The physician who treats depressed, anxious, and suicidal teens [PODCAST]

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“After almost 30 years in this profession, I have come to the conclusion that there is some truth to that, as no day or week passes that I do not have a depressed, anxious or suicidal teen on my ‘to see list.’ Could it be my own personal history of depression and suicidal ideation? Could it be my own history of being bullied as a young child? My insecurities as a teenager? My personal history of sexual assault as a young, bright-eyed medical student? Or my own history of private pain and suffering? We may never know. But one thing is for sure I do want my patients, my teens, and tweens to stop hurting. And I plan on doing something about it. One patient’s mother thinks I have a ‘healing spirit.’ That is why they come to me. I say: I hear the call and am ready to be sent.”

Uchenna Umeh is a pediatrician and can be reached at Teen Alive and on Facebook and YouTube.

She shares her story and discusses her KevinMD article, “A pediatrician’s healing spirit: treating depressed, anxious, and suicidal teens.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Uchenna Umeh. She’s a trained pediatrician, and she has a nontraditional practice that she’s going to tell you about. But first off, Uchenna, welcome to the show.

Uchenna Umeh: Thank you so much, Kevin. It’s nice to finally meet you.

Kevin Pho: Oh, it’s very exciting, it’s very exciting. So tell me a little about your story and your journey to where you are today.

Uchenna Umeh: So I’m a board-certified pediatrician, and I’m a mom, so I like to go by the word “Momatrician.” I was born, bred, buttered, and slightly burned in Nigeria, but I’m happy to be here. I live in San Antonio, Texas, right now with my three boys and two parakeets and a dog, and we’re living happily ever after.

I have 29 years under my belt of being a clinician. A few years ago, I made a hard left turn into the world of the nontraditional, and I like to say I left penicillin pediatrics behind, and now I just practice preventive pediatrics. If there’s ever been a way to prevent people from dying, it’s suicide prevention.

But it all started in 2000, actually, believe it or not, when I was seven months pregnant with my now 19-year-old son. A friend of mine who was also a resident, a surgical resident, died by suicide, and that was my first contact with suicide ever in my life. I was like, “What?” But you just don’t think. It’s like, “OK, this is one. It’s a fluke.” And then I had a 15-year-old boy die by suicide in 2000, and I was like, “OK, now that’s a patient of mine.” But I still didn’t think anything that connected the dots until 2018, when a seven-year-old patient attempted suicide twice. I was like, “OK, what’s going on?”

I wasn’t necessarily remembering the fact that I myself had been suicidal after my divorce, and I had financial crises and all kinds of messes that go with, that mess with your head when you have a divorce. But it wasn’t so much that. It was, “Why would he want to kill himself? Why would anybody want to kill himself? A child?” And so I started looking into it, and the more I looked into it, the more I realized there’s a reason why. It’s called trauma.

And so now I’m more comfortable in my knowledge, and now I’m trying to tell people about it, because the problem is that the biggest misconception about suicide is that mental illness is causing it. That is huge. I think, of all the things, if I could fix something right now, it would be that concept that mental illness is behind suicide. Mental illness is one of the 23 causes of suicide, but it’s the one that everybody goes to, and it’s not even the most common. Trauma is the most common. And so now that I know better, I’m trying to tell anybody about it. That’s it.

Kevin Pho: Now, a couple of years ago, you left a traditional practice, and now you’re doing something nontraditional to help spread your message. Share a little bit about that journey as well.

Uchenna Umeh: Well, the journey was really one of self-discovery. I mean, when I left medicine, I know enough of my friends, it was almost like the divorce, right? It was like, “Are you crazy? Have you lost your mind? You want to raise three boys by yourself? What could you have done?” Same thing with medicine: “Are you crazy? You want to leave a secure job? You’re getting paid $200,000 a year, and you want to do what now?” And I was like, “Well, you know, if I’m explaining it to you, then you’ve missed the point.”

