What is depression in teenagers?

Occasional melancholy, bad moods and short periods of feeling down are common in adolescence. Major depression, however, limits an adolescent's ability to function normally. Depression in teenagers is characterized by a persistent sad mood, irritability, feelings of hopelessness or the inability to feel pleasure or happiness for an extended period of time—weeks, months or years.

What are the symptoms of teenage depression?

Early symptoms of adolescent depression can be difficult to diagnose because they appear to be a normal part of the difficulties adolescents face. Depression may be indicated if an adolescent experiences an unusual degree of the following symptoms:

• changes in eating and sleeping habits (eating and sleeping too much or too little)
• significant weight gain or loss
• missed school, poor school performance and/or a sudden decline in grades
• withdrawal from friends and family
• no longer enjoying activities that were once pleasurable
• indecision, lack of concentration, or forgetfulness
• feelings of worthlessness or guilt
• overreaction to criticism, irritability
• feeling that nothing is worth the effort
• frequent health complaints when no physical ailment exists
• anger, rage, anxiety
• lack of enthusiasm and motivation
• drug/alcohol abuse, thoughts of death or suicide

Symptoms such as insomnia, panic attacks, delusions or hallucinations can indicate extreme depression, with particular risk for suicide. See Helpguide's Understanding and Helping the Suicidal Person.

What triggers depression in teenagers?

The reasons for depression can vary from adolescent to adolescent. Often, depression results from a confluence of factors:

• Significant events such as the death of a loved one, parents’ divorce, moving to a new area, or breaking up with a girlfriend or boyfriend can prompt symptoms. Adolescent depression can occur from neglect, prolonged absence from someone who is a source of care and nurturance, abuse and bullying, damage to self-esteem, or too many life changes occurring too quickly. In some teenagers, any major change may provoke depression.
• Earlier traumatic experiences such as abuse or incest often emerge and cause great distress as the child becomes a teen. This is because as a young child the victim did not have the life experience or language to process these painful experiences, or to protest. When such memories emerge in adolescence, the distress can be compounded if adults deny or discount the information.
• Stress, especially if the adolescent lacks emotional support.
• Hormonal/physical changes that occur during puberty also cause new and unexpected emotions. Moodiness and melancholy are often experienced and labeled as depression.
• Medical conditions such as hypothyroidism can affect hormone balance and mood. Chronic physical illness also can cause depression. When a medical condition is diagnosed and treated by a doctor, the depression usually disappears.
• Substance abuse can cause changes in brain chemistry.
• Allergies to foods such as wheat, sugar, and milk cause or exacerbate symptoms of depression.
• Nutritional deficiencies may be caused by an amino acid imbalance or vitamin deficiency.
• Genetics can predispose a teen to depression when the illness runs in the family.

What are the effects of depression in teenagers?

Many teen behaviors or attitudes that are annoying to adults are actually indications of depression:

• Drug and alcohol use – depressed teens often use substances in an attempt to self-medicate their symptoms
• Low self-esteem – depression can intensify feelings of ugliness and unworthiness
• Eating disorders – anorexia, bulimia, binge eating, or yo-yo dieting are often signs of unrecognized depression
• Self injury – cutting, burning, head banging, or other kinds of self-mutilation are almost always associated with depression
• Acting out – depression in teenagers may appear as agitation, aggression, or high risk behaviors rather than—or in addition to—gloominess
• Suicidal thoughts or attempts – teens who are seriously depressed or despondent often think, speak, or make "attention-getting" attempts at suicide, which should be taken seriously

What are the risk factors for suicide in teenagers?

An alarming and increasing number of teenagers attempt and succeed at suicide. Suicide is now the third highest cause of death in adolescents, and children as young as five have been reported to have committed suicide. It is also probable that suicidal statistics for teens are underreported, as they might overlook those whose reckless or dangerous behavior resulted in death, or those in which the cause can not be definitely identified.

There are several high-risk factors associated with teen suicide:

• previous suicidal behavior
• history of psychiatric disorder or substance abuse
• family history of suicide, psychiatric disorder or substance abuse
• loss of parent through any means
• history of abuse, violence or neglect
• social isolation/alienation, including because of being gay or being bullied

What kinds of events precipitate suicide in teenagers?

Adolescence is typically a time of extreme moods, as hormonal changes and academic and social challenges escalate. Suicidal behavior in adolescents is commonly precipitated by events or challenges that the teenager finds too difficult to tolerate. Even things that seem minor to an adult can be major to a young person, who does not have the life experience to put them into perspective or the coping skills that an adult has honed. Some common precipitants of suicidal behavior in teenagers include:

• death of a family member or close friend (particularly if by suicide)
• loss of a romantic relationship or good friendship
• loss of a parent through divorce or separation
• loss of a pet, treasured object, job or opportunity
• fear of punishment
• physical, sexual or psychological abuse
• unwanted pregnancy
• poor grades
• fight or argument with family member or loved one
• belief one has harmed or brought harm to a family member or friend
• embarrassment or humiliation
• concerns about sexuality
• suicide of a friend, acquaintance, or celebrity ("copycat" suicide)

What can teenagers do to help themselves or a friend if they begin to feel depressed?

