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As noted in the last installment, when a teenager experiences a depressive episode it’s not a normal part of adolescent development and should always be aggressively addressed. Although the stressors that evoke a depressive episode may be quite varied, there is a universality to many of the symptoms. It's helpful to think about the red flags of depression as manifesting both physically and psychologically. The onset of symptoms can develop over days to several weeks. If left untreated, many symptoms abate within six months, but more than 50% of teens will experience another episode if there has been no intervention.
In most cases the cardinal feature of depression is 'anhedonia' or a loss of interest in the activities that historically have been a source of pleasure and satisfaction for the teen. This often manifests as a sudden unwillingness to interact with friends, or a disconnect from athletic, academic, extra-curricular, or spiritual activities. In addition to anhedonia the diagnosis is made when there are four other symptoms. These can include:
Physical
- Changes in appetite: weight gain or weight loss
- Sleep disturbance: difficulty falling asleep, staying asleep or sleeping too much
- Difficulty with concentration, focus, or memory
- Psychomotor agitation: manifested as irritability, constant fidgeting, or an inability to sit still
- Psychomotor retardation: walking and talking in slow motion
- Excessive fatigue and loss of energy
- Complaints of physical pain such as headaches, back pain, stomach upset
Psychological
- Feelings of worthlessness
- Feeling helpless or hopeless
- Excessive guilt
- Chronic indecisiveness
- Excessive crying
- Thoughts of death or “not being here anymore”
- Suicidal gesturing or attempts
In addition to these symptoms, depressed teenagers typically isolate in their bedrooms, experience significant academic decline, and turn to drugs, alcohol, food or acts of self-harm to self-medicate or feel numb. They may try to escape through excessive Internet or video game use. Parents and other family members report that the adolescent is frequently angry and becomes defensive in their interpersonal interactions. This is especially true when parents first express their concerns about noticeable changes in their teenager’s mood and behaviors.
Despite any resistance, minimization, or denial on the part of the teen, significant others should trust their observations and instincts and seek out a professional assessment to either rule out or corroborate their suspicions. As I've stated in previous blog posts, rather than saying, “You need help,” the best approach is to say, “You deserve support.” This can help to reduce a teenager’s defensiveness or the belief that they are “crazy.” The good news is depression is treatable and with the help of a supportive therapist and, when needed, medication, adolescents can experience full remission, reconnecting with all of the enjoyable activities and meaningful relationships in their lives.
Missed Part 1 of this series? Click here.
