Adolescent Depression Often Overlooked

Adolescence is a time of tremendous emotional upheaval and change. Teenagers have to deal with new issues every day as they begin to move from childhood into the 'real world' of adulthood. At best this process can be confusing, irritating, frightening and demanding. Situations that might not seem important to adults have the potential to send teens into a frenzy of bad feelings. This is normal and - even if it doesn't always seem so - quite understandable.

But when the bad moods last for more than a few weeks and teenagers no longer seem like themselves, there's a chance they are experiencing clinical depression, a problem that can have serious health effects. If a teenager shows signs of depression, it's important to seek the help of a professional. Left untreated, the disorder can lead to problems that might be still more difficult to resolve.

Recent evidence from the World Health Organization indicates that by the year 2020, childhood neuropsychiatric disorders will become one of the five most common causes of morbidity, mortality and disability among children.

Joseph O'Grady, Jr., MD, Assistant Professor of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin, presents some surprising facts about depression in teens. "The rate of depression greatly increases from childhood to adolescence," says Dr. O'Grady. "The prevalence of depression in early childhood is about 2%, but by adolescence that number jumps to 6%. And girls have about twice the incidence of depression as boys." Depression is often an underlying cause of academic difficulties and social withdrawal in teens, Dr. O'Grady reports, and might be misinterpreted as a behavioral problem. Sometimes punishment is used in an attempt to 'treat' this problem within the home, at school or in the juvenile justice system, but that can do more harm than good if depression is at the root of a teenager's behavior.

"Depression in adolescents often goes undiagnosed," according to CapriMara Fillmore, MD, MPH, Assistant Professor of Public Health at the Medical College of Wisconsin and Associate Medical Director at the Milwaukee Health Department. "Nearly a third of Milwaukee high school students report feeling so sad or hopeless as to interfere with regular activities for at least two weeks, and 16% seriously consider suicide." Depression often contributes to behavior choices with lifelong health consequences like violence, substance abuse or pregnancy. The Milwaukee Health Department has initiated depression screening among the students they serve in Milwaukee Public Schools.

What to Watch For
According to Dr. O'Grady, teenagers, like adults, show a wide variety of symptoms when depression strikes. Here are some of the more common symptoms to look for in depressed teenagers:

• Difficulty functioning in school
• Withdrawal from social interaction
• Mood disorders such as irritability or erratic mood swings
• Low tolerance for frustration or anger
• Tearfulness or crying
• Substance abuse
• Inability to make decisions, concentrate and remember
• Lack of interest in things that used to interest them
• Sleep problems - sleeping too much or not being able to sleep
• Eating problems - dramatic weight gain or loss

Social issues can also be a component of teenage depression. These could include exposure to violence, chronic poverty, discrimination, or the loss of important people through death, divorce or broken relationships. And teens deal with different issues at different stages of adolescence, explains Dr. O'Grady. "For instance, in earlier adolescence, teens are dealing with identity issues; in later adolescence it's issues of independence and separation from the family." The best way to identify causes of depression, he said, is to use a comprehensive 'bio-psycho-social' model, which takes into consideration the complex biological, psychological, and social composites of a teen's life.

While the causes for teenager depression can be numerous and varied, Dr. O'Grady points out that if there is a family history of depression, a teenager is more likely to react to the difficulties of adolescence by becoming depressed.

Many Treatment Options Available
Thankfully, just as there are many possible causes of depression, there are many possible treatments, most often a combination of several different options. These options can include counseling, psychotherapy, family therapy and medication, as needed. There is no single treatment that's appropriate for every teenager, reports Dr. O'Grady.

The most important first step is to carry out a comprehensive assessment of the teenager's life so treatment can focus on the individual factors contributing to the depression. Dr. O'Grady stresses that a great deal of teenage depression goes untreated. "We need to be aggressive about treatment," he says, because if not treated, a depressed teenager can begin to have more serious problems such as academic impairment, physical problems or illness, interpersonal difficulties, violent tendencies and even thoughts of, or attempts at, suicide. The family might incur high medical bills, and the community might also pay if the child becomes involved in the juvenile justice system. Additionally, teenagers who are depressed are much more likely to experience a recurrence of depression if they aren't properly treated.

The US Department of Health and Human Services reports that an estimated two-thirds of all young people with mental health problems are not getting help. Depression has been linked to the skyrocketing number of teenage suicides, and violent behavior in teens can often be attributed to depression as well. To counter these facts, families, schools and communities are learning to work together to provide safe and supportive environments for children. If you know any teenagers who are struggling against the pain of depression, it's important to get them the assistance they need as soon as possible. Their future - and ours - could depend on it.

For free information from the US Department of Health and Human Services about child and adolescent mental health – including publications, references, and referrals to local and national resources call 1-800-789-2647; TDD 1-866-889-2647; or go to www.mentalhealth.org.

P.J. Early
HealthLink Contributing Writer

This article includes information from:
Child Psychiatry Center at Children's Hospital
The National Institute of Mental Health
The World Health Organization
US Department of Health and Human Services

For more information on this topic, see the HealthLink article Most Often, "Early" Puberty Still Normal.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.