The key symptom to look for in depression is persistent negative mood changes. Often, this looks like low self-esteem or irritability. People may think of difficult mood swings as being normal for teens, but research shows this is a myth. Most teens do not have more or deeper mood swings than other age groups. If you notice continuing problems with negative moods, or persistent mood swings, especially combined with low self-esteem, take it seriously.

Talk of suicide is another warning sign. It might seem like most teens think about suicide, but this isn't true either. Suicidal thoughts or behaviour are always a sign that something is wrong. Investigation, and likely treatment, will be needed. Suicide is second only to motor vehicle crashes as a cause of adolescent death in Canada.

Of the different kinds of depression, all involve a persistent depressed mood.

Types of depression

Major Depressive Episodes

This first type can be very serious, and affects two out of 100 teens. Generally, it is a biochemical illness that needs treatment, just as any other medical illness does. The symptoms include:

persistent depressed mood
poor sleep
eating more or less than usual
little energy or enjoyment of life
weight loss
trouble concentrating
being unable to function in life
excessive guilt
suicidal thoughts or attempts.

The illness can result in:

poor school performance
changes in relationships with friends
a difficult relationship with family.

Although unusual, it is possible for a teen to have delusions or hallucinations in major depression or bipolar depression (see following section).

Any hint of suicide must be taken very seriously and is never normal. Signs that a teen may be thinking of suicide often include:

giving away possessions
unusual neglect of appearance, and
increasingly risky behaviour.

Thoughts of suicide are often made worse in an environment that includes:

family violence
previous suicide in the family
physical or sexual abuse
disturbed family function
separation and divorce, or
drug and alcohol abuse.

Is your teenager depressed?

Teen Depression Checklist
Signs Present	Signs Absent	Symptoms
		Marked loss of interest or pleasure in most, if not all, activities
		Significant gain or loss of appetite or weight (not due to dieting)
		Sleep disturbances (too much sleep, difficulty falling asleep, nightmares)
		Higher or lower activity level
		Fatigue or loss of energy nearly every day
		Excessive or inappropriate guilt, low self-esteem
		Problems thinking or concentrating, trouble making decisions
		Suicidal thoughts or actions
		Physical complaints, such as head or stomach aches

The following questions may help you decide whether your teen needs help. Check any symptoms of depression that apply to your teen. If several seem to apply, take the list to your doctor and discuss your concerns. If you are worried about suicide, get professional help and advice immediately.

Bipolar Disorder (Manic Depression)

This type begins with mood swings lasting weeks or months, with normal periods in between. Once again, it is a physical illness that must be treated by a doctor. The teen goes through upswings (hypomania) or extreme highs (mania) where there is loss of touch with reality. Often this involves non-stop, irrational speech and activity. High periods alternate with lows that have all the symptoms of major depression.

Dysthymia

In this type of depression, the teen never seems happy and sees the world through negative eyes. Only a few symptoms of a major depression are present. The affected teen does not experience a great increase in problems with school, friends or family. However, negative mood can set a coping style that lasts through life and so becomes a serious problem. More often, this depression does not last very long and interferes less with a teen's life. Dysthymia sometimes looks like the time between major episodes of depression that has been only partially treated.

Atypical depression

The fourth type of depression involves sudden mood swings that last a few hours to a day or so. These are called acute dysphoric episodes. Depression, hurt feelings, anger, hatred, and jealousy are all common. There may be a lot of frustration and negativity, with a desire for revenge. You may notice your teen sleeping more, becoming agitated, gaining weight or seeming more nervous.

This type of depression occurs in teens who are very sensitive to rejection and criticism. They may be easily embarrassed, and are often anxious or worried. Sometimes anxiety leads to panic attacks, with shortness of breath, dizziness, fainting and a racing heart. Short mood swings are less severe than in bipolar disorder. Still, moods can lower self-esteem enough to make a teen think about suicide.

The family may be shocked by sudden emotional outbursts (explosions). At other times, teens may hold their emotions inside (implosions). In this case, the teen will not talk to anyone and demand to be left alone. Both kinds of outbursts may be present – for instance, imploding at school and exploding at home.

Adjustment reaction with depressed mood

Depression can emerge after a stressful event in a teen's life. This might be the loss of a parent through death or divorce, death of a pet, attending a new school, or moving, both of which may mean losing friends. Serious depression can be triggered by stress or loss. If you suspect this type of depression, have your teen assessed by a professional.

Other conditions associated with depressed mood

Certain conditions are linked to depression, or depression can develop from them.

These are:

behavioural problems with mood swings
eating disorders
alcohol and drug abuse
chronic anxiety
physical or sexual abuse
attention deficit disorder
experiencing a trauma
medical problems like diabetes, epilepsy or thyroid disorder.

Tools that treat depression

Treating depression in teens can be difficult. It requires more than one approach, and commitment from the teen, parents and therapist. Different tools may help, including:

medications to adjust a biochemical imbalance
psychotherapy (talk therapy)
education assessment (which reviews the teen's educational needs)
school placement (which can help a teen get the best educational opportuity)
social skills training (which teaches communication with others)
hospitalization, in severe cases

Medication

Medication is a major part of treating many depressions. Antidepressants help restore the biochemical imbalance that causes some depressions. They are not addictive, but help improve mood. Some can cause serious problems if taken in overdose and must be carefully supervised. This is especially important in the first few weeks of therapy, and should be discussed with the prescribing doctor.