And actually, someone, a friend of mine, took me to Starbucks right up the road and said, “Sit down. Let me talk to you. Do you want to become a therapist? What’s wrong with you? You’re a doctor.” We don’t have enough time in 15 minutes to see a child who is truly, truly suicidal.

And so my practice is very equal, in the sense that patients make their own appointments. It’s a direct primary care practice. It’s like Netflix for your doctor, really. So it’s a flat fee per month, and you can see me as many times as you choose. My patients see me twice a day if they want to, or twice a month if they want to. It doesn’t matter; it’s the same flat fee.

But the beauty of it is that they have my cell phone number, and I love that. I love the fact that they have my cell number, because, case in point, several weeks ago, just about when this whole COVID-19 hit, I had a 19-year-old kid who had just attempted suicide. I did not know that, but what I know is that he called me on my cell phone: “Dr. Lulu, I need,” because I go by Dr. Lulu, “Dr. Lulu, I need help. I need help.” That is what he said. And I just went into this mommy mode: “Get out of the house!” is what I said. I screamed in the house, and my son was like, “What’s that?” I yelled so hard. I said, “Get out of the house,” and he got out of the house, and I said, “Come and see me right now.”

And within 15 minutes, he was in my office. Coincidentally, his mom stopped by for something, and she noticed. She did a sign like this, and I looked, and he had fresh marks. Now, the beauty of it is he did not call his mother; he called me. And I think for that phone call, my work is worth it, because he came to the office that day, and I talked to him.

His parents chose not to put him in the hospital, and I actually agreed with it, because studies have shown that for people who are suicidal, teens specifically, the first three months after leaving the hospital have the highest rate of suicide, in those first three months. We don’t know why yet. But he didn’t want to go to the hospital, and I gave him grace for that, because I know in a very traumatic event, usually you’re fighting with the demons in your head, literally the voice telling you you’re not good enough, and that is what we need to work with, versus, “Here, take some antidepressants.”

In his case, his girlfriend broke up with him, and he felt so humiliated by that, because he thought he was all this and a bag of chips. She left him for someone else who he didn’t even think was all that. That was the problem. So it was getting his mind out of that mindset, you know: “You deserve better.” He said, “No, I don’t deserve better.” So he kept telling himself that, and that’s why people kill themselves. And I want people to hear me when I say there’s no dose of Prozac that can fix that, because generally, he was OK before his girlfriend left him.

So the top three reasons people kill themselves are financial problems, like now during COVID-19; relationship problems, believe it or not; and divorce. I know, I was suicidal after my divorce. It’s a big, big problem. And of course, if a child has mental illness, like ADHD, depression, or whatever, and they are not properly diagnosed, or they get substance abuse tossed in, and they have no support, yes, they can be suicidal. But primarily, it’s usually trauma, and for children, it’s usually from bullying.

That’s why, when we went out of school and were forced to stay at home, I said a prayer of thanks, because I knew there’s a child out there who is thanking God not to see that bully at school anymore, and for that, I was happy. But of course, after enough time, we now have an [inaudible] of cyberbullying and an [inaudible] of domestic violence, and all the things that happen when you’re at home with the aggressor, if your own aggressor happens to be at home. So it’s a double-edged sword. But I love it. I love doing it. I love doing what I’m doing.

Kevin Pho: Now, not everyone has a Dr. Lulu in their community who can really address these issues. Now, for those listening, what are some of the warning signs that you could share with my audience that their teens may be depressed or suicidal?

Uchenna Umeh: And that’s a great question. The biggest problem is most of the warning signs in teenagers are normal teenage behavior, or they could pass for normal teenage behavior. The average teenager is not going to come and say, “Mom, I want to kill myself.” What they will do, though, the top three things a teenager who’s suicidal will do: The first one is a major change in mood. Either they become more depressed or more sad, or they become more elated. When someone has made up their mind to kill themselves, they’re relieved, and they’re happy, actually. It’s a weird paradox, but it’s true.

