A Long Arm: Teen Depression

You could say it's depressing news. Not only do adolescents experience major depression at the same rates that adults do, three quarters of depressed adolescents experience further psychiatric disorder. By age 24, half of them have had another episode of major depression. And another 25% have experienced alcohol and drug problems.

Only a quarter of those with a history of major depression between ages 14 and 19 remain free of psychiatric problems through age 23. But even they are subject to residual effects of their earlier disorder during young adulthood. They make less money. They are less likely to have graduated from college. They are more likely to have a period of unemployment.

"They show functional scars," reports psychologist Peter M. Lewisohn, Ph.D., of the Oregon Research Institute, who with colleagues is examining the long-term course and consequences of adolescent depression. "We conclude that an episode of depression in adolescents really needs to be taken seriously,"

"These are very clinically important episodes," adds psychologist Paul Rohde, Ph.D. "There are occupational and educational consequences even for those who do not experience another bout of depression."

The trouble is, the vast majority of adolescents who are depressed—around 75%, Rohde reports—do not receive systematic treatment. Their episodes are consigned to resolve just with passage of time.

Yet, some adolescents are at special risk for a protracted course of the disorder, and the studies are able to pinpoint them as:

• Adolescent girls who experience a great deal of conflict with their parents
• Both males and females who have multiple episodes of major depression as teens
• Those with a family history of depression.

Providing the right kind of help early may avert the "depressive scarring" that is generated by multiple episodes. Drs. Lewisohn and Rohde champion psychoeducation rather than psychotherapy or medication.

There's no question that drugs are effective in resolving adult depression, as is cognitive behavioral therapy, although psychotherapy has been show to be more effective in preventing relapses. "But among young people, it's another story entirely," says Dr. Rohde.

"We're trying to teach the kids better ways of coping with their depression. People can learn how to deal with their depression.

"There's an approach that says 'you have an illness and you need to take a pill,'" Dr. Rohde explains. "Our approach is more, 'you have problems in living. You can help yourself by dealing with those problems better. '"

What they provide is essentially a form of cognitive behavioral psychotherapy, albeit group-based, as it's less stigmatizing. There's a focus on tracking moods; increasing pleasant activities, relaxation skills and social skills; identifying thinking errors and negative thoughts and coming up with more positive and realistic thoughts; and increasing problem-solving skills. The teens learn a variety of skills and then personalize those that prove to be the most helpful to their particular lives.

To a large degree, depression among adolescents is the manifestation of a family disorder, Dr. Lewisohn finds. The rates of mood disturbances, particularly major depression and the mildly depressed mood state known as dysthymia, are significantly elevated among their first degree relatives.

What's more, the pattern of family aggregation of psychopathology is quite specific; teens who suffer major depression have relatives primarily with mood disorders.

"There is a familial transmission of major depression from parents to their children," stresses Dr. Rohde. "It may be genetic or it may be environmental. No one knows."

What the Oregon researchers do know is that in their survey of teens in the community, seven percent had made a suicide attempt. Most such attempts are not medically lethal. But rarely are parents aware of the attempts.

Nevertheless, insists Dr. Rohde, "suicide attempts in adolescents need to be taken seriously." The reason: The biggest predictor of future suicide completions is past suicidal behavior.