Adolescent Depression

Written by Brian Krans | Published on August 2, 2012
Medically Reviewed by George Krucik, MD

What Is Adolescent Depression?

Adolescent depression is a mental and emotional disorder affecting adolescents and teens.

More commonly referred to as teenage depression, adolescent depression is not medically different from adult depression. However, symptoms in teens may manifest in different ways than they do in adults. This is due to the different social and developmental challenges facing teens.

Peer pressure, sports, changing hormone levels, developing bodies, awkward tendencies, and a host of other factors can carry many ups and downs for teenagers. However, these ups and downs can be signs of depression.

Depression is associated with higher levels of stress, anxiety, and in the worst possible scenarios, suicide. It can also affect a teen’s personal, school, work, social, and family life, which can lead to social isolation and other problems.

Depression isn’t a condition people can “snap out of.” They can’t simply “cheer up.” It is a real medical condition that can affect a person’s life in every manner if not treated properly.

Depression in adults and teens is also known as major depression or major depressive disorder.

What Causes Adolescent Depression?

There is no single known cause of adolescent depression. Research into the cause of depression has led experts to determine that multiple factors could lead to depression, including: (Mayo)

Differences in the Brain

Research has shown that adolescents have structural differences in their brains, as compared to adults. Besides the shape and structure, teens with depression can also have hormone differences and different levels of neurotransmitters.

Neurotransmitters are key chemicals in the brain that affect how brain cells communicate with one another. These hormones and neurotransmitters play important roles in regulating moods and behavior, which is why they could lead to depression.

Traumatic Early Life Events

Most children do not have good coping mechanisms, so a traumatic event can leave a lasting impression. Loss of a parent or physical, emotional, or sexual abuse can leave lasting effects on a child’s brain that could contribute to depression.

Inherited Traits

Research shows that depression has a biological component. It can be passed down from parents to their children. Children who have one or more close relatives—especially a parent—with depression are more likely to suffer from depression themselves.

Learned Patterns of Negative Thinking

Teens regularly exposed to pessimistic thinking, especially from their parents, have also been linked to depression. Differing theories exist as to the extent of the effect this can have on a child. However, learning to feel helpless instead of learning to overcome challenges can lead to depression.

How to Spot Depression in Your Child

Estimates from a study published in American Family Physician states that at any given time, up to 15 percent of children and adolescents have some symptoms of depression.

Symptoms of depression can often be difficult for parents to spot. Sometimes depression is confused with typical feelings of adjusting to the changes involved with being a teenager.

However, depression is more than just being bored or disinterested in school. Some signs of adolescent depression include (AACAP):

  • appearing sad, irritable, or tearful
  • change in appetite or weight
  • decreased interest in activities once found pleasurable
  • decrease in energy
  • difficulty concentrating
  • feelings of guilt, worthlessness, or helplessness
  • major changes in sleeping habits
  • regular complaints of boredom
  • talk of suicide
  • withdrawal from friends of after-school activities
  • worsening school performance

Some of these symptoms may not always be signs of depression. Anyone who has ever raised a teenager knows that appetite changes are often normal, namely in times of growth spurts or if he or she is particularly involved in sports.

Still, being vigilant and watching for changing signs in your teen can help get them the help they need.

How Is Adolescent Depression Diagnosed?

One problem facing adolescent depression is proper diagnosis and treatment. A qualified mental health professional—such as a psychiatrist or psychologist—will ask a series of questions about the teen’s moods, behaviors, and thoughts. This is known as a psychological evaluation.

A person must meet the criteria spelt out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) to be diagnosed with major depressive disorder. He or she must have two or more major depressive episodes for at least two weeks. The episodes must involve at least five of the following symptoms that impact his or her life (NCBI):

  • agitation or psychomotor retardation noticed by others
  • depressed mood most of the day
  • diminished ability to think or concentrate
  • diminished interest in most or all activities
  • fatigue
  • feelings or worthlessness or excessive guilt
  • insomnia or excessive sleeping
  • recurring thoughts of death
  • significant unintentional weight loss or gain

The mental health professional may also question a child’s parents about his or her behavior and mood.

A physical examination may be used to help rule out other causes of a person’s feelings. Some medical conditions can contribute to depression.

Treating Adolescent Depression

Just as depression has no single cause, there is no single treatment that can help everyone. Often, finding the right depression treatments is a trial-and-error process. It can take time to determine which treatment works best.

Numerous classes of medications are designed to alleviate the symptoms of depression. Some of the more common types of depression medications include:

Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are some of the most commonly prescribed antidepressants. They are a preferred treatment, as they tend to have fewer side effects than other medications.

