Does the depression cause the behavior? Or does the behavior lead to low self esteem and depression? There’s seldom a clear answer.

By hindering concentration, attention and motivation, depression affects success in school and social relationships.

Melissa has been secretly seeing a psychiatrist at the university; her parents have no idea she has clinical depression. Sam’s parents found out about his depression only after his suicide attempt.

Most adolescents exhibit at least some symptoms of depression from time to time. That may be one reason parents are likely to deny or dismiss even the most obvious signs of illness.

As recently as the 1970s, many experts doubted whether children and adolescents could be depressed in the same way that adults are. Emotional turmoil, irritability and anger were seen as a normal part of adolescent development. It’s now recognized that at least five to eight percent of adolescents have depression and as many as 65 percent report occasional symptoms.

As an individual advances through the teen years, bouts of depression become increasingly likely and are likely to impede normal development–hindering concentration, attention and motivation and thereby affecting success in school and social relationships.
One of every five American teens thinks about suicide, and one in ten actually makes an attempt. Suicide is the third leading cause of death for this age group.

One study found that even teenagers experiencing symptoms not serious enough for a diagnosis of depression were two to three times as likely as others to develop major depression as adults. In another study, 50.6 percent of persons experiencing major depression during adolescence later attempted suicide; 22 percent made multiple attempts and 7.7 percent succeeded in taking their own lives.

What Are the Signs?
As with adults, depression in adolescents is characterized not only by a persistent sadness but changes in appetite and sleep patterns, loss of interest in activities that used to bring pleasure, difficulty concentrating, fatigue and chronic feelings of guilt or worthlessness. In an adolescent, these signs may be masked behind anger, irritability, agitation, inattention or even disruptive behavior.

While most teens are subject to stormy moods and sadness, depression is distinguished by the extent to which it differs from the person’s normal mood, how long it lasts and how much it interferes with normal functioning. For an adolescent, the mean length of an episode of depression is seven to nine months, with a strong likelihood of recurrence. Among teenagers treated for major depression, about 70 percent experience symptoms again within a five-year period.

Depression is also frequently entwined with other debilitating problems such as anxiety, disruptive behavior or drug abuse. One study of depressed adolescents found that 43 percent had at least one other diagnosis such as anxiety (18 percent), substance abuse (14 percent) or conduct disorders (8 percent).

Risk factors for depression include a family history of depression, family conflict, poor academic performance, low self esteem and other emotional problems such as anxiety or eating disorders.

By hindering concentration, attention and motivation, depression affects success in school and social relationships.

Hormonal changes sometimes seem to trigger depression, and female teens are twice as likely as males to get depression.

Teenagers who have been victims of physical or sexual abuse, have witnessed violence or have lost a parent during childhood are highly vulnerable. So are those who are uncertain about their sexual orientation. Most cases of depression, however, cannot be traced to any specific social or family trauma. As with adult depression, there is apparently a strong genetic component; if one identical twin develops depression, the risk for the other twin is 70 percent.

Many young persons with depression have problems in school–in part because their mood affects their concentration and attention–and are also likely to get into
Does the depression cause the behavior? Or does the behavior lead to low self esteem and depression? There’s seldom a clear answer.

Where To Get Help?
For parents, it’s always difficult to know when and where to seek help. It’s important not to plant labels on children. At the same time, the consequences of delay can be enormous.
The first person to see may be the family physician or pediatrician. A thorough physical examination can rule out physical causes such as a sleep disorder, mononucleosis, anemia, thyroid problems or post-concussion syndrome.

In the Prozac era, some primary care physicians treat symptoms of depression by prescribing a selective serotonin reuptake inhibitor (SSRI). Tricyclic antidepressants available in the 1980s were generally not found to be effective in the treatment of children and adolescents, but two recent studies provided rather clear evidence that SSRIs fluoxetine (Prozac) and paroxetine (Paxil) were beneficial in reducing the symptoms of depression in adolescents. These studies, however, showed no effect of the drugs on psychosocial functioning.

As a result, referral to a mental health professional is nearly always necessary. According to the needs of the individual, treatment may involve group or individual therapy, or both. Usually the family is involved in at least some therapy and educational sessions.
A cognitive behavioral approach, aimed at changing negative thought patterns, is frequently used and has been found effective both short- and long-term. Adolescents are particularly prone to distorted thought patterns (“no one will ever like me because...”) that guides their feelings and behavior. They benefit from learning to recognize and correct these thought distortions. One study of 78 teens conducted at the University of Pittsburgh found cognitive behavioral therapy more effective at bringing about recovery than either family or supportive therapy.

Treatment plans, of course, must be tailored to the needs and personality of the individual. In nearly all cases, depression can be treated, but early recognition is important not only to head off related social and behavioral problems but to save lives. Even aside from the risk of suicide, depressed individuals are twice as likely to die as other persons.

REFERENCES:
David A. Brent, Diane Holder, David Kolko, “Treatment for Adolescent Depression,” Harvard Mental Health Letter, August, 1998.
“Child Abuse Affects Adolescent Functioning,” The Brown University Child and Adolescent Behavior Letter, August, 1999.
Gregory K. Fritz, “Child, Adolescent Depression Distinct from the Adult Version,” Behavioral Health Treatment, October, 1997.
Erica Goode, “Vital Signs: Behavior; Following the Trail of Adolescent Angst,” New York Times, January 12, 1999.
Richard Harrington, “Adolescent Depression: Same or Different?” Archives of General Psychiatry, January, 2001.
Jay Kist, “Dealing with Depression,” Current Health 2, January, 1997.
Kim Lawson, “Spot and Treat Depression in Teens before They Are Suicidal, Clinical Psychiatry News, 28(5):42, 2000.
Beverly D. Lucas, “Adolescent-Onset Depression and Adult Suicide,” Patient Care, August 15, 1999.
Zendi Moldenhauer and Bernadette Mazurek Melnyk, “Use of Antidepressants in the Treatment of Child and Adolescent Depression: Are They Effective?” Pediatric Nursing, November, 1999.
Lisa M. Pullen, Mary Anne Modrcin-McCarthy and Ellen V. Graf, “Adolescent Depression: Important Facts That Matter,” Journal of Child and Adolescent Psychiatric Nursing, April, 2000.
Sung E. Son and Jeffrey T. Kirchner, “Depression in Children and Adolescents,” American Family Physician, November 15, 2000.
Christopher Varley, M.D., and Elizabeth McCauley, Ph.D., “Diagnosis and Management of Pediatric Depression, 2000 Meeting, American Academy of Pediatrics.
Elizabeth Weller, M.D., “Child and Adolescent Mood Disorders,” American Psychiatric Association 153rd Annual Meeting, 2001.