Adolescent Depression Health Article

Definition

Adolescent depression is a disorder occurring during the teenage years marked by persistent sadness, discouragement, loss of self-worth, and loss of interest in usual activities.

See also:

• Depression
• Major depression

Alternative Names

Depression - adolescents; Teenage depression

Causes, incidence, and risk factors

Depression can be a temporary response to many situations and stresses. In adolescents, depressed mood is common because of the normal maturation process, the stress associated with it, the influence of sex hormones, and independence conflicts with parents.

It may also be a reaction to a disturbing event, such as the death of a friend or relative, a breakup with a boyfriend or girlfriend, or failure at school. Adolescents who have low self-esteem, are highly self-critical, and who feel little sense of control over negative events are particularly at risk to become depressed when they experience stressful events.

True depression in teens is often difficult to diagnose because normal adolescent behavior is marked by both up and down moods. These moods may alternate over a period of hours or days.

Persistent depressed mood, faltering school performance, failing relations with family and friends, substance abuse, and other negative behaviors may indicate a serious depressive episode. These symptoms may be easy to recognize, but depression in adolescents often starts very differently than these classic symptoms.

Excessive sleeping, change in eating habits, even criminal behavior (like shoplifting) may be signs of depression. Another common symptom of adolescent depression is an obsession with death, which may take the form either of suicidal thoughts or of fears about death and dying.

Adolescent girls are twice as likely as boys to experience depression.

Risk factors include:

• Stressful life events, particularly loss of a parent to death or divorce
• Child abuse - both physical and sexual
• Unstable caregiving, poor social skills
• Chronic illness
• Family history of depression

Depression is also associated with eating disorders, particularly bulimia.

Symptoms

• Depressed or irritable mood
• Temper (agitation)
• Loss of interest in activities
• Reduced pleasure in daily activities
• Appetite changes (usually a loss of appetite but sometimes an increase)
• Weight change (unintentional weight loss or unintentional weight gain)
• Persistent difficulty falling asleep or staying asleep (insomnia)
• Excessive daytime sleepiness
• Fatigue
• Difficulty concentrating
• Fifficulty making decisions
• Episodes of memory loss
• Preoccupation with self
• Feelings of worthlessness, sadness, or self-hatred
• Excessive or inappropriate feelings of guilt
• Acting-out behavior (missing curfews, unusual defiance)
• Thoughts about suicide or obsessive fears or worries about death
• Plans to commit suicide or actual suicide attempt
• Excessively irresponsible behavior pattern

If these symptoms persist for at least 2 weeks and cause significant distress or difficulty functioning, treatment should be sought.

Signs and tests

The doctor will perform a physical examination and order blood tests to rule out medical causes for the symptoms.

The doctor will evaluate the teen for signs of substance abuse. Heavy drinking, frequent marijuana (pot) smoking, and other drug use can be caused by or occur because of depression.

A psychiatric evaluation will also be done to document the teen's history of sadness, irritability, and loss of interest and pleasure in normal activities. The doctor will look for signs of potentially co-existing psychiatric disorders such as anxiety, mania, or schizophrenia. A careful assessement of the teenager will help determine suicidal/homicidal risks -- that is, if the teen is a danger to him or herself or others.

Information from family members or school personnel can often help identify depression in teenagers.

Treatment

Treatment options for adolescents with depression are similar to those for used to treat depression in adults. Treatments may include psychotherapy and antidepressant medications.

MEDICATION

The first medication considered is usually a type of antidepressant called a selective serotonin reuptake inhibitors (SSRI). Prozac is most often the first choice. NOTE: SSRI's carry a warning that they may increase the risk of suicidal thoughts and actions in children and adolescents. Teens and families should be alert for sudden changes or increased suicidal thoughts. Talk to your doctor about the benefits and risks of such medicine.

Not all antidepressants are approved for use in children and teens. For example, tricyclics are not approved for use in teens.

THERAPY

Family therapy may be helpful if family conflict is contributing to the depression. Support from family or teachers to help with school problems may also be needed. Occasionally, hospitalization in a psychiatric unit may be required for individuals with severe depression, or if they are at risk of suicide.

Because of the behavior problems that often co-exist with adolescent depression, many parents are tempted to send their child to a "boot camp", "wilderness program", or "emotional growth school."

These programs often use non-medical staff, confrontational therapies, and harsh punishments. There is no scientific evidence to support such programs. In fact, there is a growing body of research which suggests that they can actually harm sensitive teens with depression.

Depressed teens who act out may also become involved with the criminal justice system. Parents are often advised not to intervene, but to "let them experience consequences."

Unfortunately, this can also harm teens through exposure to more deviant peers and reduction in educational opportunities. A better solution is to get the best possible legal advice and search for treatment on your own, which gives parents more control over techniques used and options.

Though a large percentage of teens in the criminal justice system have mental disorders like depression, few juvenile prisons, "boot camps" or other "alternative to prison" programs provide adequate treatment.