Depression in Adolescents

Lehigh Valley Health Network’s pediatric behavioral health team includes board-certified pediatric and adolescent psychiatrists, licensed doctoral-level psychologists, licensed psychiatric social workers and a host of other mental health specialists. Our specialists carefully evaluate each young patient’s physical health, mental health and social and educational history. We then customize each patient’s treatment.

There are three primary types of depression: major depression (clinical depression), bipolar disorder (manic depression) and dysthymic disorder (dysthymia).

The National Institute of Mental Health, part of the National Institutes of Health, reports the following:

• Research indicates that depression onset is occurring earlier in life today than in past decades.
• Early-onset depression often persists, recurs and continues into adulthood. Depression in youth also may predict more severe illness in adulthood.
• There is an increased incidence of depression in adolescents whose parents experience depression.

Major depression

Major depression is classified as a type of affective disorder (also called mood disorder) that goes beyond the day's ordinary ups and downs. It has become a serious medical condition and important health concern in this country.

The following are the most common risk factors for major depression:

• Family history of depression (especially if a parent experienced depression as a child or adolescent)
• Excessive stress
• Abuse or neglect
• Trauma (physical and/or emotional)
• Other psychiatric disorders
• Loss of a parent, caregiver or other loved one
• Cigarette smoking
• Loss of a relationship (i.e., moving away, loss of boyfriend or girlfriend)
• Other chronic illnesses (i.e., diabetes)
• Other developmental, learning or conduct disorders

Manic depression (bipolar disorder)

Manic depression, also known as bipolar disorder, is classified as a type of affective disorder (also called mood disorder) that goes beyond the day's ordinary ups and downs. It is a serious medical condition and important health concern in this country. Manic depression is characterized by periodic episodes of extreme elation, happiness, elevated mood or irritability (also called mania) countered by periodic, classic major depressive symptoms.

Manic depression affects more than 5.7 million American adults, 18 years of age and older, each year. The median age of onset is 25. When symptoms are present before age 12, they often are confused with attention-deficit hyperactivity disorder (ADHD) – a syndrome that usually is characterized by serious and persistent difficulties resulting in inattentiveness or distractibility, impulsivity and hyperactivity.

Affecting males and females equally (although females are more likely to experience more depressive and less manic symptoms), manic depression often begins in adolescence or early adulthood. Manic depression is beginning to be better recognized in young children, although diagnosis may still be difficult.

Manic depression is likely to run in families, and in some cases is believed to be hereditary. Family history of substance abuse also increases the risk for developing manic depression. Researchers still are seeking to identify a gene (or genes) that may be responsible for this disorder.

Dysthymic disorder (dysthymia)

Dysthymia, also known as dysthymic disorder, is classified as a type of affective disorder (also called mood disorder) that often resembles a less severe, yet more chronic form of major (clinical) depression. However, people with dysthymia also may experience major depressive episodes at times.

Dysthymia occurs in up to 1.7 percent of children and in up to 8 percent of adolescents.

Symptoms

The following are the most common depression symptoms. However, each adolescent may experience symptoms differently.

• Persistent feelings of sadness
• Feeling hopeless or helpless
• Having low self-esteem
• Feeling inadequate
• Excessive guilt
• Feelings of wanting to die
• Loss of interest in usual activities or activities once enjoyed
• Difficulty with relationships
• Sleep disturbances (i.e., insomnia, hypersomnia)
• Changes in appetite or weight
• Decreased energy
• Difficulty concentrating
• A decrease in the ability to make decisions
• Suicidal thoughts or attempts
• Frequent physical complaints (i.e., headache, stomach ache, fatigue)
• Running away or threats of running away from home
• Hypersensitivity to failure or rejection
• Irritability, hostility, aggression

For a diagnosis of major depression to be made, an adolescent often needs to exhibit a "cluster" (several) of the above symptoms during the same two-week period. Major depression symptoms may resemble other problems or psychiatric conditions.

Someone with manic depression (bipolar disorder) also may experience these common manic symptoms:

• Overly inflated self-esteem
• Decreased need for rest and sleep
• Increased distractibility and irritability
• Excessive involvement in pleasurable and/or high-risk activities that may result in painful consequences; this may include provocative, aggressive, destructive or antisocial behavior (i.e., sexual promiscuity, reckless driving, reckless spending, abuse of alcohol and/or drugs).
• Increased talkativeness (may include increase in rate of speech, changes topics quickly, cannot be interrupted)
• Excessive "high" or euphoric feelings
• Severe mood changes including unusually happy or silly, or unusually angry, agitated or aggressive
• Increased sex drive
• Increased energy level
• Uncharacteristically poor judgment

Some teenagers in a manic phase experience psychotic symptoms including hallucinations and/or delusions.

Diagnosis

Because depression has shown to often coexist with other psychiatric disorders, such as substance abuse or anxiety disorders, seeking early diagnosis and treatment is crucial to the recovery of your adolescent. A child psychiatrist or other mental health professional usually diagnoses major depression following a comprehensive psychiatric evaluation. An evaluation of the adolescent's family, when possible, in addition to information provided by teachers and care providers also may be helpful in making a diagnosis. 

