Teen Depression

Understanding teen depression

There are as many misconceptions about teen depression as there are about teenagers in general. Yes, the teen years are tough, but most teens balance the requisite angst with good friendships, success in school or outside activities, and the development of a strong sense of self.  Occasional bad moods or acting out is to be expected, but depression is something different. Depression can destroy the very essence of a teenager’s personality, causing an overwhelming sense of sadness, despair, or anger.
Whether the incidence of teen depression is actually increasing, or we’re just becoming more aware of it, the fact is that depression strikes teenagers far more often than most people think. And although depression is highly treatable, experts say only 20% of depressed teens ever receive help.
Unlike adults, who have the ability to seek assistance on their own, teenagers usually must rely on parents, teachers, or other caregivers to recognize their suffering and get them the treatment they need. So if you have an adolescent in your life, it’s important to learn what teen depression looks like and what to do if you spot the warning signs.

For Teens:

Signs and symptoms of teen depression

Teenagers face a host of pressures, from the changes of puberty to questions about who they are and where they fit in. The natural transition from child to adult can also bring parental conflict as teens start to assert their independence. With all this drama, it isn’t always easy to differentiate between depression and normal teenage moodiness. Making things even more complicated, teens with depression do not necessarily appear sad, nor do they always withdraw from others. For some depressed teens, symptoms of irritability, aggression, and rage are more prominent..

SIGNS AND SYMPTOMS OF DEPRESSION IN TEENS
Sadness or hopelessness Irritability, anger, or hostility Tearfulness or frequent crying Withdrawal from friends and family Loss of interest in activities Changes in eating and sleeping habits	Restlessness and agitation Feelings of worthlessness and guilt Lack of enthusiasm and motivation Fatigue or lack of energy Difficulty concentrating Thoughts of death or suicide

If you’re unsure if an adolescent in your life is depressed or just “being a teenager,” consider how long the symptoms have been present, how severe they are, and how different the teen is acting from his or her usual self. While some “growing pains” are to be expected as teenagers grapple with the challenges of growing up, dramatic, long-lasting changes in personality, mood, or behavior are red flags of a deeper problem.

The difference between teenage and adult depression

Depression in teens can look very different from depression in adults. The following symptoms of depression are more common in teenagers than in their adult counterparts:

• Irritable or angry mood – As noted above, irritability, rather than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated, or prone to angry outbursts.
• Unexplained aches and pains - Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression.
• Extreme sensitivity to criticism - Depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. This is a particular problem for “over-achievers.”
• Withdrawing from some, but not all people - While adults tend to isolate themselves when depressed, teenagers usually keep up at least some friendships. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd.

Effects of teen depression

The negative effects of teenage depression go far beyond a melancholy mood. Many rebellious and unhealthy behaviors or attitudes in teenagers are actually indications of depression. See the table below for some of the ways in which teens “act out” or “act in” in an attempt to cope with their emotional pain:

Untreated Depression Can Lead to…
Problems at school	Depression can cause low energy and concentration difficulties. At school, this may lead to poor attendance, a drop in grades, or frustration with schoolwork in a formerly good student.
Running away	Many depressed teens run away from home or talk about running away. Such attempts are usually a cry for help.
Substance abuse	Teens may use alcohol or drugs in an attempt to “self-medicate” their depression. Unfortunately, substance abuse only makes things worse.
Low self-esteem	Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness.
Eating disorders	Anorexia, bulimia, binge eating, and yo-yo dieting are often signs of unrecognized depression.
Internet addiction	Teens may go online to escape from their problems. But excessive computer use only increases their isolation and makes them more depressed.
Self-injury	Cutting, burning, and other kinds of self-mutilation are almost always associated with depression. To learn more, see Helpguide’s Self-Injury.
Reckless behavior	Depressed teens may engage in dangerous or high-risk behaviors, such as reckless driving, out-of-control drinking, and unsafe sex.
Violence	Some depressed teens (usually boys who are the victims of bullying) become violent. As in the case of the Columbine school massacre, self-hatred and a wish to die can erupt into violence and homicidal rage.
Suicide	Teens who are seriously depressed often think, speak, or make "attention-getting" attempts at suicide. Suicidal thoughts or behaviors should always be taken very seriously.

Suicide warning signs in teenagers

An alarming and increasing number of teenagers attempt and succeed at suicide. According to the Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death for 15- to 24-year-olds. For the overwhelming majority of suicidal teens, depression or another psychological disorder plays a primary role. In depressed teens who also abuse alcohol or drugs, the risk of suicide is even greater.