Teenage moodiness is a normal part of adolescent development. In part, it is caused by hormonal changes that cause moods to fluctuate. Just knowing that these mood swings are normal can help reduce the anxiety that often accompanies these intense feelings. However, teens can become depressed beyond normal moodiness, and need help to get past these feelings. Some people think that talking about sad feelings will make them worse, but the opposite is almost always true. It is very helpful to share your worries with someone who will listen and who cares, especially a trained professional who can guide you to feeling better.

• Reach out and talk to friends, parents or teachers.
• If you are stressed out by exams, talk to your teacher or school counselor.
• If you are worried about being pregnant, see your general practitioner or family-planning clinic.
• Keep yourself occupied. Spend time with friends, especially those who are active, upbeat and make you feel good about yourself.
• Avoid hanging out with those who use drugs or alcohol to cope with feelings.
• Remember that you are not alone. Depression is a common problem and usually a passing state. Even though it feels like it will never lift, depression almost always does come and go on its own—and with proper intervention it can be controlled, greatly reduced or overcome.
• You might need medication to temporarily help you while you sort out your feelings. Be sure your parents look into this before deciding, as some antidepressants used for adults can actually make teens feel worse.
• Above all, do not do anything that can cause permanent damage to yourself or could result in your death. Remember that "suicide is a permanent solution to a temporary problem."

If you have a depressed friend, especially one who talks about suicide or is giving things away, do not consider it a betrayal to tell a responsible adult. Depression depletes energy and clouds judgment, and your friend may do something that can never be repaired if help is not received. Even if you promised not to tell, your friend needs your help, and you would rather have a friend who is temporarily angry at you than one who is no longer alive.

What can parents do if a teenager is depressed?

It is difficult for caring, concerned parents to see their children struggling. Sometimes parents wonder if their teen is being melodramatic or "just trying to get attention" with challenging behavior. Even if that were the case, it would indicate a need for some appropriate response.

The first problem is to distinguish between a more serious depression and "normal," typical adolescent moodiness, caused by hormonal changes and brain growth spurts. For example, it is common for girls to become moody, edgy, and anxious just before and during menstruation, and maybe even longer, if she suffers from hormonal problems. If grouchy behavior seems to have a pattern or cycle, it is likely the symptoms are tied to hormonal changes, and are not indicative of clinical depression. In contrast, one hallmark of clinical depression is the tendency to become isolated—to stop talking to family, and to stop spending time with friends—and this kind of moodiness does not seem to lift after a couple of weeks.

Rushing to a therapist when symptoms are actually within the range of normal can have several negative effects:

• the child feels like there must be something wrong with himself or herself, which can tip a fragile balance toward lowered self-esteem
• there may be a long-lasting stigma attached to a diagnosis
• medications may be prescribed unnecessarily, and without careful monitoring

If you suspect depression:

• Respond with love, kindness, and support.
• Repeatedly let your child know that you are there, whenever she or he needs you
• Be gentle but persistent if your adolescent shuts you out (depressed teenagers do not want to feel patronized or crowded). Do not ask a lot of questions, but make known your concern and your willingness to listen.
• Do not criticize or pass judgment once the adolescent begins to talk (the important thing is that he or she is talking and communicating feelings).
• Encourage activity and praise efforts to socialize and be active.
• Seek help from a doctor or mental health professional if the adolescent's depressed feeling doesn't pass with time. Be prepared to list behaviors, note how long and how often they have been occurring, and how severe they seem.
• Do not wait and hope that symptoms will go away on their own. When depression is severe—if adolescents are thinking about hurting themselves or about suicide—seek professional help as soon as possible.
• Parents of depressed adolescents may themselves need support. Seek out groups of parents who have experience with teen depression.

The single most important thing a parent can do to break down the social isolation that is at the heart of adolescent problems is to LISTEN:

• listen when your children talk
• listen to their music
• spend more time with them and be involved in their activities
• take them to movies and concerts, and discuss them afterward
• know their friends, and listen to them as well
• do not lecture or offer unsolicited advice or ultimatums
• do not try to talk them out of their feelings or solve their problems, just acknowledge the pain and sadness they are feeling
• do not compare your teen’s feelings, reactions or experiences to your own or to someone else’s

A parent can—and should—express their concerns directly. It is not easy to connect with teens in this way, and parents may need professional guidance to assist them. Yes, it is likely that the teenager will get angry and will say harsh things ("It's none of your business!" "Get out of my room!" "I hate you!"), but this kind of response is often an unintentional test to see if you are really able to help them. Depressed teenagers will seek answers to the following questions before confiding in an adult:

• Will you be able to handle my big feelings? (Often children will keep their feelings inside if they worry that their parents already have too much on their minds or are depressed themselves. If you yourself are experiencing depression or extreme stress, get your own help and support so that you can better help your child.)
• Can I trust you to hang in there with me, even when I act like this?
• Can I rely on you to be here for me and not to walk away or push me away?
• Will you provide a strong and safe place for me—walls that do not cave in even when I push them?
• Will you love me even when I don't know how to love myself or you?