SSRIs work on the neurotransmitter serotonin. Research shows that people with depression may have abnormal levels of neurotransmitters associated with mood regulation. SSRIs prevent your body from absorbing serotonin so it can be more effectively used in the brain.

Current SSRIs approved by the U.S. Food and Drug Administration include:

  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac)
  • fluvoxamine (Luvox)
  • paroxetine (Paxil or Pexeva)
  • sertraline (Zoloft)

The most common side effects reported with SSRIs include:

  • sexual problems
  • nausea
  • diarrhea
  • headache

Talk to your doctor if the side effects are interfering with your quality of life.

Selective Serotonin and Norepinephrine Reuptake Inhibitors

Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) prevent the reabsorbtion of neurotransmitters serotonin and norepinephrine, which help regulate mood.

Side effects of SNRIs include:

  • nausea
  • vomiting
  • insomnia
  • constipation
  • anxiety
  • headache

The most common SNRIs are duloxetine (Cymbalta) and venlafaxine (Effexor).

Tricyclic Antidepressants

Like SSRIs and SNRIs, tricyclic antidepressants (TCAs) block the reuptake of certain neurtransmitters. Unlike the others, TCAs work on serotonin, norepinephrine, and dopamine.

TCAs may produce more side effects than other antidepressants, including:

  • blurred vision
  • constipation
  • dizziness
  • dry mouth
  • sexual dysfunction
  • sleepiness
  • weight gain

Doctors will not prescribe TCAs to people with an enlarged prostate, glaucoma, or heart disease, as this can create serious problems.

Commonly prescribed TCAs include:

  • amitriptyline
  • amoxapine
  • clomipramine (Anafranil) (for obsessive-compulsive disorder)
  • desipramine (Norpramin)
  • doxepin (Sinequan)
  • imipramine (Tofranil)
  • nortriptyline (Pamelor)
  • protriptyline (Vivactil)
  • trimipramine (Surmontil)

Monoamine Oxidase Inhibitors

While monoamine oxidase Inhibitors (MAOIs) were the first class of antidepressants on the market, they are now the least-prescribed antidepressant. This is because of the complications, restrictions, and side effects they cause.

MAOIs block serotonin, dopamine, and norepinephrine, but also affect other chemicals in the body. This can cause:

  • low blood pressure
  • dizziness
  • constipation
  • fatigue
  • nausea
  • dry mouth
  • lightheadedness

People taking MAOIs must avoid certain foods and beverages, including:

  • many cheeses
  • pickled foods
  • chocolates
  • certain meats
  • beer, wine, and alcohol-free or reduced-alcohol beer and wine

Common MAOIs include:

  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • tranylcypromine (Parnate)
  • selegiline (Emsam)

Psychotherapy

Psychotherapy is the formal name of therapy. People with depression are often told to see a qualified mental health professional before or at the same time as starting medication therapy.

Many different types of therapy are available for people with depression. The more common types include:

Talk Therapy

This is the most common type of therapy, and includes regular sessions with a psychiatrist or psychologist.

Cognitive-Behavioral Therapy (CBT)

This therapy is guided to replace negative thoughts and emotions with good ones.

Psychodynamic Therapy

This therapy focuses on delving into a person’s psyche to help alleviate internal struggles, such as stress or conflict.

Problem-Solving Therapy

This therapy helps a person find an optimistic route through specific life experiences, such as the loss of a loved one or another transitional period.

Besides medication, your doctor will typically instruct your child to focus on other areas of his or her life to improve depression symptoms.

Exercise

Research shows that regular exercise stimulates the production of “feel good” chemicals in the brain that elevate mood. Enroll your child in a sport he or she is interested in. Throw a ball around or come up with games to encourage physical activity.

Sleep

Sleep is important to your mood. Make sure your child gets enough sleep each night and follows a regular bedtime routine.

Balanced Diet

It takes the body extra energy to process foods high in fat and sugar. These foods can make your child feel sluggish. Pack school lunches full of a variety of nutritious foods.

Avoid Excess Caffeine

Caffeine can momentarily boost mood. However, regular use can cause your child to “crash,” feeling tired or down.

Abstain from Alcohol

Drinking, especially for teens, can create more problems. People with depression should avoid alcohol.

Living with Adolescent Depression

Depression can have a profound impact on a person’s life, and can only compound the difficulties associated with teenage years. Adolescent depression isn’t always the easiest condition to spot. However, adolescents can return to being their normal, happy, and optimistic selves with proper treatment.

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