Adolescent depression

Definition

Adolescent depression is a disorder that occurs during the teenage years, and involves ongoing sadness, discouragement, loss of self-worth, and loss of interest in usual activities.

See also:

Alternative Names

Depression - adolescents; Teenage depression

Causes

Depression can be a temporary response to many situations and stresses. In adolescents, depressed mood is common because of:

  • The normal process of maturing and the stress associated with it
  • The influence of sex hormones
  • Independence conflicts with parents

It may also be a reaction to a disturbing event, such as:

  • The death of a friend or relative
  • A breakup with a boyfriend or girlfriend
  • Failure at school

Adolescents who have low self-esteem, are highly self-critical, and who feel little sense of control over negative events are particularly at risk to become depressed when they experience stressful events.

Adolescent girls are twice as likely as boys to experience depression. A family history of depression makes children more likely to have depression.

Events or situations over which a child or adolescent feels little control can cause depression:

  • Bullying or harassment at school or somewhere else
  • Child abuse - both physical and sexual
  • Chronic illness
  • Learning disabilities
  • Poor social skills
  • Stressful life events, particularly the loss of a parent to death or divorce
  • Unstable caregiving

Many adolescents with depression may also have:

Symptoms

Overall, depression can change or distort the way adolescents see themselves and their lives, as well as the people around them. Adolescents with depression usually see everything more negatively, and are unable to imagine that any problem or situation can be solved in a positive way.

Some or all of these symptoms of depression may be present:

  • Agitation, restlessness, and irritability
  • Appetite changes (usually a loss of appetite but sometimes an increase)
  • Difficulty concentrating
  • Difficulty making decisions
  • Episodes of memory loss
  • Fatigue
  • Feelings of worthlessness, hopelessness, sadness, or self-hatred
  • Loss of interest or pleasure in activities that were once fun
  • Thinking or talking about suicide or death
  • Trouble sleeping, excessive sleeping, or daytime sleepiness

Sometimes there may be changes in behavior or new problems at home or at school when there are no signs or symptoms of depression or sadness:

  • Acting-out behaviors (missing curfews, unusual defiance)
  • Criminal behavior (such as shoplifting)
  • Faltering school performance, grades dropping
  • Highly irresponsible behavior pattern
  • Use of alcohol or other illegal substances
  • Withdrawal from family and friends, spending more time alone

If these symptoms last for at least 2 weeks and cause significant distress or difficulty functioning, get treatment.

Exams and Tests

True depression in teens is often difficult to diagnose, because normal adolescents have both up and down moods. These moods may alternate over a period of hours or days.

Sometimes when they are asked directly, children or adolescents will say that they aren't happy or sad. Health care providers should always ask children or adolescents about symptoms of depression.

They will perform a physical examination and order blood tests to rule out medical causes for the symptoms. The doctor will also evaluate for signs of substance abuse. Heavy drinking, frequent marijuana (pot) smoking, and other drug use can be caused by, or occur because of depression.

A psychiatric evaluation will also be done to document the teen's history of sadness, irritability, and loss of interest and pleasure in normal activities. The doctor will look for signs of other psychiatric disorders such as anxiety, mania, or schizophrenia. A careful assessement will help determine the risks of suicide or homicide -- that is, whether the teen is a danger to him or herself or others.

Information from family members or school personnel can often help identify depression in teenagers.

Treatment

Treatment options for adolescents with depression include supportive care from a medical provider, talk therapy, and possibly antidepressant medications. It is important that treatment be tailored to the adolescent and the severity of his or her symptoms. Families often participate in the treatment of adolescent depression.

MEDICATION

The first medication tried is usually a type of antidepressant called selective serotonin reuptake inhibitors (SSRI). Fluoxetine (Prozac) and escitalopram (Lexapro) are the only ones FDA-approved for treating major depression in adolescents (ages 12 - 17). Fluoxetine is also approved for children age 8 and older.

NOTE: SSRIs and other antidepressants carry a warning that they may increase the risk of suicidal thoughts and actions in children and adolescents. Other evidence about these drugs has not showed that antidepressants increase suicide risk in children.

Doctors are still prescribing SSRIs and other antidepressant medications to adolescents with depression. Several important facts about taking any antidepressants include:

  • Children and adolescents who take medications should be followed by a doctor for side effects. Parents or caregivers should promptly seek medical advice if they notice suicidal thoughts or behaviors, nervousness, agitation, irritability, moodiness, or sleeplessness that is getting worse.
  • Do not abruptly stop taking these medications. This may cause symptoms to return. Families should talk with their doctor before stopping medications.

