Understanding Teen Depression

Depression in Children May Not Look Like Adult Depression

2008-05-07T18:59:00.000-07:00

When most people think about depression, they usually picture a gloomy, dispirited Sad Sack walking through life like the cartoon character who carries his own dark cloud wherever he goes. But depression may look very different in children than it does in adults. Instead of sitting quietly in his room and crying, a child may yell, scream, use foul language, be defiant, and throw temper tantrums.

Children tend to exhibit depression by displaying anger and irritability, especially with family members. When they’re at home, depressed children might argue with parents, pick fights with siblings, or become annoyed at requests to help around the house. Children who are depressed try to avoid doing things that make them feel more irritable, such as chores or homework. Moreover, it’s unlikely that a child will be able to tell anyone that she’s feeling depressed.

Depression Is Not a Choice That a Child Makes

Depression is something that happens to a child – it is not a choice. Childhood depression appears to be associated with a biochemical imbalance in the brain that leads to negative changes in a child’s mood, attitude, energy level, sleep, concentration, appetite, self-esteem, social relationships, family life and school performance.

Children who are depressed may behave in ways that test the patience of parents, teachers, siblings and friends, but they aren’t simply being willful and difficult. Depression is an unwanted illness that in no way reflects upon the moral character of a child. Depression is a serious illness that affects a child’s ability to meet the demands of his or her life situation.

Being angry and irritable is not a natural state for a child. I’ve heard depression described as anger turned inward, but there’s a limit to how much anger a person can keep inside before he lets it out on other people. When parents ask me why their child is so angry, they seem to be thinking that if they knew who or what provoked such strong feelings in their child, they could fix everything. What they don’t yet understand is that too many problems can’t be solved by a simple conversation because the problems are really manifestations of depression.

No child would voluntarily choose to be so unhappy and cut off from the satisfactions of ordinary life for long periods of time. And no parent who struggles to make sense of a child’s difficult and even provocative behavior in the midst of the responsibilities of jobs, school and family wants that child to be miserable when something can be done to help. The first step in getting the right help for a child is to understand depression, where it comes from, what it looks like, and what treatments and strategies exist to help alleviate its symptoms.

Know the Signs of Sadness

2008-03-30T20:28:00.000-07:00

The million-dollar question is: Are you depressed or just sad? Everyone experiences sadness, bad days, and blue moods from time to time. Feeling sad is not the same thing as being depressed. So the first order of business is to define what normal sadness is and how it is distinct from depression.

What exactly is sadness? Sadness can be defined as mental anguish or suffering in the absence of any physical pain, such as experiencing the death of a loved one or empathizing with a loved one who is ill. A mother watching her child suffer, for example, is not in any physical pain, but she still suffers and experiences sadness. When we are sad, our emotions are expressed through crying, talking, or thinking continuously about our sorrow. We may find it difficult to sleep, concentrate and eat. Sadness is characterized by sad feelings – the opposite of the numbness that is the main feature of depression.

The problem for many people in affluent cultures is that often sadness is not triggered by anything obvious. For example, our sadness can develop when we realize our lives or situations are not improving or even declining. Stagnating (being in a rut) or finding your life is getting worse rather than better are conditions that lead to sadness and suffering. As human beings, once our basic needs (safety, food, shelter, love) are looked after, we are driven toward self-actualization. But when our life circumstances stymie self-actualization or spiritual growth, we suffer and feel sad. The longing for material possessions, money, or an intimate relationship is often just an expression of the desire for self-realization. Later in life, many of us also begin to question our attachments to material possessions and power; as we get older, we begin to see the difference between real needs (such as love, friendship and respect) and artificial needs (such as money, power and prestige).

For those of us who like the status quo and our quality of life, sadness and suffering can develop when a life event of some kind threatens that status quo, our sense of our own identity, or our quality of life. The threat can come from an infinite variety of sources, of course, ranging from physical illness to financial hardship.

