Your child might be more than moody
Since adolescents are often moody, it can be challenging to recognize when your child has become depressed and might need help. The thing people tend to notice first is withdrawal, or when the teenager stops doing things they usually like to do. There might be other changes in her mood, including sadness or irritability. Or in their behavior, including appetite, energy level, sleep patterns, and academic performance. If several of these symptoms are present, be vigilant about the possibility of teen depression.
This is especially important because when family members and other people around a teenager note her lack of interest in most things—or what we call anhedonia, they've usually been depressed for some time. Depression is an internalizing disorder, i.e., that disturbs a patient's emotional life rather than an externalizing one, which takes the form of disruptive or problematic behavior. As such, it takes a while not only for others to recognize it but often for the patient to realize that their thinking and emotional responses are disturbed.
Note that there are two kinds of depression. In major depressive disorder—the most familiar form of depression—the symptoms occur in what may be severe episodes that tend to last from seven to nine months. But there is also another form of depression called dysthymia, in which the symptoms are milder, but they last longer, even years. So while the experience of dysthymia may be less debilitating for the child at any given moment, the risk is that there is more accrued damage and more time in which the child is kept out of the healthy development process.
Why early intervention is critical
When a teenager is depressed, their suffering isn't the only reason getting help is essential. In addition to the disorder itself, add-on effects may cause lifelong issues. With depression symptoms comes low energy and poor concentration, which are likely to impact social and academic functioning significantly.
It's easy to see the effects of poor academic functioning: falling behind in school undermines a child's confidence and self-image and can impact their future if prolonged. But social learning is just as critical as academic learning in adolescents. Deficits in social skills not only put depressed teens behind their peers but in themselves can compound their depression.
Depression plus anxiety
It's important to understand that a teenager who is depressed may also develop anxiety and need to be treated for two separate disorders. It may be that depression leads to anxiety—the negative state of mind of a depressed teenager lends itself to uncertainty. Anxiety may find fertile ground if you're not feeling good about yourself, confident, secure, or safe. It may also be because the brain regions affected by anxiety and depression are closely and mutually affected.
Two serious problems directly associated with teenage depression and anxiety are suicidal thinking (or behavior) and substance abuse. Suicide is the third leading cause of death among adolescents and young adults aged 15 to 24, and we know that most kids who commit suicide have been suffering from a psychiatric illness. Especially at risk are teenagers who hide their depression and anxiety from parents and friends. That's why it's important to be alert to signs of these disorders—withdrawal, changes in school performance, eating habits, sleeping patterns, things they enjoy doing—even when teenagers aren't forthcoming about how they feel.
Similarly, most teenagers who develop problems with substance abuse also have a psychiatric disorder, including, most commonly, anxiety or depression, which is another critical reason to get treatment in a timely way.
Treatments for depression
Fortunately, early involvement of health care professionals can shorten the period of illness and decrease the likelihood of missing important life lessons.
The most common treatment a mental health professional can use is some form of, and depending on the child's age, cognitive behavioral therapy, which may also involve teaching the parents. Cognitive behavioral therapy is based on the idea that a person suffering from a mood disorder is trapped in a negative thought pattern. Depressed kids tend to evaluate themselves negatively, negatively interpret the actions of others, and assume the darkest possible outcome of events. In CBT, we teach sufferers to challenge those negative thoughts, recognize the pattern and train themselves to think outside it. And in many cases, we see real improvement.
If the depression is moderate to severe, treatment may involve medications such as antidepressants. A combination of psychotherapy and medication usually works better than either alone.
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Ron J. Steingard, MD, is a former associate medical director and senior pediatric psychopharmacologist at the Child Mind Institute. Reviewed or updated on February 27, 2023.