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Faces of Teenage Depression

March 2004 Issue

During the adolescent years, teenagers experience a series of massive hormonal changes, brain growth, personality growth, socialization influences, and changes in body image and self-perceptions. In addition, they are trying to cope with all of this in an increasingly stressful and challenging world – one which in many significant ways is much more troubling than the world in which most of their parents grew up – a world where they must confront increasingly common problems such as parental separation and divorce, peer pressure to experiment with sometimes dangerous drugs or activities, the threat of gang violence and swarmings, racism and bigotry, worries about serious incurable diseases like AIDS and SARS, fears about terrorism, and dire predictions about a limited economic and career future once (or if) they finish high school, college, or university.

Teens often try to cope with what they’re feeling by withdrawing and hiding in their rooms away from their parents. In turn, many parents, either because they don’t know how to respond to the teen or because they believe that they are part of the reason the teen is acting this way, withdraw themselves to avoid conflict or react angrily to the irritability or anger they see being directed at them.

Most teenagers and parents find a way to navigate successfully through this troubling time and in a few years things seem to return to “normal”. So as a parent, how do you distinguish “normal moodiness” or “teenage angst” from something more serious?

How common is teenage depression?

Typical estimates are that about 4 to 12% of teens suffer depression sufficiently severe to meet the criteria for a diagnosis of Major Depression; many more probably meet the criteria for Adjustment Reaction with Depressed Mood (a less severe reaction to a specific event or events in the teen’s life) or Dysthymic Disorder (basically a form of chronic mild depression). The National Institute of Mental Health also reports that teenage girls are more likely to develop depression than teenage boys (NIMH, 2000) – however, that may indicate only that teenage boys are more likely to hide their symptoms behind surliness or anger.

What is even more worrisome is that there are repeated suggestions that many cases, perhaps as high as 60 to 80%, go undiagnosed and therefore untreated. And untreated teenage depression does not just “go away” – recent research studies indicate that about two thirds of teenagers who suffer depression experience another major depressive episode in their early adult years. Untreated teenage depression is also associated with increased risk for problems such as illness, interpersonal and social difficulties, and an increased risk for substance abuse and suicidal thinking.

Looking for Signs That May Be Associated with Teenage Depression

Bear in mind that it is not uncommon for any teen to exhibit some of these signs from time to time, and that a teen who exhibits only one or two of these symptoms for a short period of time is not necessarily suffering from depression. However, if you see several of the symptoms below and they continue for more than 4 - 5 weeks, it may be wise to seek a professional opinion:

Frequent physical complaints such as headaches, stomachaches or tiredness
Frequent absences from school or poor performance in school
Sadness and hopelessness
Lack of enthusiasm, energy or motivation
Changes in eating or sleeping patterns
Increased indecision, poor concentration, forgetfulness
Outbursts of anger, shouting, complaining, unexplained irritability, or crying
Hypersensitivity to criticism or perceived rejection or failure
Withdrawal from friends and activities
Social isolation, poor communication
Alcohol or drug abuse
Poor self-esteem or guilt
Problems with authority
Suicidal thoughts or actions

Risk Factors for Depression

In childhood, boys and girls appear to be at equal risk for depressive disorders, but during adolescence, it is generally believed that girls are twice as likely as boys to develop depression. However, this may be misleading –girls are more likely to exhibit symptoms such as sadness and crying and to express their unhappiness directly; boys are more likely to suffer alone and/or to express their distress in the form of anger or aggression (see William Pollock’s book, Real Boys).

Specific risk factors for both boys and girls:

Family or personal stress
Family history of depression, anxiety disorders, or obsessive-compulsive disorder
Loss of a parent or loved one or a romantic relationship
Attention Deficit Hyperactivity Disorder (ADHD) or learning disabilities
Chronic illnesses, such as diabetes, asthma, Crohn’s disease, etc.
Abuse, neglect, or perceived rejection by one or more family members
Other traumatic events, including natural disasters

What to Do if You Think Your Teen is Depressed

Remind yourself that anger or irritability is often the first sign in a teenager that something is wrong, so it is important to “look behind the anger” instead of reacting to it. Even if it turns out that your teen is just angry, this is good advice – reacting to anger with anger only escalates the problem – and if the underlying problem is depression, your being angry is like punishing your child for feeling depressed.

The most frustrating part of dealing with a depressed teen is that he or she often resists talking about it and may well reject your attempts at obtaining professional help. If so, it can be helpful to talk to your family doctor or a qualified counsellor yourself, to obtain information about how to live with and cope with a loved one who is suffering from depression, and advice on ways to encourage your teen to talk to a professional. The first step may be to arrange an appointment with your family doctor under the guise of an “annual checkup” – it may be easier for your teen to accept help for a “physical” problem than a psychological one. Also, your family doctor should be able to distinguish between “normal teenage angst” and depression and can probably also recommend a counsellor for you or your teen.

The other and perhaps most important thing you can do is to try to find ways to remind your teen that while you are trying not to intrude and to accept his or her need for privacy, you are always eager to give whatever help your teen is willing to accept. The knowledge that he or she is not entirely alone is extremely important and means much more than you may think at the time.

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Dr. David J. Baxter, Psychologist, Ottawa