By: Elise Montoya, PMHNP
In the wake of recent teen suicides in Indianapolis, CRG is sharing current, evidence-based information with the community. Depression can be a silent risk factor in the lives of teenagers who are struggling with emotional issues that may be difficult for others to notice. It is important to understand that an adolescent’s behavior can be a symptom of something more significant than “just a bad attitude” or “typical teenage moodiness.” This article will provide information about how to recognize and seek effective treatment for a mental health disorder that may be more common than is generally recognized.
Adolescent depression exacts a high human cost. Teenagers with depression are more likely to experience difficulty in social relationships at a time when navigating social relationships is already challenging. They are also more likely to have difficulty with family relationships. Adolescents with depression are at a significantly higher risk for early pregnancy, substance abuse, future episodes of depression, increased hospitalization, and underperformance in education and employment. All of these outcomes can have a life-long impact (Hamrin & Magorno, 2010; Zuckerbrot & Jensen, 2006). Additionally, adolescent depression is a risk factor for suicide. In the year 2013, suicide was found to be the third-leading cause of death among youth between the ages of 10 and 24 (Center for Disease Control, 2014).
DIAGNOSIS
It is important for parents and professionals to recognize the symptoms of depression in adolescents so that effective help can be provided if needed. Adolescent depression can present with the same symptoms seen in adults. These would include:
- Sad or down feelings, most of the time
- Crying spells
- Guild or feelings of worthlessness (feeling ugly, unlovable, unworthy)
- Diminished interest or pleasure in most activities (loss of interest in sports, video games, activities with friends)
- Significant gain or loss of weight (failure to gain weight as expected or weight gain more than expected)
- Significant change in appetite
- Significant change in hours slept (excess late-night TV, refusal to awaken for school)
- Decreased energy (persistent boredom)
- Decreased ability to think or concentrate (difficulty making decisions, poor performance in school, frequent absences)
- Thoughts of suicide or death (preoccupation with song lyrics that suggest life is meaningless or that talk of death; statements such as, “What’s the point?” or “I wish I were dead” or similar statements; writing about death; giving away favorite belongings)
However, adolescents who are depressed often exhibit symptoms that are not often seen in adults with the same mental health disorder, including:
- Irritability (irritable or cranky mood)
- Somatic symptoms (stomach pain, headache, dizziness, lethargy, or other non-specific symptoms)
- Behavioral problems (truancy, decline of academic performance, defiance of authorities, self-destructive behavior, running away from home, alcohol or other substance use, sexual acting out)
- Increased sensitivity to criticism (especially in high achievers)
- Withdrawal from some people, but not from everyone. (Although depressed adults tend to isolate themselves, depressed adolescents tend to maintain some friends or they may start to hang around a different group of friends.)
It is important to recognize if your teen is exhibiting SOME of these symptoms. They do not have to exhibit all of them to be experiencing depression. However, if you are unsure if your youth is just being a “typical teenager” or is truly depressed, think about how long the symptoms have lasted, how severe the symptoms are, and how the symptoms are affecting the teenager’s life. Too often, the depressed adolescent is labeled as difficult or a behavioral problem and the resulting consequences compound the depression. Conflict and punishment can worsen the youth’s feelings of guilt, worthlessness, or hopelessness.
It is important for parents to not shy away from talking to their youth about concerns that the youth may be depressed. Studies have shown that one barrier to treatment is a teenager’s fear about what their parents will think if they find out the youth is struggling. It is also important for parents to talk to the youth about their concerns, because depression alters the individual’s perception and teens often feel abnormal, helpless, and disconnected and are less likely to see how they might obtain help (Meredith, et al, 2009). Unfortunately, our society still has a lot of stigma about mental health issues. Additionally, today’s youth face an ultra-competitive school culture. These factors can make it even more difficult to acknowledge emotional difficulty or a need for help.
In a loving, non-judgmental way, share your concerns with your teen. Then encourage the youth to share what they are going through. Don’t ask too many questions and allow the youth to share his or her feelings, being respectful of the youth’s comfort level. Don’t criticize or offer unsolicited advice. Validate your youth’s feelings. What your teen needs to know and feel is that you take his or her feelings seriously.
If you are still concerned after talking to your teen, it is important for the youth to be assessed for depression. If you have a primary care provider (PCP), you can make an appointment with your teen’s physician to be screened for depression. This would be especially important if your youth has a level of trust and ease with his or her PCP. You can then ask the PCP for a referral to a mental health provider if your teen is found to be depressed.
Alternatively, you can make an appointment for your son or daughter to be screened for depression with a mental health provider such as a psychiatrist, a psychologist, a psychiatric nurse practitioner, or a licensed mental health therapist. It is important to find a mental health provider who specializes in treating adolescents. This is especially important if your youth will be prescribed medication. When your teen is seen by the primary care provider or mental health provider, be prepared to offer specific examples of how your youth’s behavior has changed, examples of how it is impacting his or her life, and any family history of depression or mental illness.
TREATMENT
The good news is that there is effective, evidence-based treatment for adolescent depression. It includes therapy and may or may not require medication. Cognitive Behavioral Therapy (see Dana Lasek’s article in this issue) has been studied and found to be effective therapy for treating depression. Medication may be considered if therapy, alone, is not successful. Medication is sometimes necessary to heal the person to the point that they are able to benefit from the therapy. Many parents and youth worry if starting an anti-depressant means that the youth will always have to take medication. This is not the case. In fact, studies have shown that successful treatment with an anti-depressant for one year can greatly diminish the chance of a recurrence of depression. Many parents have rightly been concerned about the Black Box warning, which was issued in 2003, cautioning that anti-depressants could potentially increase the risk of suicide. However, a recent large study with over 1 million study participants has shown this to not be true (Lu, et al, 2014).
SUMMARY
Adolescent depression is a serious issue with potentially long lasting consequences if left untreated. However, there is effective, evidenced-based treatment available. It starts with an accurate diagnosis and includes therapy and sometimes a combination of medication and therapy. CRG is one source of professional mental health care where questions can be answered, an accurate diagnosis can be made, and individual and group therapy is offered. In addition, medication management specifically for adolescent clients is offered.
References
Center for Disease Control, (2014). Youth Risk Behavior Surveillance, 2013. Retrieved from http://www.cdc.gov/HealthyYouth/yrbs/index.htm
Hamrin, V., Magorno, M. (2010). Assessment of adolescents for depression in the pediatric primary care setting. Pediatric Nursing, 36(2), 103-111.
Ly, A.Y., Zhang, F., Lakoma, M.D., Madden, J.M., Rusinak, D., Penfold, R.B., Simon, G., Copeland, L.S. (2014). Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: Quasi-experimental study. British Medical Journal, doi 10.1.1136/bmj/g3596
Meredith, L.S., Stein, B.D., Paddock, S.M., Jaycox, L.S., Quin, V.P., Chandra, A., Burnam, A. (2009). Perceived barriers to treatment for adolescent depression. Medical Care, 47(6), 677-685.
Zuckerbrot, R., Jensen, P. (2006). Improving recognition of adolescent depression in primary care. Archives Pediatric Adolescent Medicine, 160, 694-703.