Understand Types of Depression in Teenagers

2008-02-16T03:08:00.000-08:00

There are a couple of different types of depression that a person can experience. Several of these start during the teenage years. The most frequently diagnosed types of depression in teens include:

1. Major Depression

A person suffering from major depression experiences persistent low moods or sadness, or loss of interest or pleasure in most activities over at least two weeks. Not everyone with major depression experiences the same symptoms, but the more severe the depression, the more symptoms are experienced. Major depression has a severe impact on daily life, interfering with work, school or social activities.

People with major depression may feel despair and hopelessness, their energy levels may be extremely low and they might find it hard to motivate themselves to do even the simplest of daily tasks. People with major depression also commonly experience low self-esteem and thoughts of death and suicide. It is important to get immediate help to stay safe when having thoughts about suicide.

Major depression is identified by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy activities that were once pleasurable (see symptoms of depression). Such a disabling episode of depression may occur only once, but more commonly occurs several times in a lifetime. Major depression can occur for the first time during the teenage years.

In teenagers, an episode of depression lasts on average from seven to nine months and has many signs of depression similar to those in adults. Teenagers with depression can be:

Sad
Irritable (which may lead to aggressive behavior)
Indecisive (which may be accompanied by having problems concentrating)
Pessimistic, or even hopeless, about the future.

They may also:

Lose interest in activities that used to please them
Criticize themselves and feel that others criticize them
Feel unloved
Think that life is not worth living (thoughts of suicide may be present)
Lack energy or motivation
Neglect their appearance and hygiene.

Major depression is also known as:

Clinical depression.
Unipolar depression.
Major depressive disorder.

2. Dysthymia

Dysthymia is a less severe type of depression that can be long-lasting. It can keep a person from functioning well, feeling good, or experiencing joy. Dysthymia often starts during childhood or adolescence. Someone with dysthymia may experience fatigue, sleeping and eating problems, and be plagued by low self-esteem, guilt and negative thinking. Cognitive difficulties include concentration and memory problems.

With dysthymia, the child or adolescent is depressed for most of the day, on most days, and symptoms continue for several years. The average duration of a dysthymia period in teenagers is about four years.

Sometimes children with dysthymia are depressed for so long that they do not recognize their mood as being out of the ordinary. As a result, they may not complain of feeling depressed. Seventy percent (70%) of children and adolescents with dysthymia eventually experience an episode of major depression. When a combination of major depression and dysthymia occurs, the condition is referred to as double depression.

3. Bipolar Disorder

Bipolar disorder is the least common type of depression (also called manic-depressive illness or manic-depression). Bipolar disorder can occur anytime from childhood to old age. A person with bipolar disorder can have moods that swing between extreme highs, where they feel invincible, to paralyzing lows where they feel complete despair.

During the depressed cycle, an individual can have any or all of the symptoms of depression. During the manic cycle, the individual may have a great deal of energy and be overactive and over talkative. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated and full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

This psychiatric illness can be mild, moderate or severe. During the manic phase, the person is optimistic and buoyed by exaggerated feelings of wellbeing. Their mind is overactive and they need very little sleep but, while they have plenty of energy, they lack concentration. Work and study may suffer.

During the depressive phase, the person feels despairing and may contemplate suicide.

4. Reactive Depression

Reactive depression, also known as adjustment disorder with depressed mood, is the most common form of mood problem in children and adolescents. In children suffering from reactive depression, depressed feelings are short-lived and usually occur in response to some adverse experience, such as a rejection, a slight, a letdown, or a loss.

With reactive depression, a child may feel sad or lethargic and appear preoccupied for periods as short as a few hours or as long as two weeks. However, the child's mood improves with a change in activity or an interesting or pleasant event. These short-lived mood swings in reaction to minor events are not regarded as a form of mental disorder.

