Dr. Ole Thienhaus answers the question: “How do I know if my teenage child is depressed?”

Depression in teenagers is a more common affliction than previously thought. In fact, years ago many would have denied its existence altogether: Adolescent turmoil and normal moodiness would have been held up as explanations for any young person in emotional distress. The troubling increase in teenage suicides and suicide attempts over the past few decades has brought the issue to the forefront and made mood disorders in adolescents a major public health concern. Recent statistics reveal that in girls aged 13 to 18, almost six percent are diagnosed as suffering from clinical depression. In boys of the same age, the percentage is about four and a half.

Clinical depression is the key term here. The old notion that adolescents tend to be emotionally labile is obviously accurate: As most of us recall, growing up is a distressingly tough job, and heartbreak and despair are part of that painful transition from childhood to adult independence. But episodes lasting four to six months when the expressed mood is continuously dejected or downcast, when crying spells are accompanied by withdrawal from activities usually enjoyed, when the young person no longer socializes with friends, school performance suffers, and the future is seen as bleak: This kind of sustained gloom should concern parents, teachers and friends.

Even long periods of emotional distress do not necessarily mean that someone suffers from major depressive disorder, but it should send a signal that something’s wrong. The teen may have gotten into drugs or there may be peer conflicts or school trouble that’s more than he or she can handle. But the possibility of a first episode of major depression should also be kept in mind. Failure to intervene can exact a high price: Suicidal behavior, school failure and substance abuse are common complications. And the probability of a chronic recurrent condition is of great concern: About 70 percent of kids with depression grow up to have major depression as adults.

Ideally parents have managed to maintain a level of communication with their teenagers that lets them find out about their daughter’s or son’s troubles. It is very common, and no cause for parental self-blame, that the adolescent prefers to conduct a more in-depth discussion with a professional. The professional, such as a child and adolescent psychiatrist, or a behavioral pediatrician, or a youth counselor, comes with less baggage than any family member, and offers teens a degree of confidentiality that makes it easier to share fears and embarrassing thoughts or fantasies.

If the discovery that their child suffers from major depressive disorder expectedly comes as a shock to the parents, it is worth emphasizing that depression is amenable to effective treatments. Although it is often a chronically recurrent illness, adequate clinical management is likely to lead to long-lasting or even permanent remission.

For the affected teen, the engagement in a therapeutic relationship with a mature and trained mental health professional can be a critical ingredient towards recovery. However, in itself it is not sufficient for recovery if the emerging illness is, indeed, major depressive disorder. Systematic psychotherapy with adjunctive antidepressant medication, is required. One of the effective psychotherapies is a technique called cognitive behavioral therapy, another is interpersonal therapy. In neither of these does the patient lie on a couch, spending years trying to recall childhood memories.

Rather, in cognitive behavioral therapy he or she learns to systematically shift his or her perspective on their predicament, so as to appreciate a sense of mastery of life’s challenges over time. This is called reframing: The patient is trained, consciously, to consider and then adopt an alternative view of the identified circumstances and emotions that underlie their despair. If the treatment is managed by a skilled clinician the gains can often be accomplished in as little as twelve to twenty sessions i.e. four months or less. In interpersonal therapy, the focus is on problems in relating to others – identifying misinterpretations of others’ behavioral cues, correcting the perceptions and practicing interactions based on the newly acquired skills at decoding those around the patient.

Psychotropic medication in kids is often feared by well-meaning parents and clinicians alike. None of us like the idea of our children being on medications, let alone drugs that work on the brain. Very specifically, concerns about increased suicidal thoughts in adolescents on certain antidepressants have been widely published over the past few years, causing even greater hesitancy to prescribe such medications in young patients. However, it’s well established by now that the advantages of a carefully tailored and monitored medication treatment improve the prognosis greatly, especially if the medication is used in conjunction with psychotherapy.

The psychotherapies, as outlined above, reduce the risk of a situation triggering a cascade of self-defeating emotional reactions. The medication realigns the imbalanced state of neurochemicals that bring the emotional pain into consciousness. The data base for the effectiveness of antidepressant medication is solid enough that the U.S. Food and Drug Administration has explicitly approved one particular antidepressant, fluoxetine, as an effective and safe medication in the treatment adolescent depression.

So, should your teen get on Prozac and into psychotherapy at this point? Not necessarily. The diagnosis of major depression takes more than a bedside glance. Just like other illnesses, psychiatric disorders have a better prognosis if they are caught early, before they become chronic or have led to complications.

Ole Thienhaus, M.D. is dean of the University of Nevada School of Medicine. He lives in Reno and Las Vegas, commuting every week between the medical school’s two campuses, treating patients in urban and rurual communities.

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This entry was posted on Thursday, June 12th, 2008 at 12:06 pm and is filed under Depression, Mental Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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