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Adolescent depression

Definition

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

See also:

• Depression
• Major depression

Causes

Depression can be a temporary response to many situations and stresses. In adolescents, depressed mood is common because of:

• The normal process of maturing and the stress associated with it
• The influence of sex hormones
• 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
• 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.

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

Risk factors include:

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

Depression is also associated with eating disorders, particularly bulimia.

Symptoms

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

If these symptoms last for at least 2 weeks and cause significant distress or difficulty functioning, get treatment.

Treatment

Treatment options for adolescents with depression include supportive care from a medical provider, psychotherapy, and antidepressant medications. It is important that treatment be customized to the adolescent and the severity of depression symptoms. Families often participate in the treatment of adolescent depression.

MEDICATION

The first medication considered is usually a type of antidepressant called selective serotonin reuptake inhibitors (SSRI). NOTE: SSRIs 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 this type of 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 may also be needed to help with school problems. Occasionally, hospitalization in a psychiatric unit may be required for individuals with severe depression, or those who are suicide risks.

Because of the behavior problems that often occur 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 suggesting 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." This can harm teens by exposing them to more deviant peers and reducing their educational opportunities. A better solution is to get the best possible legal advice and search for treatment on your own. This gives parents more control over treatment techniques and options.

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

Prognosis

Depressive episodes usually respond to treatment. Early and appropriate treatment of depression in adolescence may prevent further episodes. However, about half of seriously depressed teens are likely to have continued problems with depression as adults.

Prevention

Periods of depressed mood are common in most adolescents. However, supportive relationships and healthy coping skills can help prevent these periods from leading to more severe depressive symptoms. Open communication with your teen can help identify depression earlier.

Counseling may help teens deal with periods of low mood. Cognitive behavioral therapy, which teaches depressed people ways of fighting negative thoughts, is the most effective non-medication treatment for depression. Ensure that the counsellors or psychologists you work with are well trained in this method.

For adolescents with a strong family history of depression or multiple risk factors, episodes of depression may not be preventable. For these teens, early identification and prompt and appropriate treatment of depression may prevent or postpone further episodes.