When you asked me what was wrong I said “nothing”……. After you left I whispered everything ~ The voice of a teenager
Depression in adolescence comes at a time of great personal change – when boys and girls are forming an identity distinct from their parents, grappling with gender issues and emerging sexuality, and making decisions for the first time in their lives. Depression is a medical condition that can cause a wide variety of psychological and physical symptoms. The exact cause of depression is not known. Studies suggest that depression is a biologic disorder resulting, at least in part, from an imbalance of neurochemicals in the brain, including serotonin, norepinephrine, and dopamine. These neurochemicals allow cells in the brain to communicate with each other and play an essential role in all brain functions, including movement, sensation, memory, and emotions. This interaction is supported by studies demonstrating the benefit of antidepressants, which help restore the neurochemical balance in the brain. Teenage depression is more than the occasional bad mood and sadness. It is a serious problem, which affects every aspect of a teen’s life. If left untreated, teen depression can lead to problems at home and school, drug abuse, self-loathing—even irreversible tragedy such as homicidal violence or suicide. Teens who are seriously depressed often think, speak, or make "attention-getting" attempts at suicide. An alarming and increasing number of teenagers attempt and succeed at suicide, so suicidal thoughts or behaviours should always be taken very seriously. Suicide is the third leading cause of death for adolescents 15 to 19 years old. However, depression in adolescents is probably underdiagnosed because the symptoms can be difficult to recognize. Depression is different than occasional blues and grief because depression is persistent and often interferes with the teen's ability to get along with parents and friends, complete school work, and appropriately participate in other normal daily activities. Depression is a treatable condition. Psychotherapy (counselling), drug therapy, and other measures can alleviate symptoms and help the adolescent to succeed in school, develop and maintain healthy relationships, and feel more self-confident.
Symptoms of adolescent depression
Extreme and enduring sadness is the best-known symptom of depression, although adolescents can have a number of other symptoms, including irritability, difficulty at school, changes in sleep habits, and/or feelings of worthlessness. Adolescent suicide can be prevented by knowing the symptoms of depression and other pre-suicidal behaviour. Psychosocial problems and stresses, such as conflicts with parents, breakup of a relationship, school difficulties or failure, legal difficulties, social isolation, and physical ailments (including hypochondriacal preoccupation), commonly are reported or observed in young people who attempt suicide. These precipitating factors often are cited by youths as reasons for attempting suicide. Gay and bisexual adolescents have been reported to exhibit high rates of depression. All adolescents with symptoms of depression should be asked about suicidal ideation, and an estimation of the degree of suicidal intent should be made. Important symptoms also include anger, purposelessness, substance abuse, anxiety, hopelessness, withdrawal, recklessness, mood changes. No data indicate that inquiry about suicide precipitates the behaviour. In fact, adolescents often are relieved that someone has heard their cry for help. For most adolescents, this cry for help represents an attempt to resolve a difficult conflict, escape an intolerable living situation, make someone understand their desperate feelings, or make someone feel sorry or guilty. Suicidal thoughts or comments should never be dismissed as unimportant. Adolescents must be told by paediatricians that their plea for assistance has been heard and that they will be helped.
Manifestation of depression
Serious depression in adolescents may manifest in several ways. For some adolescents, symptoms may be similar to those in adults, with signs, such as depressed mood almost every day, crying spells or inability to cry, discouragement, irritability, a sense of emptiness and meaninglessness, negative expectations of self and the environment, low self-esteem, isolation, a feeling of helplessness, markedly diminished interest or pleasure in most activities, significant weight loss or weight gain, insomnia or hypersomnia, fatigue or loss of energy, feelings of worthlessness, and diminished ability to think or concentrate. However, it is more common for an adolescent with serious depression to exhibit psychosomatic symptoms or behavioural problems. Such a teenager may seek care for recurrent or persistent complaints, such as abdominal pain, chest pain, headache, lethargy, weight loss, dizziness and syncope, or other nonspecific symptoms. Behavioural problems that may be manifestations of masked depression include truancy, deterioration in academic performance, running away from home, defiance of authorities, self-destructive behaviour, vandalism, alcohol and other drug abuse, sexual acting out, and delinquency.
Recognizing a depressed mood in an adolescent
The definition of a "depressed mood" in adolescents is somewhat different than depressed mood in an adult. Many adolescents describe feeling down, sad, or blue much of the time. In adolescents, irritability may be a better indicator of depression. Signs of irritability include feeling "annoyed" or "bothered" by everything and everyone. Rather than expressing sadness, the depressed adolescent may be moody, negative, and argumentative, picking fights as a means to express his or her emotional distress. He or she often is unable to tolerate frustration and responds to minor provocations with angry outbursts.
Other characteristics of depressed mood in adolescents include:
- Finding others uncaring
- Brooding about real or potentially unpleasant circumstances
- A gloomy or hopeless outlook
- Belief that everything is "unfair"
- Feelings that they disappoint parents or teachers
Suicide warning signs in depressed teens
Talking or joking about committing suicide. - Saying things like, “I’d be better off dead,” “I wish I could disappear forever,” or “There’s no way out.”
- Speaking positively about death or romanticizing dying (“If I died, people might love me more”).
- Writing stories and poems about death, dying, or suicide.
- Engaging in reckless behaviour or having a lot of accidents resulting in injury.
- Giving away prized possessions.
- Saying goodbye to friends and family as if for good.
- Seeking out weapons, pills, or other ways to kill themselves.
Types of depression
There are a few conditions that cause features similar to those of depression, including mood disorders related to a medical condition, substance abuse (e.g.. alcohol), or a loss. Other conditions that can cause symptoms of depression include bipolar disorder and adjustment disorder. Dysthymia is a less intense but more persistent condition than major depression. Dysthymia is usually diagnosed when a person has a depressed or irritable mood for at least one year and has at least two other symptoms of depression. The most common symptoms of dysthymia include changes in appetite and/or sleep, fatigue, low self-esteem, difficulty concentrating and making decisions, and feelings of hopelessness. It is important that depression be addressed to prevent a worsening of symptoms and problems in daily life. Although other types of depression may have fewer or less severe symptoms, the adolescent should still be evaluated by a healthcare provider.
The diagnosis of depression
The diagnosis of depression is based upon a person's symptoms, the duration of their symptoms, and the overall effect of these symptoms on the person's life. Information from parents and teachers is often considered during the evaluation. The evaluation usually begins with the child's primary care provider (e.g., paediatrician, family practitioner), although the ideal treatment for depressed adolescents should include referral to a trained mental health provider (e.g. child psychiatrist, psychologist, or other specialist). There is currently no medical test that identifies depression, although blood tests are often done to rule out other medical conditions that could be causing depression. Please feel free to add in any information in the comments box if you think it may help understanding this topic further.
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