Excerpts from Your Adolescent on Depressive Disorders
Depression is a term used to describe a common condition characterized by feelings of sadness, gloom, misery, or despair. Most people experience temporary depression at various points in their lives. Teens with a depressive disorder, however, experience disturbing symptoms that are beyond the range of normal sadness or depression.
The teen years are often a time of brooding and melancholy, but some adolescents are especially prone to frequent and very distressing periods of depression. Your teenager may have a depressive disorder if his mood is consistently sad or if he sees his life and future as grim and bleak.
Identifying the Signs
There are two basic types of depression: major depression, which lasts at least two weeks, and the milder but chronic dysthymic disorder, in which a long?standing depressed mood seems to be connected with the teenager's temperament or disposition. Teens with depression may also have anxiety or exaggerated fears. Not all youngsters with severe depression appear depressed. Instead, they may seem irritable or moody, swinging from great sadness to anger.
Usually there are other clues or signals that a youngster is depressed. He may lose interest or pleasure in many activities. He may sleep or eat too little or too much and may have difficulty concentrating or making decisions. Feelings of worthlessness, guilt, or anger may find expression in suicidal thoughts or ruminations about death.
During a period of depression, a teenager may look sad, tearful, withdrawn, uncharacteristically listless, and dull. He may seem to lack initiative or may appear agitated. He may neglect his appearance, looking dirty, with mismatched clothes and disheveled hair. This is not a fashion statement. His movements are slow; his voice sounds monotonous; his speech reflects hopelessness and despair. He frequently says things such as I'm stupid or No one loves me or I'm bad. While sensitive at these times to rejection by others, the depressed teen often has a negative or depressing effect on others, causing them to avoid him.
Teens with dysthymic disorder have milder symptoms of depression?a depressed, irritable, volatile mood; appetite and sleep changes; diminished energy; low self - esteem; feelings of hopelessness; poor concentration and indecisiveness - for a year or longer. This chronically depressed mood colors every experience, impression, and response, and the teen experiences most things negatively.
Causes and Consequences
Depression is a complex and multifaceted condition. Likely rooted in a genetic and/or biochemical predisposition, depression also can be linked to unresolved grief, possibly in response to early real or imagined losses of nurturing figures. Depression may also reflect that the adolescent has learned feelings of helplessness rather than feeling empowered to seek solutions for life's problems. Depressed thinking tends to be negative, hopeless, and self-defeating?reinforcing further feelings of depression.
Some seriously depressed adolescents have experienced early life and environmental stresses, including childhood trauma, such as the death of a parent or other significant person. They may live in families where they regularly witness or are victims of parental aggression, rejection or scapegoating, strict and punitive treatment, and parents abusing each other. Such family pressures may contribute to the development of depressed mood disturbance in a teenager.
Girls appear to suffer from feelings of depression during adolescence more often than boys (this continues into adulthood with women experiencing more depressive episodes than men). Complex neurobiological and sociocultural factors are the likely explanation for this difference. Because boys are often encouraged to translate feelings into actions, their depression is more likely to produce external behavioral disturbances and acting out. Girls, on the hand, are more often focused on or preoccupied by their internal feelings. As a result, they may be acutely self-conscious about their bodies and performance.
Depression usually interferes with a teenager's social and academic functioning. When an adolescent is depressed, school performance usually deteriorates. While depressed, a teenager cannot concentrate. He believes himself to be hopelessly unable to finish schoolwork, and he may skip classes and see his grades drop. Feeling depleted, listless, and incompetent, he may lose interest in extracurricular activities and drop out.
While teenagers are naturally more likely to sleep late in the morning whenever possible, a depressed teen will nap excessively throughout the day or go to bed early in the evening. He may complain of headaches or stomachaches, especially before attending a new social event.
Hopelessness, despair that things will never change, and a general feeling of deadness may be expressed in suicide attempts or dangerous and self?injurious behavior. In addition, depressed teenagers may use drugs or alcohol, in some cases as self-medication to try to relieve their depression.
During adolescence, teens with severe depression may also have other emotional disorders, including delinquent behavior, school attendance problems, anxiety disorders, substance abuse, and eating disorders.
How to Respond
In trying to decide whether symptoms are serious enough to seek help, talk with your teenager. Let him know that you see his sadness. By showing interest and the desire to help him understand his feelings, you bring hope to the teen. Parents often have difficulty understanding why a teen feels such a catastrophic sense of loss or perceived failure, so it's important to listen carefully to the teen and to try to imagine yourself in your youngster's position. Without pressuring him, point to activities he enjoys and handles successfully. Help build self-esteem by recognizing small triumphs and admiring his competence.
