Adolescent Depression

Every young person probably feels "down in the dumps" from time to time when things appear to go wrong at school, home, with friends, teachers or family--feelings that "when it rains, it pours" and that "life isn't fair." These feelings can be exaggerated when an adolescent is thinking about and testing values and priorities about competition, grades, friendships and perhaps discrimination or poverty.

Adolescence is often a period of complicated and demanding conflicts. Teens undergo a shakeup physically, psychologically, emotionally and socially. They are vulnerable to being overwhelmed by the many changes and pressures brought to bear during this critical time.

 

Special Problems There is some indication that adolescents experience more loneliness than other age groups. The position of the young person in today's society may contribute to a sense of meaninglessness, powerlessness and isolation. They are neither children nor adults. School failure can create a strong sense of rejection; a lack of meaning or challenge can create boredom or apathy; social expectations may be unrealistic; and conflicting messages from family and loved ones may magnify the struggle for independence.

The young person is confronted with developmental changes in relationships with others. There is a need for adjustment to losses or breaking off of critical attachments and the surfacing of new needs and desires for relations with others.

Depression, rather than a depressed mood, is an illness. The illness presents many of the same symptoms, but it varies in length of time and intensity. If the adolescent displays some of the following symptoms for more than a few weeks and is doing poorly in school, seems socially withdrawn and not interested in once-enjoyed activities, the individual should be evaluated for a possible depressive illness. Mental depression may get worse and last for several weeks to several years unless it is properly treated.

Symptoms The high rate of depression and suicide among young people has prompted researchers to identify those factors relevant to adolescent depression. The most important symptoms are:

• Sadness
  
• Fluctuation between apathy and talkativeness
  
• Anger and rage, verbal sarcasm and attack
  
• Overreaction to criticism
  
• Guilt
  
• Feelings of being unable to satisfy ideals
  
• Poor self-esteem
  
• Loss of confidence
  
• Feelings of helplessness or hopelessness
  
• Intense ambivalence between dependence and independence
  
• Feelings of emptiness in life
  
• Restlessness and agitation
  
• Pessimism about the future
  
• Death wishes, suicidal thoughts, plans or attempts
  
• Rebellious refusal to work in class or cooperate in general
  
• Sleep disturbances
  
• Increased or decreased appetite, severe weight gain or loss

A young person's depression is different from an adult's in several important ways. Each individual's illness is different, and the treatment must be flexible enough to recognize those differences. It is sometimes more difficult for the clinician to diagnose teenagers because:

• Adolescents do not always understand or cannot express feelings very well.
  
• Symptoms are often dismissed as "just growing up."
  
• The young person may not be aware of the concept of depression and not report anything wrong.
  
• There is a strong tie between "getting into trouble" and feeling depressed. It is difficult to sort out if the teenager is depressed because of being in trouble, or in trouble because of being depressed.

Depression in the adolescent has been linked to poor academic performance, truancy, delinquency, alcohol and drug abuse, disobedience, self-destructive behavior, sexual promiscuity, rebelliousness, grief, running away, alienation, feelings of inferiority and loneliness.

The young person may have suffered an increase in the severity of life events, high stress, a number of psychiatric and physical illnesses, a lack of support from family and other people important in the individual's life and a decrease in the ability to cope. Adolescents may attempt to escape loneliness and depression in a number of ways. Some poor and dysfunctional ones are:

• Hero or heroine worship of celebrities
  
• Denying a need for relationships
  
• Denying that loneliness or depression exist
  
• Gratifications like drugs, alcohol, "fun," other forms of escape

  These strategies may only lead to new problems, deeper levels of despair and erosion of relationships with others, the law or school.
  Some better ways of coping are:

  • Trying to make new and more friends
    
  • Exploring and making better use of existing social connections
    
  • Increasing activity in sports and job or school activities
  
  All of these may lead to social activities that increase acceptance and a sense of belonging.

  

  How is Depression Treated? An adolescent who is surrounded by close friends and family who understand the depression and are supportive will likely have an easier time than someone who is isolated.
  
  The two most common ways of treating depression are with medication, psychotherapy, or a combination. Sometimes a person must be hospitalized for intense treatment or for the individual's own safety. For many patients, the medication is useful in treating the symptoms, and talking to a mental health professional can help them understand why they are depressed and how to handle future stressful situations. Anti-mania medication is employed most often to treat the "high side" of manic depression (characterized by severe mood swings from uncontrollable highs to deep lows), while antidepressant medication has been useful in controlling the depressive side. All medication used in these treatments can be prescribed only by physicians.
  
  Psychotherapy is also effective in treating stress-related depression. In this treatment, a person has the opportunity to explore events or feelings that are painful or troubling and which might have contributed to the depression. The role of the therapist is to help the patient look beyond the problem and explore these feelings. For therapy to succeed, there must be trust, respect and confidence between the therapist and the patient.
  

  Where to Find Help When a depressed adolescent realizes the need for help and begins to look for it, a major step toward recovery has been taken. If someone you know is unable to act alone, you or a trusted friend or family member should help the young person find treatment. There are many mental health professionals working in private or public facilities and in private practice, as well as in schools. The Mental Health Association in your community may be able to help you find appropriate services available locally.