Because of the very real danger of suicide, teenagers who are depressed should be watched closely for any signs of suicidal thoughts or behavior. The warning signs include:

• Talking or joking about committing suicide.
• Saying things like, “I’d be better off dead,” “I wish I could disappear forever,” or “There’s no way out.”
• Speaking positively about death or romanticizing dying (“If I died, people might love me more”).
• Writing stories and poems about death, dying, or suicide.
• Engaging in reckless behavior or having a lot of accidents resulting in injury.
• Giving away prized possessions.
• Saying goodbye to friends and family as if for good.
• Seeking out weapons, pills, or other ways to kill themselves.

Helping a depressed teenager

If you suspect that a teenager in your life is suffering from depression, take action right away. Depression is very damaging when left untreated, so don’t wait and hope that the symptoms will go away. Even if you’re unsure that depression is the issue, the troublesome behaviors and emotions you’re seeing in your teenager are signs of a problem. Whether or not that problem turns out to be depression, it still needs to be addressed - the sooner the better.

Talk to your teen

The first thing you should do if you suspect depression is to talk to your teen about it. In a loving and non-judgmental way, share your concerns with your teenager. Let him or her know what specific signs of depression you’ve noticed and why they worry you. Then encourage your child to open up about what he or she is going through.

TIPS FOR TALKING TO A DEPRESSED TEEN
Offer support	Let depressed teenagers know that you’re there for them, fully and unconditionally. Hold back from asking a lot of questions (teenagers don’t like to feel patronized or crowded), but make it clear that you’re ready and willing to provide whatever support they need.
Be gentle but persistent	Don’t give up if your adolescent shuts you out at first. Talking about depression can be very tough for teens. Be respectful of your child’s comfort level while still emphasizing your concern and willingness to listen.
Listen without lecturing	Resist any urge to criticize or pass judgment once your teenager begins to talk. The important thing is that your child is communicating. Avoid offering unsolicited advice or ultimatums as well.
Validate feelings	Don’t try to talk teens out of their depression, even if their feelings or concerns appear silly or irrational to you. Simply acknowledge the pain and sadness they are feeling. If you don’t, they will feel like you don’t take their emotions seriously.

If your teen claims nothing is wrong, but has no explanation for what is causing the depressed behavior, you should trust your instincts. Remember that denial is a strong emotion. Furthermore, teenagers may not believe that what they’re experiencing is the result of depression. If you see depression’s warning signs, seek professional help. Neither you nor your teen is qualified to either diagnosis depression or rule it out, so see a doctor or psychologist who can.

Visit your family doctor

Make an immediate appointment for your teen to see the family physician for a depression screening. Be prepared to give your doctor specific information about your teen’s depression symptoms, including how long they’ve been present, how much they’re affecting your child’s daily life, and any patterns you’ve noticed. The doctor should also be told about any close relatives who have ever been diagnosed with depression or another mental health disorder.

As part of the depression screening, the doctor will give your teenager a complete physical exam and take blood samples to check for medical causes of your child’s symptoms. In order to diagnose depression, other possible causes of your teen’s symptoms must first be ruled out. The doctor will check for medical causes of the depression by giving your teenager a complete physical exam and running blood tests. The doctor may also ask your teen about other things that could be causing the symptoms, including heavy alcohol and drug use, a lack of sleep, a poor diet (especially one low in iron), and medications (including birth control pills and diet pills).

Seek out a specialist

If there are no health problems that are causing your teenager’s depression, ask your doctor to refer you to a psychologist or psychiatrist who specializes in children and adolescents. Depression in teens can be tricky, particularly when it comes to treatment options such as medication. A mental health professional with advanced training and a strong background treating adolescents is the best bet for your teenager’s best care.

When choosing a specialist, always get your child’s input. Teenagers are dependent on you for making many of their health decisions, so listen to what they’re telling you. No one therapist is a miracle worker and no one treatment works for everyone. If your child feels uncomfortable or is just not ’connecting’ with the psychologist or psychiatrist, ask for a referral to another provider that may be better suited to your teenager.

Explore the treatment options

Expect a discussion with the specialist you’ve chosen about treatment possibilities for your son or daughter. There are a number of treatment options for depression in teenagers, including one-on-one talk therapy, group or family therapy, and medication.