Parents who show their kids that disagreements and painful feelings can safely be expressed—and that they can be resolved—make it safe for their kids to open up to them. The sharing of confusion, sadness, loneliness, shame, and other strong emotions often decreases the intensity, and opens the way for real communication, which in turn reduces the isolation that is such a large part of depression.

How is teenage depression treated?

Depression is commonly treated with therapy or with therapy and medication. A combination of approaches is usually most effective:

• Cognitive-behavioral therapy focuses on the causes of the depression and helps change negative thought patterns.
• Group therapy is often very helpful for teens, because it breaks down the feelings of isolation that many adolescents experience (sometimes it helps just to know that "I'm not the only one who feels this way").
• Family therapy as an adjunct to individual therapy can address patterns of communication and ways the family can restructure itself to support each member, and can help the teenager feel like others share the responsibility for what happens in the family.
• Physical exercise is helpful in lifting depression, as it causes the brain's chemistry to create more endorphins and serotonin, which change mood.
• Creative expression through drama, art or music is often a positive outlet for the strong emotions of adolescents.
• Volunteer work is sometimes helpful for adolescents. Helping someone else whose problems are greater than one's own offers a perspective and also an opportunity to be helpful, which can increase one's sense of purpose and meaning.
• Medication for depression should be used with great caution, and only under careful supervision. Recent studies by both the UK government and the FDA have led to warnings that not all psychiatric drugs may be appropriate for teenagers and children. Seek a physician who works specifically with teenagers.
• Hospitalization may be necessary in situations where a teen needs constant observation and care to prevent self-destructive behavior. Hospital adolescent treatment programs usually include individual, group and family counseling as well as medications.
• Special schools, wilderness challenges, or "boot camps" are sometimes recommended for troubled teens. These alternatives are intended to help adolescents learn coping skills, develop confidence, learn to trust and work with others, improve academics and/or deal with negative behaviors. Whether or not they are good options largely depends on the staff running the program. In many cases, they are not trained mental health professionals and may use confrontation, humiliation and punitive measures designed to break down resistance rather than build up internal strengths. Sometimes these programs do more harm than good, and can even result in worse outcomes for adolescents. Before considering such alternatives, do careful research on their philosophy, methods, and the background of their employees.
  

Read more about the risks and benefits of medication for depression in teenagers in the links provided on Helpguide's Medications for Treating Depression - Making Informed Choices. Read the complete text of the concerns and warnings in the links.This information is not intended to be a substitute for medical advice but may help you with questions for your doctor.

References and resources for depression and suicide in teenagers

Children's Mental Health: Children And Depression – Provides basic facts about the cause of depression in children and adolescents. (National Mental Health Association)

The Nemours Foundation’s KidsHealth site provides 3 sites on depression written for parents and teenagers:

• Depression – Breaks down the different types of depression in teenagers -from mild to severe- their symptoms and remedies.
• Understanding Depression – The risks, causes and diagnosis of depression in children and adolescents.
• When Your Child is Depressed – Getting help and things you can do to help.

When Your Child Feels Sad – Comprehensive article from McMan's Depression and Bipolar Website* including background information and discussion of medications (*this is an individual's website, privately funded, with a bookstore link) (McMan Web)

Teen Depression – Comprehensive article includes discussion of ways to treat depression without medications. Other helpful information found throughout entire website. (Depression Learning Path, UK)

Teen Suicide – Written for the teenage reader, this article includes a checklist of symptoms, discusses causes, and suggests interventions. (American Psychiatric Association)

Understanding and Preventing Teen Suicide – Discusses risk factors, includes suggestions for parents, and also has a section on coping with loss, for either a teenager who has lost a friend or parent who has lost a child to suicide. (KidsHealth for Parents by Nemours Foundation)

Related Helpguide articles

• Depression: Signs, Symptoms, Causes, and Treatment Strategies
• Depression Self Help: Living with Depression in Yourself and Others
• Medications for Treating Depression and Anxiety: Making Informed Choices
• Bipolar Disorder: Signs, Symptoms and Treatment
• Psychotherapy and Relationship / Marriage Counseling
• Holistic Mind-Body Mental Health Therapies
• Complementary and Alternative Approaches to Mental Health Treatment

Jaelline Jaffe, Ph.D., Lisa Flores Dumke, M.A., and Jeanne Segal, Ph.D., contributed to this article. Last modified on: 7/8/05.

