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Real Talk: Talking with teens about depression - a doctor's perspective



A medical professional discusses depressive behavior in teens

The teen years can be an extremely difficult period given the drama that permeates the often-everyday life of today’s adolescents.  Depression affects teenagers far more often than many of us realize. The estimation is that one in five adolescents from all walks of life will suffer from depression at some point during their teen years. However, while depression is highly treatable, most depressed teens never receive help.

 

Adolescents deal with issues such as peer pressure, academic expectations and their changing bodies which can bring a lot of ups and downs for teens, so it’s no wonder their moods swing like a pendulum. But for some teens, the lows are more than just temporary feelings — they're a symptom of depression. Adolescent depression goes beyond the normal moodiness. It’s a serious health problem that impacts every aspect of a teen’s life.

 

Childhood and adolescence are usually a happy time for both. The “moodiness” of the toddler or the adolescent is usually a product of some environmental trigger and the unhappiness is rarely anything more than short lived.  When children or adolescents appear sad very often, or to an excessive “degree” in response to these environmental triggers or for no apparent reason it may be a sign of clinical depression.  Depression distorts normal perception, causes behavior changes and can result in self- injurious behavior or even suicide. It’s therefore important for parents to be cognizant of the difference between the normal moodiness of adolescents and real clinical depression. Adolescent depression causes a persistent feeling of sadness and loss of interest in activities. It affects how your teenager thinks, feels and behaves, and it can cause emotional, functional and physical problems. The negative effects of teenage depression go far beyond a melancholy mood. Depression can destroy the essence of your teen’s personality.


What causes adolescent depression?
The very nature of adolescence is a period accompanied by many physical, emotional, social and psychological changes. Although these changes are not in and of themselves problematic, they may produce unsettling emotions and issues that create the usual “blues” or “moodiness” parents often encounter. Normal moodiness is usually due to the excitement of first-time events or “likes” which can dissipate quickly. Consider the excitement of first love and the concomitant first heartbreak. The elevation of homeruns or touchdowns and the devastation of strikeouts and fumbles. Additionally, adolescents haven’t had the exposure the the disfluencies in life long enough to develop adequate coping strategies to deal effectively to these inevitable life occurrences.

Additionally, an adolescent can develop feelings of worthlessness and inadequacy over their grades, or problems with friends and fitting in, as peer acceptance becomes one of the most significant factors in an adolescent’s life and how they see themselves. School performance, social status with peers, sexual orientation, or family life can each have a major effect on how a teen feels. All these factors can cause significant adolescent stress, that they may be ill equipped to cope with.

Like the sad and indecisive old gray donkey in Winnie the Pooh adolescent depressive disorders are conditions in which adolescents display persistent negative moods and a lack of pleasure in life (there are few if any upswings in mood). 

Many social psychologists believe that today’s adolescents have more pressure and stresses than prior generations. Although we, the parents, often feel today’s adolescents have it easy, it’s often been identified as the “best of times and the worst of times” for today’s teens.  Many assert that today’s adolescents are bombarded with conflicting messages from media and parents as well as few outlets for the often-unrealistic demands they feel pressured and frustrated by daily. As well as the negative effects of social media.  Today’s adolescents, more than before, need adult guidance to help them understand these personal and interpersonal changes and pressures they are experiencing at increasingly younger ages.  When their moods disrupt their ability to function and manage the variables in their lives, it may indicate a serious depressive disorder.

There are many factors in an adolescent’s life that can create or contribute to clinical depression.  Researchers have noted some internal and external factors that put some adolescents more at risk for depression than others.  These factors are biological, environmental and psychological.  Some people have an “imbalance” of certain brain chemicals called neurotransmitters that may cause depression.  Other factors that have been identified through research that can contribute to depression in adolescents are, a family history of depression or having experienced the death of a parent or a divorce.  Additionally, a negative, self-defeating way of thinking about life events has also been noted as a predisposing factor.

The importance of recognizing and treating adolescent depression is critical! Different from young children suicide for depressed adolescents is although not common, a very real possibility. 

There are many forms of adolescent depression – not all adolescents display the same type of symptoms or the same symptoms to the same degree.  Some depressed adolescents experience a depressive disorder called bipolar disorder wherein they alternative between extreme highs and lows of emotion and demonstrate concomitant behavior.  The diagnosis of depression in adolescents is complicated by several factors.  Among them, the “normal” moodiness of adolescence and withdrawal from family may cover up real depression.  Additionally, adolescents often lack an understanding of what they are feeling and experiencing and may lack the ability or desire to communicate their feelings and be reluctant to seek help.

What's normal and what's not
It can be difficult to tell the difference between the ups and downs that are just part of being a teenager and teen depression. Talk with your teen. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming.

Depression symptoms can vary in severity, but changes in your teen's emotions and behavior may include the examples below.

There are numerous symptoms of depression that parents need to be aware of.  The symptom most psychologists cite would be a dramatic “change” for the worse, such as a withdrawal and apathy toward activities and people they used to enjoy participating in, or being with,  which is called anhedonia, and a dramatic change in mood toward persuasive feelings of sadness and happiness. They may be very difficult to motivate at home or in school.  They may also spend an inordinate amount of time alone or in their room.