At the same time, try to determine whether the teenager seems capable of handling the feelings on his own or whether he seems overwhelmed. If the symptoms persist, particularly if they begin to interfere seriously with multiple areas of his life, ask his doctor or his school for the name of a child and adolescent psychiatrist or other professional trained to work with adolescents.
Treatment should begin with a full evaluation, which usually includes all members of the family. The assessment must include an evaluation of the risk of suicidal behavior and will seek to rule out substance use or an underlying physical disease or illness that could also produce depressive symptoms, as well as distinguish depression from simple bereavement.
Parents will be asked to describe symptoms and such behavioral changes as irritability, moodiness, and sleep and appetite changes and to report the duration of symptoms as well as any possible precipitating event.
Many parents who are also seriously depressed may have trouble accurately describing their teenagers' symptoms. They may either view everything in negative terms, therefore exaggerating problems, or be so preoccupied with their own depressive symptoms that they fail to observe their adolescent accurately. In such families, it is not uncommon for parents to be unaware of their teenager's sadness, suicidal thoughts, and sleep disturbances.
Individual Psychotherapy Therapy offers support and empathy while encouraging exploration of the depressed feelings and symptoms. While creating a sense of safety by setting limits on dangerous behavior, a therapist will encourage a teenager to express his upsetting feelings, usually a sense of loss, powerlessness, aggression, or danger. Therapy helps the adolescent deal with these feelings rather than act them out. If a teenager's self-esteem seems particularly low, therapy may work to improve confidence and competence through skills training.
If a specific circumstance or event has precipitated the depression?divorce, for example-therapy gives the youngster a chance to resolve some of his feelings and accept even an unhappy reality.
Cognitive-Behavioral Therapy Often effective in treating depression in adolescents, cognitive therapy focuses on the irrational beliefs and distorted thoughts that are part of depression, such as a negative view of the self, the world, and the future. Usually a depressed teen personalizes failure, magnifies negative events, and minimizes positive events and attributes. Sometimes these negative thought patterns have been formed or reinforced by the teen's home environment. Cognitive therapy focuses on identifying negative thought patterns or distortions and on helping the adolescent change his thinking.
Group Therapy Group therapy for depressed teens can help them develop or improve social skills, which can lead to a greater sense of mastery and improved self-esteem. Teens may find it easier to express feelings in a supportive peer?group environment. This can be especially helpful during a developmental stage when peer groups are an increasingly important resource. Support groups for parents can help them manage specific problem behaviors, use positive reinforcement, better communicate with adolescents, and become better listeners for their youngster.
Family Therapy If the teenager is willing and able to work within a family context, family therapy can address certain problems that may worsen depression in teens: lack of generational boundaries; severe marital conflict; rigid or chaotic rules; and neglectful or overly involved parent?child relationships.
Family therapy can also help parents manage specific problem behaviors, use reinforcement correctly, listen and communicate with their teenager in an age?appropriate manner, and support the teenager as he prepares to move beyond his family structure. In addition, other family members with psychiatric disorders may be identified during family sessions, and they can be assisted in getting their own treatment.
Medication In moderately and severely depressed adolescents, antidepressants, such as bupropion (Wellbutrin), desipramine (Norpramin), fluoxetine (Prozac), imipramine (Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor), may be prescribed in combination with psychotherapy. Before the teen begins taking a medication, specific target symptoms should be identified in a discussion between the youngster, the parent, and the physician. Possible side effects and other aspects of the medication should be fully discussed; when tricyclic antidepressant medications, such as imipramine, are prescribed, your child's physician may want to monitor for potential side effects by conducting periodic physical exams and occasional electrocardiograms (EKGs).
Hospitalization Any seriously depressed adolescent at risk for suicidal or self-endangering behavior must be immediately assessed. If he is preoccupied with suicide or has a well?thought?out plan, this constitutes an emergency situation, and his safety should be assured. That a teenager could be so unbearably unhappy that he would choose to kill himself is something that's almost too painful for a parent to examine. But with the increasing prevalence of teen suicide, no parent can afford to ignore the possibility.
Before the mid-1970s, suicide by adolescents appeared to be a rare event; now one out of ten teens contemplates suicide, and nearly a half million teens make a suicide attempt each year. Sadly, suicide has become the third leading cause of death for high school students. Indeed, the actual rate of death by suicide may be higher, because some of these deaths have been incorrectly labeled "accidents."
Facts for Families
#4 The Depressed Child