And I’ll tell you what, I had a client, a guest on my podcast, whose son did just that. When he died by suicide, nobody saw anything, until she came on my podcast and I was asking her questions like, “Did he talk about dying?” She’s like, “Oh yeah, about three weeks before he died, he started asking me, ‘Where do people who kill themselves go?’ But, you know, what has that got to do with anything?” I said, “Wait, hold up. Did he say anything else?” “Well, he asked his father if people who die go to heaven.” Second point. And then, wait, his poetry teacher noticed that his poems were really dark and took a dark turn. He didn’t say anything. And his lacrosse teacher noticed that his attitude had changed completely. He was happier during a road trip; specifically, he noticed that he was much more talkative than normal.

The kid gave four signs, but nobody noticed it, because nobody talked to each other. The father didn’t talk to the mother, the mother to the teacher, the lacrosse, you know what I mean? So all of them didn’t say anything, but all of those are signs of suicidal behavior.

The top sign, though, that a child is going to kill themselves is a child who has attempted suicide. They have the highest rates of suicide completion. The second high risk is family history of suicide, an uncle or a brother or a parent. That’s a high risk for a child. Again, think trauma: the trauma of losing a child to suicide, the trauma of losing a parent to suicide, versus mental illness. From losing a parent, we say, “Yes, you’re sad, but before your parent died, you were OK.”

I want people to see that the question to ask is not, “Why do you want to kill yourself?” It’s, “What happened?” Because two weeks ago, you were fine. This week, you lost your job, your mother died of COVID-19, you were diagnosed with cancer, or whatever. Something catastrophic happened, and you let all of those thoughts win, and that’s why you kill yourself. They get trapped. They feel hopeless and helpless and have no purpose. They’re like, “You know what? Nobody would notice if I die.” They say things like that to themselves, and they believe it.

So the top three signs for parents to listen to: a major change in mood, even if the child suddenly becomes reckless, like he’s driving really fast down the street with no seat belt. And I say that because suicide is second only to accidents as the leading cause of death for kids aged 10 through 34. And I call 34-year-olds kids, because they’re kids, 10 through 34. Second only to accidents, suicide kills children in that age group more than all medical diseases put together, including COVID-19. So when it’s second only to accidents, the question to ask yourself is, of those accidents, how many of them were really suicides? And that’s the problem.

So look for your child asking you questions about death, talking about death, writing about it, ruminating about death, and a sudden change in behavior: giving away their prized possessions. If your child comes back from school with his best friend’s favorite pair of glasses or favorite mug or whatever, you’d better find out what’s going on with that best friend, because people who love their stuff don’t give their stuff away. This is a huge sign that’s missed.

And parents, I empower parents to have open-door communication with your child. Go in and look through their things. If a child acquires a means to kill themselves, e.g. a gun, they’re going to use it. And if the child is writing in their journal: Alexandra Valoras was a 17-year-old girl who died a few years ago. After she died, everyone found out that she had a 200-page journal, 200 pages of nothing but self-loathing. Bad, bad. She’s like, “I failed. I’m a failure.” But to the outside world, she was class captain. She played lacrosse; she played music. Her father thought she was everything, except she did not think she was. And it was only after she made her bed one night, walked into the road, and jumped off an embankment to her death that he found her journal. So it is easier for people to say yes than “I need help.” So ask the question.

And I tell the parents, I came up with this word, TALK, because the American Foundation for Suicide Prevention talks about “Talk Saves Lives,” and I came up with a mnemonic: TALK. T stands for tune in to the right radio frequency of your child. Tune in. In other words, notice your child, know your child, know when they are not acting OK, and don’t just toss it into teenage behavior, because you might miss that minute, that two seconds, that window, right?

