Depression

Source: The National Youth Violence Prevention Resource Center - www.safeyouth.org

It is entirely normal to feel "blue" occasionally, or to feel down for a while after something bad happens. For teenagers with major depression however, feelings of sadness and hopelessness may last for weeks or months and can eventually dominate their lives. They lose interest in activities they used to enjoy, and relationships with family and friends can begin to suffer.

Depression can lead to poor school attendance and performance, running away, and feelings of worthlessness and hopelessness. Some teens try to make the pain of depression go away by drinking or taking drugs, which only makes the depression worse. Still others contemplate suicide.

Depression is not a sign of weakness—it is a real medical illness. The vast majority of teens with depression can be helped with treatment, which typically includes counseling and/or medication. Unfortunately, most teens with mental health problems do not get the help they need. And when depression isn't treated, it can get worse, last longer, and prevent teens from getting the most out of life. So, it is important to get help immediately if you think you or a friend may be suffering from depression.

How common is depression among teenagers?
Major depression strikes about 1 in 12 adolescents.[1] In any given 6-month period, about 5 percent of 9- to 17-year-olds are estimated to be suffering from major depression.[2]

What are the symptoms of major depression?
All too often, depression is left untreated because people fail to recognize the symptoms and believe that it is just normal sadness, a phase that a teen is going through, or a sign of weakness. This can be a terrible mistake. It is important to know the symptoms, so that you can distinguish depression from occasional normal sadness or moodiness.

Common symptoms of depression include:

• Sad or irritable mood
• Loss of interest in activities that were once enjoyable
• Large changes in appetite or weight
• Difficulty sleeping, or oversleeping
• Slow or agitated movement
• Loss of energy
• Feelings of worthlessness or guilt
• Difficulty concentrating
• Frequent thoughts of death or suicide[3]

Most teens experience some of these symptoms occasionally. But if a teen has a number of these symptoms for more than a few weeks, he or she is likely to have major depression, and may need professional help.

Teenagers often show depression in other ways as well.

Some other signs to watch for in teens include [4]:

• Frequent headaches, muscle aches, stomach aches or tiredness, without a medical cause
• Frequent absences from school or poor performance in school
• Talk of or efforts to run away from home
• Boredom, sulking
• Lack of interest in spending time with friends or family
• Alcohol or substance abuse
• Social isolation, poor communication
• Fear of death
• Extreme sensitivity to rejection or failure
• Increased irritability, anger, hostility, or crying
• Reckless behavior
• Neglect of clothing and appearance
• Difficulty with relationships
• Changes in mood

If you suspect that you or a friend may be suffering from depression, talk to an adult you can trust—and get help.

Depression can take many forms...
Some teens experience only one episode of major depression. Other teens may experience many bouts during their teenage years.

Some teens suffer from dysthymia, a less severe and chronic form of depression that may continue for years, interfering with a teen's ability to enjoy and get the most out of life. A teen with dysthymia also may have occasional episodes of major depression.

Other teens suffer from bipolar (or manic-depressive) disorder, which involves severe mood swings from periods of depression to periods of high energy, overly inflated self-esteem, and agitation or hyperactivity. [5] (For more information on bipolar disorder, visit the following Web site:http://www.nimh.nih.gov/publicat/bipolarupdate.cfm.) Twenty to 40 percent of adolescents with major depression develop bipolar disorder within 5 years. [6]

Some teens are at greater risk for depression than others...
Teenage girls are twice as likely as boys to develop depression, [7] and teens with a family history of depression are also at greater risk. [8] Other things that put teens at higher risk include:

• Stress [9]
• Loss of a parent or loved one [10]
• Break-up of a romantic relationship [11]
• Attention, conduct, or learning disorder(s) [12]
• Chronic illnesses, such as diabetes [13]
• Abuse or neglect [14]
• Other trauma, including exposure to violence and natural disasters [15]

Depression and drug use
Depression and drugs are a dangerous combination. Depressed teens—like depressed adults—frequently also have problems with alcohol or other drugs.[16] Sometimes drug and alcohol use can lead to depression; but more frequently, teens who are depressed seek out alcohol and other drugs to avoid dealing with their depression and how it makes them feel.

Depression and suicide
Suicide can be a deadly outcome of depression. Teens who are depressed are much more likely than other teens to attempt suicide. Among teens who develop major depression, as many as 7 percent (or 1 in 14) will commit suicide as young adults.[17] If a teenager thinks or talks about suicide, it is important to take the threat seriously and seek professional help.

What You Can Do
If you think you may be suffering from depression...
Find help. Being depressed can make you feel exhausted, worthless, helpless, and hopeless. It can make you believe that nothing you do will make a difference and that things cannot get better. It is important to realize that these negative views are part of the illness. Effective treatments are available that can help you feel better!

There are many people you can talk to in order to get the help you need:

• psychologist
• a psychiatrist
• your school counselor or nurse
• your parents or a trusted family member
• your family doctor
• your clergy
• a social worker
• a professional at a mental health center

Seek help immediately!

If you think that a friend is depressed...
Talk to your friend. Your friend may not realize that he or she is suffering from depression. Listen to your friend, and make sure your friend knows that you care. Help your friend understand that no matter how overwhelming problems seem, help is available.

Encourage your friend to find help. Remember that you're not a professional therapist and that the most helpful thing you can do is to make sure your friend gets help. Encourage your friend to talk to a professional, such as a school counselor or family doctor, or to a trusted family member.