5. Seasonal affective disorder (SAD)

Depression is more common in the winter months and in the Northern Hemisphere, which suggests to some researchers that brain chemistry is affected by sunlight exposure. This is often called seasonal affective disorder (SAD). Some studies have shown that light hitting the back of the eye (retina) stimulates the brain to make chemicals that lift a person’s mood.

Apart from depression, other characteristics of SAD include eating more and gaining weight, excessive sleeping and withdrawing from others. Usually, a person with SAD comes out of their ‘hibernation’ in the spring.

How Depression Affects School Performance

2008-01-24T17:00:00.000-08:00

1) Ability to focus and pay attention.

The depressed teen is often preoccupied with negative thoughts and feelings and finds it hard to put his full attention on schoolwork. Problems with concentration at school are one of the major complaints for teens experiencing depression. A depressed teen can improve his ability to sustain attention if he gets a good night’s sleep and feels rested.

2) Completing class work.

When a teen is depressed, he has little energy to apply to activities that he perceives as being stressful or of low interest. A depressed teen may withdraw from typical activities and become resistant to teacher requests to participate in classroom activities. In this situation, it is good that the teachers can provide daily feedback to parents regarding a teen’s completion of assignments. It works better if this is used in a positive instead of a negative way, so that it doesn’t add undue pressure to the teen’s stress level. if he has a bad day, you can ignore it and try to focus on the next day being a better one.

3) Completing homework.

Teenagers who are depressed often have great difficulty finishing their homework because they lack focus, energy and motivation. Most teenagers, of course, prefer to have no homework, but they do it because they know they have to. They’re also aware that if they don’t get it done, they may pay a price in the future. The depressed teen is stuck in an unpleasant here and now. He’s not thinking about the future, and when he does, it’s without much hope or interest. You might create a behavior plan to set up rewards for good homework completion. If homework continues to be a problem, you can try to enroll your teen in an after school homework program or suggest finding a peer study buddy.

4) Getting to school.

Many depressed teens have difficulty getting up in the morning and going to school. Because they are tired and have a hard time dealing with stressful events, they may try to avoid school. You can help by encouraging your teen to develop good routines for going to bed and waking up. The less your teen has to think about what he has to do in the morning or at night, the better. The process should become automatic, so that it goes smoothly.

5) Peer Relations.

Depressed teens often have difficulties that lead to social isolation. It’s another depression cycle. A teen may withdraw and isolate him from friends and classmates, leading to loneliness, which may perpetuate the depression. Having friends and social support system can be of great help to a teen dealing with depression. You should encourage your teen to attend after-school activities that teach a mix of social and academic skills, through activities such as non-competitive sports, special interest clubs or skills enhancement programs.

Depression and the Risk of Suicide

2007-12-20T17:32:00.000-08:00

Three million teenagers consider or attempt suicide every year.
Suicide is the third leading cause of death in adolescents.
Approximately one-fourth of adolescent deaths are the result of suicide.
While girls are more likely to make attempts BUT boys are more likely to complete the act.

Do I have your attention? This is a very real problem in this century. Even if it doesn’t seem to apply to your teen at this time, please read this section carefully. You may be able to assist another parent help a teen at risk. Suicide is hard to talk about and hard to think about, but please don’t skip this section. Adults who are well informed are a teen’s best ally in times of crisis.

How can you determine whether your teen is at risk to commit suicide?

It is important to take the warning signs of teen suicide seriously and to seek help immediately if you think that you know a teenager who might be suicidal. Here are some of these symptoms to look for:

1. Extreme personality changes
2. Loss of interest in activities that used to be enjoyable
3. Significant loss or gain in appetite (changes in eating habit)
4. Sleeping too much or too little.
5. Fatigue or loss energy
6. Withdrawal from family and friends (losing the desire to go out)
7. Neglect of personal appearance or hygiene
8. Sadness, irritability, or indifference
9. Having trouble concentrating or pay attention in class
10. Extreme anxiety or panic
11. Drug or alcohol use or abuse
12. Aggressive, destructive, or defiant behavior
13. Feeling worthlessness, hopelessness, helplessness
14. Feeling negative or pessimistic
15. Crying frequently
16. Loss of interest in school or schoolwork / drop in school performance
17. Preoccupation with death and dying
18. Self-injury or self-destructive behavior.