Not all antidepressants are approved for use in children and teens. For example, tricyclics are not approved for use in teens.

TALK THERAPY

Almost all adolescents with depression benefit from some type of talk therapy. They should understand that talk therapy is a good place to talk about their feelings and concerns, and most importantly, to learn ways to deal with them.

Types of talk therapy include:

  • Cognitive-behavioral therapy teaches depressed people ways of fighting negative thoughts. An adolescent with depression can learn to be more aware of his or her symptoms, detect what seems to make depression worse, and learn problem-solving skills.
  • Family therapy may be helpful if family conflict is contributing to the depression. Support from family or teachers may also be needed to help with school problems.
  • Psychotherapy can help adolescents understand issues that may be causing their behavior, thoughts, or feelings.
  • Joining a support group of people who are experiencing problems like yours can also help. Ask your therapist or doctor for recommendations.

Occasionally, people with severe depression, or those who are suicide risks may need to be hospitalized in a psychiatric unit.

Important knowledge, skills, and lifestyle changes for adolescents to learn include:

  • Take medications correctly and learn how to manage their side effects.
  • Learn to watch for early signs that depression is getting worse, and know how to react when it happens.
  • Try to exercise more and seek out other activities that you enjoy.
  • Avoid alcohol, narcotics (whether or not they have been prescribed), and other illegal drugs. Understand that these substances affect the brain and make the depression worse over time, and they may also impair your judgement about suicide.
  • When you are struggling, talk to someone you trust about how you are feeling. Try to be around people who are caring and positive.

See also: Electroconvulsive therapy

Outlook (Prognosis)

Depressive episodes usually respond to treatment. Early and appropriate treatment of depression in adolescence may prevent further episodes. However, about half of seriously depressed teens are likely to have continued problems with depression as adults.

Possible Complications

  • Drug, alcohol, and tobacco abuse
  • Effects on school performance and interpersonal relationships
  • Other psychiatric problems, such as anxiety disorders
  • Teenage suicide
  • Violence and reckless behavior

Adolescents with additional psychiatric problems usually require longer and more intensive treatment.

When to Contact a Medical Professional

There are numbers you can call from anywhere in the United States, 24 hours a day, 7 days a week: 1-800-SUICIDE or 1-800-999-9999.

Call your health care provider right away if you notice one or more of these suicide warning signs:

  • Giving most cherished possessions to others
  • Personality change
  • Risk taking behavior
  • Threat of suicide or plans to hurt yourself
  • Withdrawal, urge to be alone, isolation

See: Suicide and suicidal behavior for more information

Call your health care provider if you notice:

  • Depression that is not improving or is gradually getting worse
  • Nervousness, agitation, irritability, moodiness, or sleeplessness that is new or getting worse
  • Side effects of medications

NEVER IGNORE A SUICIDE THREAT OR ATTEMPT!

Prevention

Periods of depressed mood are common in most adolescents. However, supportive relationships and healthy coping skills can help prevent these periods from leading to more severe depressive symptoms. Open communication with your teen can help identify depression earlier.

Make sure teens get professional help to deal with periods of low mood. Early identification and prompt and appropriate treatment of depression may prevent or postpone further episodes.

In homes with adolescents:

  • Do not keep alcohol in the home or keep it securely locked
  • Lock all guns and keep ammunition separately
  • Secure all prescription medications

References

US Preventive Services Task Force. Screening and treatment for major depressive disorder in children and adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics. 2009;123:1223-1228.

Zuckerbrot RA, Cheung AH, Jenson PS, Stein REK. Identification, assessment, and initial management guidelines for adolescent depression in primary care. Pediatrics. 2007;120:e1299-e1312.

Cheung AH, Zuckerbrot RA, Jenson PS, Ghalib K. Treatment and ongoing management guidelines for adolescent depression in primary care. Pediatrics. 2007;120:e1313-e1326.

Bostic JQ, Prince JB. Child and adolescent psychiatric disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 69.

Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers. National Institute of Mental Health (NIMH). January 13, 2010. Accessed January 13, 2010.


Review Date: 2/14/2010
Reviewed By: Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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