The article below was taken from the website - Kids-In-Crisis - an online resource page for kids and teens, who are having difficult life problems or have questions and don't know how or where to turn for help.

A friend seems:

• unable to make decisions
• unable to concentrate and remember
• to have lost interest or please in ordinary activities-like sports, band, talking on the telephone
• to have more problems with school and family.

A friend complains of:

• loss of energy and drive - they seem to have "slowed down"
• trouble falling asleep, staying asleep or getting up
• appetite problems, and they are losing or gaining weight
• headaches, stomach aches or backaches
• chronic aches and pains in joints and muscles

  A friend's behavior has suddenly changed so that:
  

• they are restless or more irritable
• they want to be alone most of the time
• they have started cutting classes or dropped hobbies and activities

  A friend has talked about:
  

• death
• suicide
• attempted suicide
  

  Symptoms:
  

• Missed school or poor school performance
• Changes in eating and sleeping habits
• Withdrawl from friends and activities once enjoyed
• Persistant sadness and hopelessness
• Problems with authority
• Indecision, lack of concentration or forgetfulness
• Poor self-esteem or guilt
• Overraction to criticism
• Frequent physical complaints such as headaches or stomachaches
• Anger and rage
• Lack of enthusiasm, low energy, or motivation
• Drug and/or alcohol abuse
• Thoughts of death or suicide

  Depressed teens who exhibit symptoms such as insomnia, panic attacks,
  and delusions or hallucinations, are at particular risk for suicide.

  - Symptoms of Teen Depression - This site is no longer online but is linked here through Internet Archive. http://www.pol.org/features/healthworks/depression/teen.htm
  

Myths and Facts:

Myth: Teens don’t suffer from "real" depression.

Fact: Depression can affect people at any age or of any race, ethnic or economic group.

Myth: Teens who claim to be depressed are weak and just need to pull themselves together. There’s nothing anyone else can do to help.

Fact: Depression is not a weakness, but a serious health disorder. Both teens and adults who are depressed need professional treatment. A trained therapist or counselor can help them learn more positive ways to think about themselves, change behavior, cope with problems, or handle relationships. A physician can prescribe medications to help relieve the symptoms of depression. For many people, a combination of psychological therapy and medications is beneficial.

Myth: Talking about depression only makes it worse.

Fact: Talking through feelings may help a friend recognize the need for professional help. By sharing friendship and concern and giving uncritical support, you can encourage your friend to talk to his or her parents, or another trusted adult, like a teacher or coach, about getting treatment. If your friend is reluctant to ask or help, you can talk to an adult - that’s what a real friend will do!

Myth: People who talk about suicide don’t commit suicide.

Fact: WRONG! Unfortunately, I know this not to be true from personal experience. ALWAYS TAKE A COMMENT ABOUT SUICIDE/DEATH AS A CRY FOR HELP! DON’T EVER TAKE IT AS JUST TALK! Many people who commit suicide have given warnings to friends and family. A signal or warning may be a statement such as "I wish I were dead," "I can’t take this anymore; I want out," or "My parents would be better off without me." Some people even tell a friend about a plan to kill themselves before they actually do. If a friend talks like this, take it seriously! Immediately make a responsible adult aware of what your friend has said. IMMEDIATELY AND ALWAYS! Better your friend should be mad at you for telling, then they should end up dead!

Myth: Telling an adult that a friend might be depressed is betraying a trust. If someone wants help, he or she will get it.

Fact: Depression, which zaps energy and self-esteem, interferes with a person’s ability or wish to get help. And many parents may not understand the seriousness of depression or thoughts of death or suicide. It is an act of true friendship to share your concerns with a school guidance counselor, a favorite teacher, you own parents, or another trusted adult. If the first adult you talk to doesn’t help or "blows you off," talk to another. As adults, as human beings, we all have things going on in our lives that distract us from time to time. We might not understand the seriousness of what you are telling us the first time. Tell us again, and again, until we listen and until we do something to help.

What Can I Do to Help?

Negative thinking, inappropriate behavior, or physical changes need to be reversed as quickly as possible.

If a friend shows many symptoms of depression, you can listen and encourage him or her to ask a parent or teacher about treatment.

If your friend doesn’t seek help quickly, talk to an adult you trust and respect - especially if your friend mentions death or suicide!

- Adapted from Depression: Define It. Defeat It. This site is no longer online, but is linked here through Internet Archive. http://www.hoptechno.com/book34.htm
 

If you suffer any one or a combination of these factors,
then you should seek help from your doctor, school counselor,
or another adult that you trust.