Tragically, many of these signs go unrecognized. And while suffering from one of these symptoms certainly does not necessarily mean that one is suicidal, it’s always best to communicate openly with a loved one who has one or more of these behaviors, especially if they are unusual for that person.

The Differences between Anxiety and Teen Depression

2007-10-07T17:44:00.000-07:00

Anxiety

About half the children experiencing depression also experience anxiety. Anxiety is easy to overlook because a child may not talk about his fears, especially if he’s an adolescent. Young children tend to be much more open and at ease in sharing their fears and worries.

Anxiety usually takes one of two forms:

1. A generalized anxiety disorder
2. Anxiety related to panic attacks.

Symptoms of generalized anxiety relate to feelings of restlessness, being on edge, being overwhelmed, having difficulty concentrating, and experiencing muscle tension or sleep disturbance. With generalized anxiety, there may be more fears, but they aren’t as intense as when a panic attack is involved.

The most common forms of a panic attack in children relate to school phobia or separation anxiety when a child is asked to leave the physical proximity of a parent. Children in these situations may become so anxious that they throw up, have major temper tantrums, and act defiant, even if they’re usually well behaved.

The Differences between Anxiety and Depression

Anxiety differs from depression in that an anxious child usually has more energy and doesn’t have as much negative attitude toward life. Instead, the anxious child is afraid and has fears that impede his ability to meet the demands placed on him. Anxiety can have a negative impact on his ability to attend school, engage in social activities, and simply be able to relax.

While the anxious child may avoid participating in activities, he does so for a different reason than the depressed child. The anxious child tries to avoid dealing with situations that make his nervous. The depressed child avoids dealing with a situation because he lacks the energy and frustration tolerance to deal with it. The anxious child also experiences the stress of perceived negative events more intensely.

But there’s one way in which anxiety and depression are similar. Threats regarding the negative consequences of a child’s behavior almost never produce the desired results. Instead, they’ll probably make the situation worse. Threatening an anxious child will only cause more anxiety and lead to an “Oh, on!” response. The depressed child may not react to the threat because he doesn’t have the energy or motivation to care, which results in a “So what?” response.

Myths about Depression in the Young

2007-10-01T21:28:00.000-07:00

When dealing with children and adolescents, it is important not to write off their feelings or brush them aside. There are many myths about depression in the young, which we must be careful not to fall prey to:

1. It is normal for teens to be moody. This is not true. Feeling sad is different from having a depressive disorder. Normal mood swings of adolescence will not impair the person’s functioning or cause them to commit suicide.

2. Depressed people are mentally weak and need to pull themselves together. Depression is an illness that needs treatment. Teenagers with this illness cannot just pull themselves together and get well. They need help.

3. Talking about depression only makes it worse. Part of helping children and adolescents with depression is to allow them to talk through their problems and help them to process relevant issues in their thinking patterns or difficulties in their interpersonal relationships. Talking about depression gives them an outlet and can make things better.

4. People who talk about suicide do not commit suicide. In a local study of teens who committed suicide in 2003, it was found that about 50 per cent wrote a suicide note. In a much larger study by local psychiatrists, many depressed teens also informed people close to them of their sadness and intention to kill themselves.

5. Telling on a friend is betraying a trust. When a child or adolescent is depressed, he/she sees the world in a different light. If he/she needs help, he/she may not know how to ask for it. Helping a friend who is depressed is not betraying their trust. Without help, your friend may have very little hope of getting out of it.

