Ron J. Steingard, MD
Since adolescents are often moody, it can be difficult to recognize when your son or daughter has become depressed, and might need help. The thing people tend to notice first is withdrawal, or when the teenager stops doing things she usually likes to do. There might be other changes in her mood, including sadness or irritability. Or in her behavior, including, appetite, energy level, sleep patterns and academic performance. If several of these symptoms are present, be vigilant about the possibility of teen depression.
This is especially important because by the time family members and other people around a teenager note her lack of interest in most things, or what we call anhedonia, she’s usually been depressed for some time. Depression is an internalizing disorder, i.e. one that disturbs a patient’s emotional life, rather than an externalizing one, which takes the form of disruptive or problematic behavior. As such, it takes a while not only for others to recognize it but often for the patient herself to realize that her thinking, and emotional responses, are disturbed.
Note that there are actually two kinds of depression. In major depressive disorder—the most familiar form of depression—the symptoms occur in what may be severe episodes that tend to last from seven to nine months. But there is also another form of depression called dysthymic disorder, in which the symptoms are milder, but they last longer, even years. So while the experience of dysthymia may be less debilitating for the child at any given moment, the risk is that there is more accrued damage, more time in which the child is kept out of the healthy development process.
Why early intervention is critical
When a teenager is depressed, his suffering isn’t the only reason it’s important to get help. In addition to the disorder itself, there are add-on effects that may cause lifelong issues. With Depression symptoms comes include low energy and poor concentration, two factors that are likely to have a significant impact on social and academic functioning.
It’s easy to see the effects of poor academic functioning: falling behind in school undermines a child’s confidence and self-image, and can impact his future if it’s prolonged. But social learning is just as critical as academic learning in adolescence. Deficits in social skills not only put depressed teens behind their peers, but in themselves can compound their depression.
Depression plus anxiety
It’s important to understand that a teenager who is depressed may also develop anxiety, and may need to be treated for two separate disorders. It may be that depression leads to anxiety—the negative state of mind of a depressed teenager lends itself to uncertainty. If you’re not feeling good about yourself, or confident, or secure, or safe, anxiety may find fertile ground. It may also be because the regions of the brain affected by anxiety and depression are close together, and mutually affected.
Two serious problems that are directly associated with teenage depression and anxiety are suicidal thinking (or behavior), and substance abuse. Suicide is the third leading cause of death among adolescents and young adults aged 15 to 24, and we know that most kids who commit suicide have been suffering from a psychiatric illness. Especially at risk are teenagers who hide their depression and anxiety from parents and friends. That’s why it’s important to be alert to signs of these disorders—withdrawal, changes in school performance, eating habits, sleeping patterns, things they enjoy doing—even when teenagers aren’t forthcoming about how they feel.
Similarly, the majority of teenagers who develop substance abuse problems also have a psychiatric disorder, including, most commonly, anxiety or depression, which is another important reason to get treatment in a timely way.
Treatments for depression
Fortunately, early involvement of health care professionals can shorten the period of illness and decrease the likelihood of missing important life lessons.
The most common treatment a mental health professional is apt to use is some form of cognitive behavioral therapy, and depending on how young the child is, it may involve teaching the parents as well. Cognitive behavioral therapy is based on the idea that a person suffering from a mood disorder is trapped in a negative pattern of thought. Depressed kids tend to evaluate themselves negatively, interpret the actions of others in a negative way, and assume the darkest possible outcome of events. In CBT, we teach sufferers to challenge those negative thoughts, to recognize the pattern and train themselves to think outside it. And in many cases we see real improvement.
If the depression is moderate to severe, treatment may involve medications such as antidepressants. A combination of psychotherapy and medication usually works better than either alone.