Cobain

Question: What exactly is your clinical background/specialty?

Cobain: I am a registered nurse, with credentials in psychiatry and mental health. I work in a hospital. To be more specific, I work in a mental health unit with mostly depressed and suicidal patients 13 and up.

I teach suicide intervention workshops, and I belong to the American Association of Suicidology. I'm also a member of the Washington State youth suicide prevention committee.

I am also successfully receiving treatment for major depression. Also, I've battled with thoughts of suicide in the past.

Question: Why do you think so many teens today seem obsessed with death and suicide?

Cobain: The teens who are obsessed with death are probably depressed. I would say that 40-50 percent of depression is genetic. The rest of it would be brain chemistry and life stresses.

Question: How long have you been a counselor?

Cobain: I am not a counselor. I have been a psychiatric nurse for 7 years.

Question: Do you think alcohol and drug use plays a large part in the tendency for teens to be depressed?

Cobain: Absolutely. Substance abuse is one of the risk factors for depression and suicide.

Question: Ms. Cobain, how did your life change after Kurt became famous?

Cobain: It didn't change when he became famous. It changed after he died. I was already helping people who were depressed and suicidal. His death was the impetus for me to work harder and in different ways, and to focus on youth.

Question: How do you treat someone without counseling? What exactly do you do?

Cobain: The classic treatment for depression is medication and talk therapy. Although, when treating depressed teens, you do not have to use medications often. Talk therapy is necessary to change negative thought patterns and to teach new coping skills. Without counseling, medication becomes more necessary, depending upon the severity of the depression.

Guest: Was Kurt always depressed?

Cobain: I got the information that he was depressed from his mother, judging by his childhood and the pictures I've seen him paint and the lyrics that he wrote. Kurt was depressed for a long, long time. The fact is that most depressed adults first develop depression in their teens.

Question: I heard that when teens spend too much time on the Internet, that can cause depression.

Cobain: I think anyone who spends too much time online, and not enough in the 'real' world, can get depressed. Any kind of withdrawal from the usual activities in your life can be a sign of depression. Most substance abuse is (an attempt) to medicate some kind of emotional pain.

The cause of most suicides is depression, which is a form of emotional pain. These are the behaviors parents can look for that might indicate depression. A significant loss or gain in appetite is a sign of depression.

Question: I have this friend who used to do a lot of stuff and lived a pretty exciting life, but for the last few years, he decided to give up and wait to die. Any suggestions?

Cobain: First, there are questions that must be answered: Are there changes in his sleeping habits? Does he seem withdrawn from friends and family? Does he appear to be neglecting personal appearance and hygiene? Are there signs of prolonged sadness, irritability, or indifference? Is he performing poorly in school, or getting into trouble? If so, there is a good chance. You should get your friend to a professional.

Question: What kind of professional?

Cobain: I'd like to see them evaluated by a psychiatrist and clinical psychologist with expertise in adolescent mental health.

Question: Hey, I think that I am depressed. I stay isolated, make great grades, (but) don't do much with my friends, but they don't do much anyway. I eat a lot ... and I am irritable according to some. Am I depressed?

Cobain: You could be depressed. Why not check it out?

Question: How do I check it out?

Cobain: You can be evaluated by a mental health professional. You can also go to your family doctor. They would ask a lot of questions about your life, your activities, your feelings.

Question: What would they do?

Cobain: There are specific symptoms that indicate depression. There are also specific types of depression. It is also necessary to have an accurate diagnosis so you can get the best treatment. That is the best way to a fast improvement.

Question: Is feeling like you have no friends a sign of depression?

Cobain: Do you mean you have no friends and no one cares about you?

Question: Both. I mean, I guess I have friends, but sometimes, it's like, when I have a problem, none of my "friends" seem to care. So I come on here, and annoy people with my problems.

Cobain: That might be healthy in a way, but it will not work forever if you're depressed.

Question: Well, sometimes it's like I base my life around this stupid chat room (no offense anyone).

Cobain: You know, the people in chat rooms don't know you well enough to help you if you're really in trouble.

