Adolescent depression

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

Causes

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.

Exams 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.

Outlook (Prognosis)

Depressive episodes usually respond to treatment, and early and comprehensive 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.

Possible Complications

Teenage suicide is associated with depression as well as many other factors. Depression frequently interferes with school performance and interpersonal relationships. Teens with depression often have other psychiatric problems, such as anxiety disorders.

Depression is also commonly associated with violence and reckless behavior. Drug, alcohol, and tobacco abuse frequently coexist with depression. Adolescents with additional psychiatric problems usually require longer and more intensive treatment.

When to Contact a Medical Professional

Call your health care provider if one or more warning signs of potential suicide are present.

Be alert to the following signs:

• Withdrawal, with urge to be alone, isolation
• Moodiness
• Personality change
• Threat of suicide
• Giving most cherished possessions to others

NEVER IGNORE A SUICIDE THREAT OR ATTEMPT!

Prevention

Periods of depressed mood are common in most adolescents. However, supportive interpersonal relationships and healthy coping skills can help prevent such 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 and recognizing them as symptoms, not the truth about their world, is the most effective non-medication treatment for depression. Ensure that counsellors or psychologists sought are trained in this method.

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

MacKenzie DL, Gover AR,  Armstrong GS, Mitchell O. A National Study Comparing the Environments of Boot Camps With Traditional Facilities for Juvenile Offenders. Washington, DC. National Institute of Justice, US Dept. of Justice; 2001.

Borque B, Han M, Hill S. A National Survey of Aftercare Provisions for Boot Camp Graduates. Washington, DC. National Institute of Justice, US Dept. of Justice; 1996.

Bottcher J, Isorena T. First-year evaluation of the California Youth Authority Boot Camp. In: D MacKenzie, E Herbert, eds. Correctional Boot Camps: A Tough Intermediate Sanction. Washington, DC: National Institute of Justice, US Dept of Justice; 1995.

MacKenzie D, Souryal C. Multi-site Evaluation of Shock Incarceration. Washington, DC: National Institute of Justice, US Dept of Justice; 1994.

Peters M, Thomas D, Zamberlan C. Boot Camps for Juvenile Offenders Program Summary. Washington, DC: Office of Juvenile Justice and Delinquency Prevention, US Dept of Justice; 1997.