Among symptoms citied that often indicate depression are:

- Suicidal thoughts or self-abusive behaviors such as “accident proneness” or other self-injurious behavior – like “cutting”

- Change in eating, sleeping or activity levels (too much or too little)

- Lack of energy, enthusiasm or motivation to achieve in school, or to complete responsibilities at home

- Changes in overall school performance without other possible explanations such as specific subject difficulty

- Overreaction to any criticism or perceived failures - this overreaction may take the form of the adolescent being hostile and aggressive towards parents or teachers

- The depressed adolescent may also be overwhelmed with guilt, have low self-esteem, feeling worthless or ever being able to do anything right or always feeling like a failure

- A pervasive feeling of hopelessness – that they have nothing to “looking forward to” that the future is empty - and this is often cited as critical, they may feel have no capacity in any way to change either the way they are feeling or the events that are precipitating or contributing to these feelings.

Feeling inordinately sad is a hallmark symptom of depression.  These adolescents will look unhappy, constantly feel rejected and helpless in dealing with life circumstances.  They may appear withdrawn and inhibited constantly worrying about themselves, other people, and other things over which they have little control.  They may also cry frequently with little or no provocation.

Adolescents may also have a preoccupation with food – hiding food in their rooms or seeming to have a vague but constant need to eat. At the other extreme they might be listless about their food, pushing it around on their plate stating that they are full or complaining of stomachaches.

READ MORE: A mom's perspective on teen depression

Insomnia (inability to sleep) or hypersomnia (oversleeping) may also be present.

They may fall asleep during any type of passive activity such as watching T.V, be listless, lethargic and constantly yawning - or conversely not able to fall asleep at night or not sleeping through the night any longer.

The normally energetic adolescent will complain of always being tired, or bored – dragging themselves through activities or avoiding chores or responsibilities because they feel too tired to do them. They may complain of vague “aches & pains” or headaches and stomachaches that don’t “go away”.  This “somatatization” may cause frequent school absences and missed appointments.

The adolescent may also take the blame for everything that goes wrong not only in their lives but also in everyone else’s.  They may be extremely sensitive, hyper-self critical and brought to tears over the slightest problem.  They can be extremely unreasonable, holding on to a hurt or nursing a grudge for a long time.

All the symptoms listed above do not all need to be present for an adolescent to be diagnosed as depressed.

While depression can cause tremendous pain for your teen—and disrupt everyday family life—there are plenty of things you can do to help your child start to feel better. The first step is to learn what teen depression looks like and what to do if you spot the warning signs.

If you’re unsure if your teen is depressed or just “being a teenager,” consider how long the symptoms have been going on, how severe they are, and how different your teen is acting from their usual self. Hormones and stress can explain the occasional bout of teenage angst—but not continuous and unrelenting unhappiness, lethargy, or irritability.

Depression in adolescents is a very serious disorder, and to avert potential suicidal attempts or dangerous self-destructive behaviors, (depressed adolescents are more likely to be substance abusers) it is important that adolescents get prompt professional treatment.  Families should consult mental health professional to decide on which of the numerous forms of treatment is best for their adolescent. 

READ MORE: Discussing important issues with your teen

How to help a depressed teenager
Depression is very damaging when left untreated, so don’t wait and hope that worrisome symptoms will go away. If you suspect that your teen is depressed, bring up your concerns in a loving, non-judgmental way. Even if you’re unsure that depression is the issue, the troublesome behaviors and emotions you’re seeing are signs of a problem that should be addressed.

Hold back from asking a lot of questions (most teenagers don’t like to feel patronized or interrogated) but make it clear that you’re ready and willing to provide whatever support they need.

Focus on listening, not lecturing! 

Be gentle but persistent.  Don’t give up if they shut you out at first. Talking about depression can be very tough for teens. Even if they want to, they may have a hard time expressing what they’re feeling. Be respectful of your child’s comfort level while still emphasizing your concern and willingness to listen.

Acknowledge their feelings.  Don’t try to talk your teen out of depression, even if their feelings or concerns appear silly or irrational to you. Well-meaning attempts to explain why “things aren’t that bad” will just come across as if you don’t take their emotions seriously. Simply acknowledging the pain and sadness they are experiencing can go a long way in making them feel understood and supported.

The important thing is to get them talking to someone and get useful help. There are numerous forms of therapy and medications available that have been found to be beneficial with adolescents. One of the most popular and successful forms of therapy with adolescents is; Cognitive Behavioral Therapy:  This type of therapy helps to correct negative or self-defeating ways of “thinking”, such as unrealistic self or family expectations or irrational thoughts that lead to depressive feelings. Depression caused by irrational or self-defeating thinking is common among adolescents

When adolescents are depressed, they frequently feel alone and believe nothing is available that can help them improve what they are experiencing.  With guidance, support, direction and the therapy they need they can be helped dramatically and the further deepening of their depressive feelings leading to the destruction of their relationships with family and friends can be avoided.  Adolescence can indeed be the “best of times” for today’s young people.

 



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