A is ask the question. Already, most people think erroneously that if you ask about suicide, the child is going to become suicidal. You know, people say that all the time. No. If you ask a child who is struggling with that thought, believe it or not, they’re going to be like, “Yes, Mom, oh my god, yes.” Or they might tell you, “You know what I need? Yes, I’ve been thinking about it.” And then you ask them, “Do you have a plan?” Then you’ve now opened the door. “Do you have a plan? Would you like to talk to someone? Let me take you to get help,” versus, “Do you want me to help you?” Because a teenager is going to say, “Hmm,” right? And that’s not the answer. They really want to say yes inside, but they’re not going to say it.

So L is: When you ask the right question, you’d better listen. So I use the words “lean in and listen.” So when you lean in, what do you do? You’re vulnerable. You close up the space. Your heart is closer; your ears are closer. You’re vulnerable. You’re ready to accept what they’re going to say. So ask the question, and listen, right?

And then K is: Keep open lines of communication. Studies have shown that suicidal teens who can identify one single trusted adult in their immediate environment will thrive. So every time a child kills themselves, that tells us that that child could not find one single adult to trust. And so I want you, listening to me, to be the one. Make the pledge today to be the one. And there’s actually a hashtag, #BeTheOne, which is about what I’m saying now. Be the one that the child can come to and trust enough to tell you, “You know what, things are not good.”

But don’t rush to take them to a psychiatrist or a counselor or someone who’s going to quickly put them on medication, because that’s two wrongs that don’t make a right. And so I ask you to ask them again: What happened? Because generally, the child would say, “Well, I’ve been bullied at school for months,” or “I’ve been raped,” or whatever, I don’t know. But they would tell you. Usually, there’s trauma at the crux, at the core of suicide. And so that’s what I wanted to say. And I’m sorry, I do talk; I can go on and on and on. But that’s it in essence.

Kevin Pho: No, that’s tremendously powerful advice. I’m a parent of teenagers, and a lot of my listeners are parents of teenagers as well. So you briefly touched upon this toward the end of that answer, in terms of the next step. So let’s say you recognize some of these signs. What’s the determination of when to get your child help? Where is that line where you need to bring in your child to see a psychiatrist or pediatrician?

Uchenna Umeh: So where do you draw that line? That’s a great question. So first of all, a child who is suicidal, it’s a cry for help. I want people to hear me: It’s not a cry for attention, which is what people think. It’s not attention-seeking; it’s a cry for help. After your child has killed themselves, it’s not the time to start going back and saying, “Well, I wish I had known.” If you hear about it, I want you to implore your child. Say, “Please, I would like to take you to get help.”

Now, that’s different from getting medication, because in 2015, the WHO actually declared the stigma of mental illness a public health crisis. The stigma. And so people who are suicidal who don’t have a mental illness per se don’t need that extra layer of stigma, you see what I mean? So most providers, doctors, are going to be quick to say, “Oh my gosh, she’s depressed.” Oh my gosh, she’s not. Wait. Because, again, if I’m being bullied at school, and I’m skipping school, and I don’t want to go to school, I’ll have a stomach pain every day. An antidepressant has a side effect of suicidal ideation, so be very careful before you jump to give them medication. Get therapy. Get a good therapist. Find one who actually connects with your kid, and they are out there.

I mean, I don’t know how long they’ve been suicidal, but now you’ve kind of stepped in. The child is relieved, I promise you, because now there’s light at the end of the tunnel. It’s not the time for you to panic. It’s time for you to calm down. Sit down on the floor if you have to. And I usually jokingly say, take off your clothes if you have to. I want your child to see you vulnerable, see you present in the moment and intentional and mindful, and say, “Listen, I promise you, I’ll get you help.” Get them someone that they can talk to, that they can trust.

Call Dr. Lulu. My number is [phone number removed by the editor]. Just take the number already down. Dial 988. That is a national suicide hotline: 1-800-273-TALK. There’s a warm body, there’s a warm heart at the end of the phone who can talk to you, because the worst thing I want is for you to say the wrong thing when a child is suicidal. So don’t engage. Even I would not want to engage with my son when my son was having a little bit of a crisis at Stanford.