Talk therapy is often a good initial treatment for mild to moderate cases of depression. Over the course of therapy, your teen’s depression may resolve. If it doesn’t, medication may be warranted. However, antidepressants should only be used as part of a broader treatment plan.

Unfortunately, some parents feel pushed into choosing antidepressant medication over other treatments that may be cost-prohibitive or time-intensive. However, unless your child is considered to be high risk for suicide (in which case medication and/or constant observation may be necessary), you have time to carefully weigh your options before committing to any one treatment.

Risks of teenage antidepressant use

Antidepressant medication can be helpful, particularly for severe cases of depression. However, medications always come with risks and side effects of their own. When it comes to antidepressant use in teenagers, there are a number of safety concerns that parents should be aware of. Before starting your child on medication, you should carefully weigh the potential benefits against the risks.

Antidepressants and the Teenage Brain

Antidepressants were designed and tested on adults, so their impact on the youthful, developing brain is not yet completely understood. Some researchers are concerned that the use of drugs such as Prozac in children and teens might interfere with normal brain development. Says neuroscientist Amir Raz, quoted in a June 2007 article in Scientific American Mind, "The human brain is developing exponentially when we are very young, and exposure to antidepressants may affect or influence the wiring of the brain, especially when it comes to certain elements that have to do with stress, emotion and the regulation of these."

Antidepressant Suicide Warning for Teens

Antidepressant medications may increase the risk of suicidal thinking and behavior in some teenagers. All antidepressants are required by the U.S. Food and Drug Administration (FDA) to carry a “black box” warning label about this risk in children and adolescents. In May 2007, the FDA recommended that the warning be expanded to include young adults from ages 18 to 24. The risk of suicide is particularly great during the first one to two months of antidepressant treatment.

Certain young adults are at an even greater risk for suicide when taking antidepressants, including teens with bipolar disorder, a family history of bipolar disorder, or a history of previous suicide attempts.

Teenagers on antidepressants should be closely monitored for any sign that the depression is getting worse. Warning signs include new or worsening symptoms of agitation, irritability, or anger. Unusual changes in behavior are also red flags.

According to FDA guidelines, after starting an antidepressant or changing the dose, your teenager should see their doctor:

• Once a week for four weeks
• Every 2 weeks for the next month
• At the end of their 12th week taking the drug
• More often if problems or questions arise

Supporting a teen through treatment

As the depressed teenager in your life goes through treatment, the most important thing you can do is to let him or her know that you’re there to listen and offer support. Now more than ever, your teenager needs to know that he or she is valued, accepted, and cared for.

• Be understanding.  Living with a depressed teenager can be difficult and draining. At times, you may experience exhaustion, rejection, despair, aggravation, or any other number of negative emotions. During this trying time, it’s important to remember that your child is not being difficult on purpose. Your teen is suffering, so do your best to be patient and understanding.
• Encourage physical activity. Encourage your teenager to stay active. Exercise can go a long way toward relieving the symptoms of depression, so find ways to incorporate it into your teenager’s day. Something as simple as walking the dog or going on a bike ride can be beneficial
• Encourage social activity. Isolation only makes depression worse, so encourage your teenager to see friends and praise efforts to socialize. Offer to take your teen out with friends or suggest social activities that might be of interest, such as sports, after-school clubs, or an art class.
• Stay involved in treatment. Make sure your teenager is following all treatment instructions and going to therapy. It’s especially important that your child takes any prescribed medication as instructed. Track changes in your teen’s condition, and call the doctor if depression symptoms seem to be getting worse.
• Learn about depression. Just like you would if your child had a disease you knew very little about, read up on depression so that you can be your own “expert.” The more you know, the better equipped you’ll be to help your depressed teen. Encourage your teenager to learn more about depression as well. Reading up on their condition can help depressed teens realize that they’re not alone and give them a better understanding of what they’re going through.

The road to your depressed teenager’s recovery may be bumpy, so be patient. Rejoice in small victories and prepare for the occasional setback. Most importantly, don’t judge yourself or compare your family to others. As long as you’re doing your best to get your teen the necessary help, you’re doing your job.

Taking care of the whole family

As a parent dealing with teen depression, you may find yourself focusing all your energy and attention on your depressed child. Meanwhile, you may be neglecting your own needs and the needs of other family members. While helping your depressed child should be a top priority, it’s important to keep your whole family strong and healthy during this difficult time.