Tips for Parents

There is no such thing as a perfect parent, just as there is no such thing as a perfect teen. Don’t blame yourself if you find that your teen is depressed. Here are some things you can do to find a solution:

i) Understanding Your Teen. You understand your teen best. Your teen’s temperament will determine how she/he can be handled. Different techniques work for different teens. Recognize that your teen has feelings too.

ii) Understanding Yourself. Be aware of your own emotions. If you are stressed, it would be difficult to look after your teens. Taking care of yourself is the first step to being a good parent. If you cannot handle your own emotions, neither can your teen.

iii) Understanding Techniques. A variety of techniques are available to help parents deal with teens.

Behavior modification is based on reinforcing good behavior and avoiding reinforcement of bad behavior. This is commonly used in young children who respond rapidly to rewards and punishments.
Older children may need more subtle handling through using responsibilities and consequences. Read up on different techniques from books on parenting, and apply them to your teen, bearing in mind the first two points.

Getting a Grip on Depression

1. Children and adolescents can be depressed.

2. Depression is a medical condition and needs a medical evaluation.

3. Depressed children and adolescents may be missed because they are quiet and withdraw.

4. Depression can lead to suicide.

5. Depression can be treated but needs to be identified first.

6. Good relationships protect against depression.

7. Depression can be prevented by good parenting that promotes resilience and protects against excessive stress.

How Depression Affects School Performance

2007-08-12T18:36:00.000-07:00

When a teen is failing or doing poorly in school, parents may react with understandable frustration and try all sorts of strategies, from bribery to punishment, to get their teen to turn things around. When all things fail, tension rises and everyone becomes exasperated and at a loss to figure out the cause – and a cure – of the problems at school.

Depression, and not willfulness or laziness. Approximately 4% to 12% of school-aged children (depending upon their age) meet the criteria for being depressed, and since depression isn’t just experienced at home, it’s likely to affect a teen’s performance at school, too. Teenagers experiencing symptoms of depression usually have difficulty completing schoolwork and are at risk for academic underachievement and failure. Without early diagnosis and treatment, a teen is likely to have a negative cycle of depression > school failure > increased depression because of the failure.

School failure has a negative impact on a teen’s self esteem. A depressed teen is apt to have difficulty working to his academic and intellectual capability. He seldom completes his homework, and his test grades are likely to go down because he is tired and has trouble concentrating. To complicate matters, his teachers nay not recognize the symptoms of depression.

School may also be s source of stress for your teen. For a depressed teen, school may be the primary situation in which substantial demands are placed on her. Significant social stress might result if your teen has difficulty fitting in with his peer group.

Depression is likely to affect your teen in the following areas in school:

1) Ability to focus and pay attention. The depressed teen is often preoccupied with negative thoughts and feelings and finds it hard to put his full attention on schoolwork. Problems with concentration at school are one of the major complaints for teens experiencing depression. A depressed teen can improve his ability to sustain attention if he gets a good night’s sleep and feels rested.

2) Completing class work. When a teen is depressed, he has little energy to apply to activities that he perceives as being stressful or of low interest. A depressed teen may withdraw from typical activities and become resistant to teacher requests to participate in classroom activities. In this situation, it is good that the teachers can provide daily feedback to parents regarding a teen’s completion of assignments. It works better if this is used in a positive instead of a negative way, so that it doesn’t add undue pressure to the teen’s stress level. if he has a bad day, you can ignore it and try to focus on the next day being a better one.

3) Completing homework. Teenagers who are depressed often have great difficulty finishing their homework because they lack focus, energy and motivation. Most teenagers, of course, prefer to have no homework, but they do it because they know they have to. They’re also aware that if they don’t get it done, they may pay a price in the future. The depressed teen is stuck in an unpleasant here and now. He’s not thinking about the future, and when he does, it’s without much hope or interest. You might create a behavior plan to set up rewards for good homework completion. If homework continues to be a problem, you can try to enroll your teen in an after school homework program or suggest finding a peer study buddy.

4) Getting to school. Many depressed teens have difficulty getting up in the morning and going to school. Because they are tired and have a hard time dealing with stressful events, they may try to avoid school. You can help by encouraging your teen to develop good routines for going to bed and waking up. The less your teen has to think about what he has to do in the morning or at night, the better. The process should become automatic, so that it goes smoothly.