When he was in school, he said, “Mom, I’m a little,” and he was overwhelmed. He took 21 credits, 21 credits, whatever, I don’t know the term. He was overwhelmed with school. Schoolwork was a bit too much for him. Plus, he was all the way in California, and I live here in Texas. So he said, “Mom, I had a little dose of suicidal ideation.” He voiced it out to me, and he said, “Oh my god, we need to know.” I said, “OK, let’s talk about it. What happened?”

He said, “Well,” and I went through all the things I’m thinking could be causing it. It’s not a relationship issue. Could it be academic? A lot of children are overwhelmed by academic pressures, because their parents, the Nigerian parents, want everybody’s child, all the kids, to be a doctor until further notice. You must get straight A’s. But what if the child is struggling at school? And so he said, well, he took 22 credits. It was a lot for him. What did we do? We dropped some of the credits, and he was fine.

So I need you to ask your child what is going on, versus getting all reactive and rushing to the doctor. If you have a family history of anxiety and depression and all that, then maybe you should. So don’t get me wrong: Mental illness is one of them. Depression and anxiety are some of the symptoms of suicidal behavior, but I don’t want you to jump on treating a symptom rather than the root cause. And that’s, I think, the word I need to use: A symptom is not the root cause. A headache is not the root cause. Maybe a brain tumor is the root cause, and you have a headache as a symptom. So same thing: When a child is suicidal, it is a symptom of something grave going on in the child.

Maybe their pastor is molesting them, I don’t know. I don’t know, but there’s a block, and the child is feeling, “Actually, I can’t tell my mother.” Maybe the child is gay. Maybe they’re LGBTQ. They have the highest rates of suicide of all youth put together. Why? Because society ostracizes gay people. They feel like, “Well, it doesn’t matter either way. No one’s going to believe me. You know, I’m looking, and somebody’s going to kill me.” There’s homophobia. All of these things drive the child to kill themselves. That’s what I want you to hear from me, not “Give them medication.”

I keep saying that because Big Pharma is who I’m having to fight with, because they’ve got a big voice and they’ve got the money. So right now, I need to get to people’s hearts, so that maybe they will hear me and not Big Pharma, who is pushing Prozac every day. And people, you know, let me tell you something: In the last four years in America, prescription-strength antidepressants have quadrupled. In the last four years in America, suicide rates have tripled. Is there something wrong with that math? Yes. And that’s the problem.

Kevin Pho: Well, we’re talking to Uchenna Umeh. She’s a pediatrician and an expert on teenage suicide. She wrote the KevinMD article “A pediatrician’s healing spirit: treating depressed, anxious, and suicidal teens.” You’ve given us such tremendous advice. What’s your take-home message for the KevinMD audience?

Uchenna Umeh: Take-home message: If you think suicide, think mental anguish, not mental illness. That’s it.

Kevin Pho: And how can people reach you?

Uchenna Umeh: Well, I live on Facebook, and I do have a book on teen suicide, for all it’s worth. It’s called A Teen’s Life. It’s available on Amazon or on my website, which is teenalive.com. Just coincidentally, since all the mess has been going on, I have another book, called How to Teach Your Children About Racism, which is basically breaking down what you should do and how you should talk to your child about racism and these relations.

But generally, I hang out on Facebook. So if you go there, there are nine of us with that first name and that last name, but I’m the only one with the middle initial L, as in love, right? So you can find me there. Otherwise, if you google the word “the Momatrician,” M-O-M-A-T-R-I-C-I-A-N, you will see everything about me. I do go by Dr. Lulu the Momatrician, because I’m a mom and I’m a pediatrician. So that’s it. You can find me pretty much anywhere on social media, and on KevinMD.

Kevin Pho: Thank you so much for your time and for joining me on the show.

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