If your friend doesn't seek help quickly, talk to an adult you trust and respect— especially if your friend mentions death or suicide. Depressed teens may be unmotivated or unable to seek out help on their own because the depression can make them feel that things are hopeless and that nothing they do will make a difference. You can be the most help by referring your friend to someone with the professional skills to provide the help that he or she needs while you continue to offer support. Talk with an adult you trust about your friend's situation so that you aren't carrying the burden by yourself.

Helpful Links

Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is recognized as the leading federal agency for protecting the health and safety of people in the United States. CDC's Web site contains a number of fact sheets and publications on relevant issues, such as:

• "TIPS 4 Youth"-Teens who smoke are more likely to suffer from depression. Learn more about cigarettes and smoking from this resource.
• "Suicide in the United States"

Center for Mental Health Services
The Center for Mental Health Services (CMHS) leads federal efforts to treat mental illness by promoting mental health and preventing the development or worsening of mental illness, when possible. Available at the CMHS Web site are a number of fact sheets and other information, including "Major Depression in Children and Adolescents."

National Institute of Mental Health
A component of the National Institutes of Health (NIH), the National Institute of Mental Health (NIMH) works to diminish the burden of mental illness through research by better understanding, developing treatment for, and (eventually) preventing mental illness. Available at the NIMH Web site are a number of fact sheets and other information, including:

• '"Let's Talk About Depression"
• "Depression"
• "What To Do When A Friend Is Depressed"
• '"In Harm's Way: Suicide In America"
• "Frequently Asked Questions About Suicide"

National Strategy for Suicide Prevention
This site provides information about suicide and suicide prevention efforts, and links to other resources. It includes advice and numbers to call if you, or someone you know, may be considering suicide. It is a collaborative effort of the Substance Abuse and Mental Health Services Administration (SAMHSA), NIH, CDC, and the Health Resources and Services Administration (HRSA).

A Teenager's Guide to... Fitting in, Getting involved, Finding yourself
Family and Youth Services Bureau, U.S. Department of Health and Human Services
The ideas in this booklet can help you learn to deal with tough times and enjoy the good times by finding the people and places that are right for you. You might find these ideas useful in your everyday life. Or read them to see if they might be helpful to a friend.

Youth Mental Health Issues
Children, Youth and Families Education and Research Network (CYFERNET), U.S. Department of Agriculture
This site contains links to a number of publications and resources for youth and their families on depression and other teen mental health issues.

References

1. Birmaher, B., Ryan, N.D., Williamson, D.E., et al. (1996). Childhood and adolescent depression: a review of the past 10 years. Part 1. Journal of the American Academy of Child and Adolescent Psychiatry, 35(11), 1427-39.
2. Schaffer, D., Fisher, P., Dulkan, M.K., et al. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 865-77.
3. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition (DSM IV). Washington, DC: American Psychiatric Press.
4. National Institute of Mental Health. Depression in Children and Adolescents: A Fact Sheet for Physicians.
5. Lewinsohn, P.M., Klein, D.N., Seely, J.R. (1995). Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. Journal of the American Academy of Child and Adolescent Psychiatry, 34(4), 454-63.
6. Birmaher, B., Ryan, N.D., Williamson, D.E., et al. (1996). Childhood and adolescent depression: a review of the past 10 years. Part 1. Journal of the American Academy of Child and Adolescent Psychiatry, 35(11), 1427-39.
7. Birmaher, B., Ryan, N.D., Williamson, D.E., et al. (1996). Childhood and adolescent depression: a review of the past 10 years. Part 1. Journal of the American Academy of Child and Adolescent Psychiatry, 35(11), 1427-39.
8. Harrington, R., Rutter, M., Weissman, M.M., et al. (1997). Psychiatric disorders in the relatives of depressed probands. Comparison of prepubertal, adolescent and early adult onset cases. Journal of Affective Disorders, 42(1), 9-22.
9. Lewinsohn, P.M., Rohde, P., Seeley, J.R. (1998). Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications. Clinical Psychology Review, 18(7), 765-94.
10. Wells, V.E., Deykin, E.Y., Klerman, G.L. (1985) Risk factors for depression in adolescence. Psychiatric Development, 3(1), 83-108.
11. Monroe, S.M., Rohde, P., Seeley, J.R., et al. (1999). Life events and depression in adolescence: relationship loss as a prospective risk factor for first onset of major depressive disorder. Journal of Abnormal Psychology, 108(4), 606-14.
12. Spencer, T., Biederman, J., Wilens, T. (1999). Attention-deficit/hyperactivity disorder and comorbidity. Pediatric Clinics of North America, 46(5), 915-27.
13. Kovacs, M. (1997). Psychiatric disorders in youths with IDDM: rates and risk factors. Diabetes Care, 20(1): 36-44.
14. Brown, J., Cohen, P., Johnson, J.G., et al. (1999). Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 38(12), 1490-6.
15. Krug, E.G., Kresnow, M., Peddicord, J.P., et al. (1998). Suicide after natural disasters. New England Journal of Medicine, 338(6), 373-8.
16. Deykin, E.Y., Levy, J.C., Wells, V. (1987). Adolescent depression, alcohol and drug abuse. American Journal of Public Health, 76, 178-182.
17. Weissman, M.M., Wolk, S., Goldstein, R.B., et al. (1999). Depressed adolescents grown up. Journal of the American Medical Association, 281, 1701-13.