Kyle Craig, a musician, athlete and high-achieving student at Vanderbilt University, was the only one who saw the train coming.
His family affectionately called him "strong, large and in charge," but in just one year, Kyle lost his social confidence and became increasingly paranoid in an almost imperceptible downward spiral that deceived nearly everyone.
In the early hours last May, Kyle -- the all-American kid -- stepped out in front of a passenger train and ended his life at the age of 21.
"Kyle was confident, not arrogant," said his father, Walter "Chip" Craig of Spring Lake. N.J., as he choked back tears. "He was bright, beautiful -- a thrill a minute, focused, happy, achieving and social."
That may have been part of his undoing.
Kyle turned to Adderall -- a drug legally prescribed for attention deficit disorder (ADHD), which helped him stay up all night to study and perform the next day. By Friday, exhausted but eager to party, he would take more, mixing it with alcohol.
He had a respectable 3.5 average, but as he watched his fraternity brothers get 3.8s and 4.0s, eyeing careers on Wall Street, Kyle thought he could do better, ignoring lifelong advice that he need only "do his best."
At first he got the blue $10 pills from friends. Then, he feigned ADHD and sought a prescription from a doctor who didn't ask too many questions. And because of confidentiality laws, his parents never knew.
"Knowing that someone else is taking them and that gives them the edge, he was willing to try it," said his mother, Andrea Craig. "If he's into something, he's in all the way -- to take it to the next level."
By junior year in 2009, when Kyle told his parents he had lost interest in the fraternity parties that used to be so much fun, they thought perhaps this personality change was a sign of maturity, but only in retrospect did they realize these were the earliest signs of a growing psychosis caused by Adderall abuse.
After his death Kyle's classmates and friends told his parents, "Everyone takes Adderall."
The Craigs make no excuses for Kyle's choices, but they believe the effects of Adderall abuse, coupled with a cluster of suicides in his hometown that year, likely created the "perfect storm" that lured him to the train tracks.
Suicide is the third leading cause of death among 15- to 24-year olds and accounts for more than 12 percent of all annual deaths in that age group, according to the Centers for Disease Control and Prevention (CDC). One-third is positive for alcohol and 1 in 5 has evidence of prescription drugs.
"The hardest part is missing him...missing him," said his mother, struggling. "He was such a bright light. There's sadness, now that we know everything we know and trace it backwards to the exit ramp. If we could have known, I wonder what a difference it would have made."
Now, the Craigs, who say they are "still raw" from the loss, want others to know the danger of Adderall, a highly addictive drug that works on the brain like cocaine or methamphetamine, and is rampant on the most competitive college campuses.
An estimated 1 in 5 students has abused Adderall, a powerful combination of four time-released amphetamines that increase the amount of dopamine and norepinephrine in the brain, according to the CDC.
For those with ADHD, the drug increases alertness, libido and overall cognitive performance, improving mood and stemming fatigue. For the last 15 years, treatment with Adderall has helped significantly improve many lives.
But for those who do not have the disorder, the drug, like other powerful amphetamines, causes euphoria, increasing the risk of addiction.
According to the CDC, 1 in 12 Americans is diagnosed with ADHD and sales of Adderall have soared more than 30-fold since 2001.
And so has abuse of the drug, says the CDC.
The pill popping starts in high school, where 1 in 10 students in grades 7 to 12 has used Adderall to help with school performance, according to a 2006 study by the Partnership for a Drug-Free America.
They share it, buy it from one another, or fake ADHD to obtain it, and misuse carries on into college, where academic pressures are even greater.
Writer Joshua Foer, who took Adderall for a week as an experiment, said he was so productive he felt as though he had been "bitten by a radioactive spider."
"Depressives have Prozac, worrywarts have Valium, gym rats have steroids, and overachievers have Adderall," he wrote in 2005 for Slate magazine.
Classified as a schedule II controlled substance, the Food and Drug Administration acknowledges its potential for abuse.
Between 2000 and 2005, the FDA identified nearly 1,000 cases of psychosis or mania -- particularly hallucinations -- linked to drugs like Adderall and in 2007 it directed drug companies to inform patients of adverse psychiatric symptoms.
"Selling or giving away these drugs may harm others, and is against the law, as well," said FDA spokesman Sandy Walsh. "Adderall has a boxed warning about the potential for abuse that alerts physicians that the drugs 'should be prescribed or dispensed sparingly.'"
"The package insert clearly states the risks associated with incorrect dosage, misuse or abuse and recommends that doctors properly monitor patients," said Denise Bradley, a spokesman for Teva Pharmaceuticals, which manufacturers Adderall. "This medicine is not recommended for patients with a history of drug abuse."
But Fallon Schultz, a licensed clinical social worker and addiction specialist from Howell, N.J., said misuse of the drug can actually chemically alter the brain.
A 2009 report in Scientific American suggests that despite the short-term benefits of the drug, long-term use could change brain function enough to depress mood and boost anxiety. Young brains are particularly vulnerable because they are not fully developed until the mid-20s.
In a patient without ADHD, the amygdala -- the part of the brain that controls emotions and aggression -- can become overactive from stimulants like Adderall, leading to increased dopamine levels.
Studies at UCLA show that those who use amphetamines have higher rates of aggression, psychosis and suicide, according to Schultz.
"It tricks the brain that it doesn't need to make dopamine, and dopamine is the only chemical in the brain that once it is damaged, you never get it back," said Schultz. "That results in severe depressions and mood dysregulation."
Not only that, but the drug can sometimes trigger irreversible schizophrenia and bipolar disorder.
