Does the depression cause the behavior? Or does the
behavior lead to low self esteem and depression? There’s seldom
a clear answer.
By hindering concentration, attention and motivation,
depression affects success in school and social relationships.
Melissa has been secretly seeing a psychiatrist at the university; her
parents have no idea she has clinical depression. Sam’s parents
found out about his depression only after his suicide attempt.
Most adolescents exhibit at least some symptoms of depression from time
to time. That may be one reason parents are likely to deny or dismiss
even the most obvious signs of illness.
As recently as the 1970s, many experts doubted whether children and adolescents
could be depressed in the same way that adults are. Emotional turmoil,
irritability and anger were seen as a normal part of adolescent development.
It’s now recognized that at least five to eight percent of adolescents
have depression and as many as 65 percent report occasional symptoms.
As an individual advances through the teen years, bouts of depression
become increasingly likely and are likely to impede normal development–hindering
concentration, attention and motivation and thereby affecting success
in school and social relationships.
One of every five American teens thinks about suicide, and one in ten
actually makes an attempt. Suicide is the third leading cause of death
for this age group.
One study found that even teenagers experiencing symptoms not serious
enough for a diagnosis of depression were two to three times as likely
as others to develop major depression as adults. In another study, 50.6
percent of persons experiencing major depression during adolescence later
attempted suicide; 22 percent made multiple attempts and 7.7 percent succeeded
in taking their own lives.
What Are the Signs?
As with adults, depression in adolescents is characterized not only by
a persistent sadness but changes in appetite and sleep patterns, loss
of interest in activities that used to bring pleasure, difficulty concentrating,
fatigue and chronic feelings of guilt or worthlessness. In an adolescent,
these signs may be masked behind anger, irritability, agitation, inattention
or even disruptive behavior.
While most teens are subject to stormy moods and sadness, depression is
distinguished by the extent to which it differs from the person’s
normal mood, how long it lasts and how much it interferes with normal
functioning. For an adolescent, the mean length of an episode of depression
is seven to nine months, with a strong likelihood of recurrence. Among
teenagers treated for major depression, about 70 percent experience symptoms
again within a five-year period.
Depression is also frequently entwined with other debilitating problems
such as anxiety, disruptive behavior or drug abuse. One study of depressed
adolescents found that 43 percent had at least one other diagnosis such
as anxiety (18 percent), substance abuse (14 percent) or conduct disorders
Risk factors for depression include a family history of depression, family
conflict, poor academic performance, low self esteem and other emotional
problems such as anxiety or eating disorders.
By hindering concentration, attention and motivation, depression affects
success in school and social relationships.
Hormonal changes sometimes seem to trigger depression, and female teens
are twice as likely as males to get depression.
Teenagers who have been victims of physical or sexual abuse, have witnessed
violence or have lost a parent during childhood are highly vulnerable.
So are those who are uncertain about their sexual orientation. Most cases
of depression, however, cannot be traced to any specific social or family
trauma. As with adult depression, there is apparently a strong genetic
component; if one identical twin develops depression, the risk for the
other twin is 70 percent.
Many young persons with depression have problems in school–in part
because their mood affects their concentration and attention–and
are also likely to get into
Does the depression cause the behavior? Or does the behavior lead to low
self esteem and depression? There’s seldom a clear answer.
Where To Get Help?
For parents, it’s always difficult to know when and where to seek
help. It’s important not to plant labels on children. At the same
time, the consequences of delay can be enormous.
The first person to see may be the family physician or pediatrician. A
thorough physical examination can rule out physical causes such as a sleep
disorder, mononucleosis, anemia, thyroid problems or post-concussion syndrome.
In the Prozac era, some primary care physicians treat symptoms of depression
by prescribing a selective serotonin reuptake inhibitor (SSRI). Tricyclic
antidepressants available in the 1980s were generally not found to be
effective in the treatment of children and adolescents, but two recent
studies provided rather clear evidence that SSRIs fluoxetine (Prozac)
and paroxetine (Paxil) were beneficial in reducing the symptoms of depression
in adolescents. These studies, however, showed no effect of the drugs
on psychosocial functioning.
As a result, referral to a mental health professional is nearly always
necessary. According to the needs of the individual, treatment may involve
group or individual therapy, or both. Usually the family is involved in
at least some therapy and educational sessions.
A cognitive behavioral approach, aimed at changing negative thought patterns,
is frequently used and has been found effective both short- and long-term.
Adolescents are particularly prone to distorted thought patterns (“no
one will ever like me because...”) that guides their feelings and
behavior. They benefit from learning to recognize and correct these thought
distortions. One study of 78 teens conducted at the University of Pittsburgh
found cognitive behavioral therapy more effective at bringing about recovery
than either family or supportive therapy.
Treatment plans, of course, must be tailored to the needs and personality
of the individual. In nearly all cases, depression can be treated, but
early recognition is important not only to head off related social and
behavioral problems but to save lives. Even aside from the risk of suicide,
depressed individuals are twice as likely to die as other persons.
David A. Brent, Diane Holder, David Kolko, “Treatment
for Adolescent Depression,” Harvard Mental Health Letter, August,
“Child Abuse Affects Adolescent Functioning,” The Brown University
Child and Adolescent Behavior Letter, August, 1999.
Gregory K. Fritz, “Child, Adolescent Depression Distinct from the
Adult Version,” Behavioral Health Treatment, October, 1997.
Erica Goode, “Vital Signs: Behavior; Following the Trail of Adolescent
Angst,” New York Times, January 12, 1999.
Richard Harrington, “Adolescent Depression: Same or Different?”
Archives of General Psychiatry, January, 2001.
Jay Kist, “Dealing with Depression,” Current Health 2, January,
Kim Lawson, “Spot and Treat Depression in Teens before They Are
Suicidal, Clinical Psychiatry News, 28(5):42, 2000.
Beverly D. Lucas, “Adolescent-Onset Depression and Adult Suicide,”
Patient Care, August 15, 1999.
Zendi Moldenhauer and Bernadette Mazurek Melnyk, “Use of Antidepressants
in the Treatment of Child and Adolescent Depression: Are They Effective?”
Pediatric Nursing, November, 1999.
Lisa M. Pullen, Mary Anne Modrcin-McCarthy and Ellen V. Graf, “Adolescent
Depression: Important Facts That Matter,” Journal of Child and Adolescent
Psychiatric Nursing, April, 2000.
Sung E. Son and Jeffrey T. Kirchner, “Depression in Children and
Adolescents,” American Family Physician, November 15, 2000.
Christopher Varley, M.D., and Elizabeth McCauley, Ph.D., “Diagnosis
and Management of Pediatric Depression, 2000 Meeting, American Academy
Elizabeth Weller, M.D., “Child and Adolescent Mood Disorders,”
American Psychiatric Association 153rd Annual Meeting, 2001.