Antidepressants have been available for over 35 years. Serotonin specific reuptake inhibitors (SSRIs) have been available in Canada, starting with Prozac®, since 1989. Tricyclic antidepressants have been available since the 1950s, but are unsafe when taken in overdose. Newer agents, the serotonin-noradrenaline reuptake inhibitors (SNRIs) are also available.

Studies have been done on using herbal remedies such as Omega-3s and St. John's Wort for depression. Omega-3s may help prescription antidepressants work better. St. John's Wort may also have a role. However, it has not been fully studied especially in comparison to known and effective anti-depressants. Also, it is hard to accurately measure the effective ingredient in herbal remedies. For these reasons, St. John's Wort is not currently recommended for children.

Psychotherapy

In psychotherapy, a therapist talks to the teen and tries to understand the problems. If a trusting relationship is formed, the teen can gather the self-esteem needed to improve.

Confidentiality is a must between therapist and patient. Unless a teenager is suicidal or likely to hurt someone, all discussions are kept between the therapist and the teen. Even parents are not included. However, the therapist can usually keep parents well informed while maintaining confidentiality.

Many troubled teens act out or engage in antisocial behaviour that, along with missed appointments, will slow treatment. Parents can provide support by encouraging the teen to attend every session.

During therapy, the teen may learn how earlier experiences relate to present feelings. Early childhood difficulties can include:

separation from mother or father
neglect by parents
physical trauma
sexual abuse
over-protection
death of a loved one
chronic physical illness
bodily injury
fighting by parents, and
external factors like war or earthquake.

Such experiences can cause overwhelming anxiety and lead to panic, helplessness, and depression. Therapy teaches the teen to deal with these feelings in a healthy way.

Psychotherapy helps make the connection between past experiences and present symptoms. The time this takes will depend on the teen and the nature of the problem. Personal motivation and the family's commitment also make a difference.

Another type of psychotherapy is group therapy, where teens interact with their peers. They can exchange thoughts and talk about their problems. Finding that others share the same feeling can help the teen feel less alone.

In cognitive therapy, teens explore the link between negative thinking and depressed mood and behaviour. Self-esteem and social skills improve. Problem solving is encouraged. The teen must have the maturity to recognize negative thinking patterns. For instance, common depressive thoughts include:

"It's all my fault."
"Nothing ever works for me."
"I'm worthless."
"I'll never have a satisfying relationship."
"He hasn't called me yet, so he's probably out with someone else."

The focus may be on feeling inadequate, helpless, and hopeless about the future, no matter what positive ideas are presented. Negative thoughts are magnified, and positive events ignored. This leads to sad mood, low self-esteem, guilt, apathy, withdrawal and suicidal ideas. Cognitive therapy helps people recognize negative reactions and search for a more positive approach.

Mindfulness-based stress reduction is an alternate 'talk therapy' based on moving anxious or depressed thoughts from the forefront of thinking to the background of awareness. Teens are trained to use all of the senses to stay present in the moment. Relief from stressful thoughts and feelings can come after gaining full control. Breathing, relaxation and mindful meditation are all part of this training.

Family therapy is also useful in treating depressed teens. Here, the 'patient' is the family. This takes some heat off the teen. Families discover that moodiness and behaviour problems can be symptoms of depression. Rather than being blamed, parents become part of the healing process. They discover how to change themselves to help their child. For instance, parents can learn to avoid saying things like, "You're worthless," "You're hopeless," or "You're lazy." Parents can learn to communicate with their child in a way that the teenager respects.

Other family members are often depressed too. There may be marital conflict, or rigid or chaotic rules. All family members need to understand how this affects the situation. Sometimes, it may be best for the teen to live away from home during recovery.

Social skills training and parent effectiveness training, often done at the same time, may help heal depression. This is especially true if stress on the teen comes from peer pressure, teasing, or bullying. Healthy adolescents need friends and a social life. Parents learn about positive discipline. For example, the common practice of grounding children can often lead to more depression, especially if it lasts a long time. Prolonged grounding upsets the social network, may cause more rebellion, and increases the risk of severe depression. However, grounding for a short while may be useful.

Hospitalization

A teen with suicidal tendencies may be admitted to hospital. If addiction is involved, treating the depression requires stopping any abuse by cutting off access to drugs and alcohol. If a depressed teen is fighting with peers and parents, being in hospital may relieve the conflict, and offer a quieter, safer environment in which to recover. Health professionals can observe the teen over time, which gives valuable information and helps with diagnosis and management.

Depression can be beaten

Depression is very treatable! Several approaches may be combined to create the environment and chemistry the teen needs to function in a healthy way. Medications can stabilize symptoms, so psychological therapy can take hold and help with the underlying stress. Otherwise, symptoms may be too overwhelming for a teen to take full advantage of therapy. Using a combined approach, even seriously depressed teens can improve.

Teenage Depression Help is available and important

1-800-668-6868