He came back three months later and his mother and him were just over the moon, couldn’t believe it,” he said.
Exactly who is prescribing antidepressants to teenagers is alarming to child psychiatrist Dr Jon Jureidini, who controversially argues that we must “let children cry”.
“Most psychiatric medication is prescribed in general practice. And while that’s particularly the case with adults, also the case with children, I don’t think there’s any role for psychiatric medications being initiated in general practice,” Dr Jureidini said.
“And there’s very little role for psychiatric medications being given at all to children, I think we need to be incredibly conservative about their use.
“I think we need to trust young people’s capacity to survive that distress and come out the other side more complete, better functioning, more able to deal with frustration and difficulties that occur in the future.”
While not commenting directly on Eden, he said it’s clear that there is some “reckless prescribing” and that for some young people, “these drugs will do more harm than good”.
“A lot of the time, I think we, as adults and clinicians and therapists, are not medicating the children’s pain so much as our own,” Dr Jureidini said.
“[Dr Jureidini] might find himself second guessing what he believes if it was his child,” Ms Waugh said.
“If [Eden] wasn’t medicated for his anxiety now, I cannot picture how bad his life would still be.
“[It’s] one thing to have theories, one thing to love a child who wishes he was dead.”
“It’s just allowed him to be more him,” Mr Waugh said.
Eden says he is doing better than he was last year. He has regular psychotherapy and has even been able to take up CrossFit.
“I’m thinking about starting to reduce the levels I have, because I feel like I should be pretty OK without it,” Eden said.
“But if it does start up, under stress and anxiety, all that starts to take its toll again, then we’ll go back onto it.”