Manic depression (bipolar disorder)

For a diagnosis of manic depression to be made, an individual must exhibit both depressive and manic symptoms to a varying degree, depending upon the severity of the disorder. The symptoms of manic depression, especially in a teenager, may resemble other problems (i.e., drug abuse, attention-deficit hyperactivity disorder, delinquency). Always consult your adolescent's health care provider for a diagnosis.

Seeking early diagnosis and treatment is crucial to recovery. A diagnosis often is made after a careful psychiatric examination and medical history performed by a psychiatrist or other mental health professional. 

Dysthymic disorder (dysthymia)

For a diagnosis of dysthymia to be made, a depressed or irritable mood must persist for at least one year in children or adolescents and must be accompanied by at least two other major depressive symptoms (noted above). The symptoms of dysthymia may resemble other medical problems or psychiatric conditions. Always consult your adolescent's health care provider for a diagnosis.

Because depression has shown to often coexist with other psychiatric disorders, such as substance abuse or anxiety disorders, seeking early diagnosis and treatment is crucial to the recovery of your adolescent.

A child psychiatrist or other mental health professional usually diagnoses dysthymia following a comprehensive psychiatric evaluation. An evaluation of the adolescent's family, when possible, in addition to information provided by teachers and care providers also may be helpful in making a diagnosis.

Treatment

If you suspect your child has a problem with depression, seek treatment. One reason some depressed children escape identification is that the parents fault themselves for their child’s difficulties. Consequently, the child doesn’t get the help he or she needs. This guilt isn’t necessary, because there are effective treatments.

Major depression

Mood disorders, including major depression, can be treated. Treatment always should be based on a comprehensive evaluation of the adolescent and family. Treatment may include one or more of the following:

• Antidepressant medications (especially when combined with psychotherapy; has shown to be very effective in the treatment of depression in children and teens)
• Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy) for the adolescent (focused on changing the adolescent's distorted views of themselves and the environment around them; working through difficult relationships; identifying stressors in the adolescent's environment and learning how to avoid them)
• Family therapy
• A collaboration with the adolescent's school to provide appropriate support for adolescent while he or she is recovering

Parents play a vital supportive role in any treatment process.

For several reasons, many parents of children or adolescents with depression never seek the appropriate treatment for their adolescent, although many people with major depression who seek treatment improve – usually within weeks. Continued treatment may help to prevent recurrence of the depressive symptoms.

Without appropriate treatment, symptoms of depression can persist for weeks, months or years. In addition to causing interpersonal and psychosocial problems, depression in children and adolescents also is associated with an increased risk for suicide. Further, this risk rises, particularly among adolescent boys, when the depression is accompanied by other mental health disorders (i.e., conduct disorder, substance abuse). It is crucial for parents and care providers of children and adolescents to take all depressive and suicidal symptoms very seriously and seek treatment immediately. Suicidal behaviors are medical emergencies. Consult your adolescent's health care provider for more information.

Manic depression (bipolar disorder)

Mood disorders, including manic depression, can be treated. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Treatment may include one or more of the following:

• Medication (i.e., mood-stabilizing medications, such as lithium, valproic acid or carbamazepine, and/or antidepressants)
• Psychotherapy (most often cognitive-behavioral, supportive, psychoeducational and/or interpersonal therapy)
• Family therapy
• A collaboration with the adolescent's school to provide appropriate support for adolescent while he or she is recovering

Parents play a vital supportive role in any treatment process.

Recognizing the varied and extreme mood swings associated with manic depression is crucial in obtaining effective treatment, and avoiding the potentially painful consequences of the reckless, manic behavior.

In most cases, long-term, preventive treatment is necessary to stabilize the mood swings associated with manic depression.

Dysthymic disorder (dysthymia)

Mood disorders, including dysthymic disorder, can be treated. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Treatment may include one or more of the following:

• Antidepressant medications (especially when combined with psychotherapy, has shown to be very effective in the treatment of depression in children and teens)
• Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy) for the adolescent (focused on changing the adolescent's distorted views of themselves and the environment around them; working through difficult relationships; identifying stressors in the adolescent's environment and learning how to avoid them)
• Family therapy
• A collaboration with the adolescent's school to provide appropriate support for adolescent while he or she is recovering

Parents play a vital supportive role in any treatment process.

Dysthymia is associated with an increased risk for major depression if a child or adolescent does not receive appropriate treatment. Dysthymia also increases the risk for a child or adolescent to develop other mental health disorders. Appropriate treatment helps to reduce the severity of symptoms and the risk for relapse of a depressive episode.

Because episodes of dysthymia may last for longer than five years, long-term, continued treatment may help to prevent recurrence of the depressive symptoms.

Specific treatment for depression will be determined by your adolescent's health care provider based on:

• Your adolescent's age, overall health and medical history
• Extent of your adolescent's symptoms
• Your adolescent's tolerance for specific medications or therapies
• Expectations for the course of the condition
• Your opinion or preference