"Doctors prescribe too easily, colleges don't take misbehavior seriously, parents are in denial and young adults need to be better educated," she said.
She said students easily fool doctors because they can find symptoms of ADHD on the Internet. "When a college kid comes in and repeats these things a little too well, a red flag should go up," Schultz added.
There also needs to be better follow-up. "You don't write a prescription and then not see a patient for a year, especially when what we are seeing is so widespread."
And students need to know the dangers, as well. "They are playing with fire," said Schultz. "We don't paint a scary enough picture for our kids, a real picture of addiction."
Kyle's mood swings, subtle personality changes and eventual depression were "only trackable in hindsight," said his mother, a 54-year-old who works in commercial communications.
Over the summer, Kyle casually mentioned that he had used the drug for studying, and at one point, his mother saw a prescription bottle in his backpack.
"I truly fault myself," she said. "I didn't do any homework on it like a parent should. But he had the green light from a doctor."
There were other ominous signs -- he was a little more aggressive, not as "cool and easy," and bit "edgy."
"There was a distinct change in his manner and confidence and overall health," said his father, a 56-year-old lawyer. "And when we look back to that summer, we now know it was the tip of the iceberg."
Still, Kyle was "firing on all cylinders," surfing, holding a summer job as a waiter and securing an internship at a prestigious investment bank in New York City. And from all appearances, he was doing well when he returned to Vanderbilt in the fall, "knocking it out of the park again with a 3.8," said his father.
"From the summer of 2009 until his death [Kyle] was seemingly happy, outgoing, physically fit and active, achieving at a very high level at school, rush chairman at the fraternity, out and about, dating and very, very normal," he said. "That's the thing about Adderall. It's so deceptive."
But later, they learned that Kyle had sought help from a college counselor and expressed concerns about social anxiety. In writings they found after his death, Kyle wished he could enjoy people the way he had before.
That, too seemed to pass, and Kyle left for his junior semester abroad in Barcelona in January.
Kyle later told his therapist he had stopped Adderall in February. "He went cold turkey and that was a really rough stretch," said Andrea Craig.
But friends in Barcelona said Kyle was social and upbeat, going to classes.
"He had down periods, we all do, but he wasn't sitting at home in a dark room," said his father. "His character strength was part of his downfall, because he could continue to tell us and show us, he was fine."
In one phone call home Kyle seemed depressed, but when his parents visited him in April, he was "back on top." They talked about his mood swings and suggested he see a therapist when he returned home in 10 days.
Kyle had only two sessions with a therapist, and was told to stay away from alcohol, but his parents never heard that warning.
On May 21, the night of his sister's senior prom, Kyle joined a flock of friends home from college at the local bars. He talked with friends about his upcoming internship, dancing, buying celebratory drinks.
"It ended up going too long and at some point a few beers moved to too many beers, and the depression from the alcohol came on to that psyche," said his father. "Unfortunately that night his best friends weren't around to watch him."
Kyle ended up by himself, refusing a ride home and stepping onto nearby railroad tracks, just a few miles from the spot where several other local youths had taken their lives. Just minutes before taking his life, Kyle text-messaged his siblings, parents and a few close friends, "I love you."
Only after his suicide, did the therapist tell the Craigs that she had "multiple concerns" about Kyle and intended to include the Craigs in a third session, which never took place.
"It was probably the early stage of paranoia when he was alone wondering, 'What's happening to me?'" speculated his father. "It comes in a wave -- a tsunami that you can't see over. A darkness. And if you don't have real adult skills when it comes, you probably don't make it over it."
After his death, the Craigs wondered why neither the doctor nor Kyle's counselors had shared their concerns about his deteriorating mental health.
"The medical and legal system works totally against the parent," said Chip Craig. "No parent is able to get into this loop until an official intervention has been determined and that can come too late."
Dr. Igor Galynker, a psychiatrist and director of the Family Center for Bipolar Disorder at Beth Israel Medical Center in New York, agrees that families should be more involved in the health care of adult children.
"Family and parents cannot be kept in the dark," said Galynker, author of "Talking to Families about Mental Illness."
He is critical of the "explosion" of ADHD diagnoses and "profit-driven" pharmaceutical companies that "do everything possible to twist doctors' arms into treating diagnoses they don't need."
As mental health issues increasingly plague college students, Galynker said colleges need to do a better job of communicating with parents.
"When you are a teenager, your parents supervise you. When you work, if you start behaving erratically, your co-workers will take care of you. Nobody tolerates it in the workplace," he said. "But in college, you have young adults without any supervision."
Chip and Andrea Craig say that their heartbreak is unfathomable, but they hope Kyle's story can make a difference in another young adult's life.
As hundreds of friends from Kyle's hometown, prep school and college poured in to his funeral service, many told the Craigs that Kyle's leadership and strength had helped them.
One, who had attempted suicide twice, told them, "He is the reason I am alive. He pulled me forward because he made me go get help."
Ultimately, help didn't come soon enough for Kyle.
"There is a void, emptiness," said Chip Craig. "He was such a joy for 22 years. Really, it's just a blink -- that beautiful life and all the promise he had."
Andrea Craig advises all parents to get help for their children immediately at the slightest sign of depression, even when its interspersed with normal behavior. And talk openly with children about Adderall and its dangers.
"We feel the loss every minute of every day," she said. "As parents, we have concern for his brother and sister, and I think that helps us to be stronger than we really want to be."
"But we have to readjust," she said. "We were a family of five and now we are a family of four."
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