• Take care of yourself – In order to help a depressed teen, you need to stay healthy and positive yourself, so don’t ignore your own needs. The stress of the situation can affect your own moods and emotions, so cultivate your well–being by eating right, getting enough sleep, and making time for things you enjoy.
• Reach out for support – Get the emotional support you need. Reach out to friends, join a support group, or see a therapist of your own. It’s okay to feel overwhelmed, frustrated, helpless, or angry. The important thing is to talk about how your teen’s depression is affecting you, rather than bottling up your emotions.
• Be open with the family – Don’t tiptoe around the issue of teen depression in an attempt to “protect” the other children. Kids know when something is wrong. When left in the dark, their imaginations will often jump to far worse conclusions. Be open about what is going on and invite your children to ask questions and share their feelings.
• Remember the siblings – Depression in one child can cause stress or anxiety in other family members, so make sure “healthy” children are not ignored. Siblings may need special individual attention or professional help of their own to handle their feelings about the situation.
• Avoid the blame game – It can be easy to blame yourself or another family member for your teen’s depression, but it only adds to an already stressful situation. Furthermore, depression is normally caused by a number of factors, so it’s unlikely—except in the case of abuse or neglect—that any loved one is “responsible”.

Related links for teen depression

General Information about Teen Depression

Depression – Breaks down the different types of depression in teenagers, as well as the symptoms and remedies. (Nemours Foundation)

Depression in Boys – While teen depression is more prevalent in girls, teenage boys have their own special risk factors and warning signs. This article delves deeper into male teen depression.(Psychology Today)

Depression in Girls – With society and hormonal changes wreaking havoc, girls need extra care in the teen years. Learn what parents can do. (Psychology Today)

Teen Suicide

About Teen Suicide –- Discusses teen suicide statistics, risk factors, warnings signs, and how to get help.  Also find coping tips for those who have lost a child to suicide. (Nemours Foundation)

Don’t Let 20/20 Hindsight Happen to You – Article on the importance of watching for the warning signs of teen suicide. Includes advice for parents. (University of Michigan Health System

Youth Depression  - Offers a comprehensive list of warning signs and behaviors in suicidal teenagers, as well as advice on how to help. (Suicide Awareness Voices of Education)

Teenage Depression and Violence

Depression and Violence in Teens – Discusses the explosive mixture of depression and school bullying in teens. Includes tips on preventing teenage violence. (Caremark)

The Storms of Youth: Violence and Depression in Adolescents – Looks into the connection between adolescent depression and violence, including the warning signs of violence in teens. (athealth.com)

Warning Signs of Youth Violence – Learn why some teenagers turn violent, what the warning signs are, and who is at risk. (American Psychological Association)

For Parents

Distracted Professionals Neglect Teen Depression (Career Journal) – Many parents are too stressed out and busy at work to notice signs of depression in teenagers. It’s also tempting to “hide” in work when family problems become too overwhelming.

Where to Find Help for Your Child – Series of articles on when to seek help for your child and where to find it. (American Academy of Child & Adolescent Psychiatry)

For Teachers

Suicide: A Teacher’s Experience (Indiana University - Center for Adolescent Studies) – A teacher’s personal account of a student’s suicide attempt. Includes suggestions on handling potentially depressed students.

Depression in School: A Student’s Trial (Indiana University - Center for Adolescent Studies,) – From a formerly depressed teen’s perspective, how teachers can help depressed students.

Antidepressants for Teens

About Using Antidepressants in Children or Teenagers – Medication guide from the FDA covers common questions about antidepressants in young adults. (U.S. Food and Drug Administration)

Kids on Meds - Trouble Ahead – Article explores the possible dangers of antidepressant use in children and teens. (Scientific American)

Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers – Fact sheet from the federal government on medication for children and teens. (National Institute of Mental Health)

Delving Deeper into Teen Depression

Depression in Children and Adolescents – Fact sheet for physicians provides in-depth information about depression in teens, including risk factors, diagnosis, and treatment. (National Institute of Mental Health)

The Use of Medication in Treating Childhood and Adolescent Depression – Guide to drug treatment of depression in children and teens, prepared by the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry. (ParentsMedGuide.org)

Melinda Smith, M.A., Suzanne Barston, Jaelline Jaffe, Ph.D., Lisa Flores Dumke, M.A., and Jeanne Segal, Ph.D., contributed to this article. Last modified on: 11/15/07.