5) Peer Relations. Depressed teens often have difficulties that lead to social isolation. It’s another depression cycle. A teen may withdraw and isolate him from friends and classmates, leading to loneliness, which may perpetuate the depression. Having friends and social support system can be of great help to a teen dealing with depression. You should encourage your teen to attend after-school activities that teach a mix of social and academic skills, through activities such as non-competitive sports, special interest clubs or skills enhancement programs.

Warning Signs of Teen Depression

2007-08-01T01:31:00.000-07:00

It is not easy to recognize the signs of depression in teenagers, especially since some of the same behaviors may simply behaviors may simply indicate that a teen has had a bad day. But if your son has experienced five or more of these symptoms for more than two weeks is diagnosed as having a depressive illness.

1. Persistent sadness; or feeling down gloomy

It is a feeling of sadness that lingers for days and will not simply go away. Teenagers describe a sense of “heaviness” or “weariness” in their hearts. This feeling is often worse in the morning.

Sadness

- Complains about being unhappy
- Frequently cries
- Does not take pleasure in things

2. Difficulty falling asleep or stay asleep; or sleeping excessively

Sleep disturbances are very common in depression. Teenagers have difficulty initiating or maintaining sleep, or may feel that the little sleep they get is not refreshing. On the other hand, some teenagers feel tired and lethargic all the time, and may sleep more than usual.

Problems with Sleep

- Sleeps too much
- Has difficulty falling asleep
- Frequently wakes up at night
- Has difficulty getting up in the morning

3. Changes in Peer Relationship

- Avoids getting together with old friends
- Has new friends who seem to have a lot of problems
- Frequently complains about how other teens treat him

4. Feeling tired and lacking in energy

Together with the loss of interest in activities, they often feel tired more easily. They have trouble getting through the work day, and may lack energy to complete tasks.

Low energy

- Always seems tired
- Doesn’t seem to get things done like he or she used to
- Doesn’t participate in activities like he or she used to
- Avoids engaging in activities that require effort

5. New Difficulties in Concentration

- Complains about being unable to concentrate
- Spends less time on things that used to be of interest
- Doesn’t seem to be listening when spoken to

6. Recent Decline in School Performance

- Does poorly on tests
- Does less well than usual in school grades
- Spends less time than usual on homework
- Exhibits a decline in school behavior

7. Irritability

- Directs more mean-tempered remarks toward others than usual
- Lacks patience with parents or siblings
- Has significantly more difficulty dealing with negative events
- Yells and screams at others often
- Is easily frustrated

8. Pessimism

- Talks about the future being hopeless
- Expects to fail or do poorly
- Makes frequent negative comments about himself / herself

9. Negative Body Language

- Rarely seems to smile or laugh anymore
- Seems to have lost his sense of humor
- Has little facial expression when spoken to
- Frequently walks with his head down

10. Weight loss or weight gain; or decrease or increase in appetite

This is one of the most common symptoms. Loss of appetite is more common than increased appetite. Teenagers find food tasteless and have no desire to eat, causing them to lose weight. Alternatively, some teenagers eat more to cope with their sad feelings and may gain weight as a result.

Changes in Eating Routine

- Eats a lot less than usual
- Eats significantly more and has gained a lot of unneeded weight
- Does not sit down to eat meals with the family anymore

11. Frequent thoughts of death or suicide

Teenagers may feel that life is meaningless and wish that their lives would end. While passive thoughts of suicide may be common, actual attempts are less so. However, any verbalized suicidal ideation should be taken seriously and discussed with a doctor or counselor.

Suicidal Comments or Self-Abusive Behavior

- Talks about wanting to be dead
- Is obsessed with death in art and music
- Makes cuts on her body

** Depressed children have expressed great relief when they realize that the bad things happening in their lives aren’t their fault.