Question: Author, I think I am depressed because I can't eat and can't sleep at all. All I do is toss and turn. Does that mean I am depressed?

Cobain: Signs of depression come in clusters. What else is going on?

Question: I can't eat at all. All I do was punch and hurt myself.

Cobain: If you're hurting yourself, you need to seek help right away.

Question: What can I do?

Cobain: Can you talk to your mother about this?

Question: I don't want her to know.

Cobain:Then I want you to go to another adult that you trust. Say this (to them): "I'm hurting myself and I don't know how to stop. Please tell me what to do."

I want to know, will you do that?

Question: Okay.

Question: Your book discusses the use of electric shock therapy. Do you support the use of this type of therapy as treatment for depression? For any other conditions? How can this help?

Cobain: Actually, the only reason I mentioned shock therapy in the book is that it is one of the treatments for severe depression. It's only used as a last resort. Also, shock therapy is and rarely used with teens. There are many other options before you get to ECT.

Question: Can depression be caused by biological factors? If so, what are some?

Cobain: Yes, it can be caused by biological factors. Also, if you have another medical or mental health condition, that worsens the depression.

Question: Ms. Cobain, dysthymia has often been not considered a disorder. Why shouldn't it just be called "getting the blues?"

Cobain: Because dysthymia is a mental health disorder. Most people with dysthymia will develop a major depression. It does not always have to be treated with talk therapy or medications. You need to learn to take care of yourself very well ... it is important to get some kind of help for it. Plus, dysthymia is uncomfortable, it leaves you feeling bad.

Question: Dysthymic disorders are usually chronic. They lead to clinical depression many times.

Question: Do the kids you see ever ask about Kurt?

Cobain: Everybody asks me about Kurt. I tell them that he chose a permanent solution to a temporary problem.

Question: Author, if you meet a depressed or suicidal teen, does it help to tell him that he is loved and appreciated?

Cobain: Yes, but it also helps to tell them that you are concerned and you'd like to help.

Asking the question, "Are you suicidal?" gives the friend permission to talk about it. If the answer is yes, express your concern. Also, stay with the person while you call for help, and call a crisis line. Take them to a hospital; get an adult immediately. Also, let your friend know that there's nothing to be ashamed of.

Question: How do you feel about intervention in addiction cases?

Cobain: Intervention is a skilled procedure. They are best done by experienced professionals. They are helpful in some cases, but not in all.

Question: Does drug addiction and violence have a common root?

Cobain: I'm not an expert on domestic violence, but in domestic violence cases, substance abuse is often a factor.

Question: How should parents approach a child addicted to hard drugs?

Cobain: I would just say that people who abuse substances are more likely to be violent than those who do not.

Question: Author, isn't the problem with depression that "when nothing matters anymore" then why does it matter to get help for depression?

Cobain: The answer is that when somebody is depressed to the point when nothing matters anymore, someone else will need to step in and make sure that they get help. Be aware of the symptoms of depression before it gets to the point where "nothing matters any more." That's the purpose of my book.

Question: I'm sure your book will help many people.

Cobain: Thank you very much. That's my hope.

Cobain: If you need me to answer questions in the future, contact www.freespirit.com. Then, go to the author Q&A section.

Question: Thanks Ms. Cobain. This has been a very enlightening evening.

Cobain: These were better questions than most of the interviewers have asked me!

Question: Author, the people that ask questions here at CNN are the sharpest in the internet, thanks.

Question: I don't know about everywhere, but in our state if you believe someone is in imminent danger to himself and/or others, you can go to the magistrate's office and petition for involuntary commitment.

Cobain: That differs state by state. In my county, you can call and have a person evaluated.

Question: Yes, Author, that's what a petition is for to be evaluated to see if one needs hospitalization. If not, they are released, but an involuntary commitment kind of makes it mandatory that the person in trouble gets help immediately.

Cobain: Don't just let somebody die because you think there's nothing you can do about it. You can save lives. If anyone hints that they might be contemplating suicide, your job is to believe them.

Show concern, ask the question, and get help.

You were all great. Thanks for having me!