Adolescent Depression

The teenage years are notorious for being a tumultuous and stressful time, for both teens and parents. There are a number of issues that adolescents are facing that make this time a difficult one, such as maturing into an adult, attempting to achieve independence, shifting hormones, and social stressors with friends or partners. These stressors can be further impacted by a myriad of difficult life events, such as parental divorce, death of a loved one, break up of a relationship, bullying at school, or learning difficulties. Because of all of these factors, most parents expect some moodiness and acting out once a child reaches his or her teen years. However, since depression can be common in teens, how can a parent decipher between typical teenage angst and a more serious depressive episode?

Most youth are able to achieve a balance between the difficulties they are facing and healthy friendships, school success, enjoyment in activities, and a strong sense of self. Yet it is common to see mood swings; hormonal and social changes often shift a compliant and easy-going child into a teen who is moody, defiant, irritable, angry or scared. These extremes in mood can make the diagnosis of depression very difficult. Although studies show that eight per cent of teens experience depression, only half of these are diagnosed, and only half of those diagnosed ever receive treatment. A part of this is that it is hard to differentiate depressive symptoms from typical moodiness. In addition, teens express depression much differently than adults do, as their depression can come out as anger or irritability, rather than sadness. They also shift from one extreme to another very quickly, where they can be seen as angry and volatile one minute, and laughing the next. Their moods also tend to fluctuate depending on their circumstances, so they can appear fine when out with their friends, which makes many parents discount the difficulties they see in the home.

In order to identify a depression, it is important to consider the length and severity of the moody symptoms, as well as how different the teen appears from his or her typical self. A depression tends to have a significant impact on the teen’s personality, leading them to express overwhelming sadness, despair, or anger. When a teen is depressed, any changes to personality, mood, or behaviour will often be dramatic and long-lasting, which should alert parents to an underlying problem. If a parent sees these changes, they should ask about the teen’s feelings, any symptoms of depression (described below), and whether they have thoughts about suicide. As many adolescents may deny their feelings, a parent should trust their instincts and persist with their questioning, as well as seek professional help, if they sense something is wrong.When making a diagnosis, a professional will evaluate whether the teen is displaying any of the following signs and symptoms:

appetite issues or weight gain
sleep difficulties
agitation or restlessness
issues with concentration, memory, or decision making
feelings of worthlessness, hopelessness, sadness
loss of interest in activities previously enjoyed
talk of death or suicide

Even if the adolescent is not displaying any recognizable signs of sadness or changes in mood, they may show changes in behaviour, such as:

breaking the rules
becoming defiant
engaging in illegal activity (such as shoplifting)
doing poorly in school
using drugs or alcohol
running away from home
withdrawing from others
engaging in reckless behaviour
acting violent
developing eating disorders
engaging in self-harm

One of the most important aspects of diagnosis is that the teen would be showing impairments in daily functioning that are affecting several areas of his or her life, such as in school, with friends, and within the family.

Adolescents are particularly at risk for developing depression if they have low self-esteem, are highly self critical, are extremely sensitive to rejection or failure, and feel as if they have little control over negative events in their life. Girls are twice as likely as boys to develop depression, which may be due to hormonal changes, shifts in self-esteem that occur for many girls when they enter adolescence, or ways that they have been socialized to be more emotionally sensitive. There are also some life events that place adolescents at greater risk of depression, such as loss of a parent, relationship break up, having a chronic illness, experiencing abuse or neglect, going through a trauma (such as a natural disaster), and having a learning, attention, or conduct disorder.

One of the most important aspects of depression that concern parents is the risk of suicide. Parents should watch for certain signs and behaviours that may indicate a teen is thinking about suicide, such as engaging in risky behaviour, showing a personality change, giving away possessions, writing poems or stories about death or suicide, and withdrawing from others. A teen may also make disturbing comments, such as “I’d be better off dead,” or “There’s no way out.” In addition, they may talk or joke about suicide, romanticize the idea of death, seek out a means for killing themselves (such as weapons or pills), or start saying good-bye to others in a final manner. If a parent notices any of these behaviours or is concerned about his or her child’s safety, then they should seek treatment immediately.

Depression in teens in highly treatable, as long as adults learn how to recognize it so that they can get the help they need. A parent should begin by talking to their child, sharing their concerns, and offering support, without lecturing or burdening the child with a barrage of questions. A teen can receive treatment through medical means, such as antidepressants, but these must be monitored carefully for adverse side effects. Therapy can also be helpful, as the teen can be taught healthy coping strategies and positive thinking patterns, as well as have a place to share feelings, feel supported, and enhance self-esteem. While in treatment, a parent can help their child’s recovery by being patient, supportive, and understanding, as well as encouraging healthy habits, such as physical activity, social involvement, adequate sleep, and preventing the use of alcohol and drugs. It will also be important for parents to look after themselves during this time, as dealing with these issues can be very stressful.

Like many adults, teens go through hard times that may result in feelings of depression. Although this can be stressful for the family, treatment can be very successful in alleviating symptoms and helping teens to cope, which will result in a strong resiliency for the future. 

- Dr. Tamara D. Hanoski, R Psych, 2010