Health Topics

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 may also predict more severe illness in adulthood.
• There is an increased incidence of depression in children whose parents experience depression.

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

• Family history of mental illness, including depression and suicide (especially if a parent experienced depression as a child or adolescent)
• Excessive stress
• Abuse (physical, sexual, emotional) or neglect
• Trauma (physical, emotional, sexual)
• Other psychiatric disorders
• Loss of a parent, caregiver, or other loved one, especially at an early age, to divorce, death, or abandonment
• Loss of a relationship (i.e., moving away, loss of boyfriend/girlfriend)
• Other chronic illnesses (i.e., diabetes)
• Other developmental, learning or conduct disorders

The following are the most common symptoms of major depression. However, each child or adolescent may experience symptoms differently. Symptoms may include:

• Persistent feelings of sadness, irritability, hostility or aggression
• Feeling hopeless or helpless
• Having low self-esteem
• Feeling inadequate
• Excessive guilt
• Recurring thoughts of suicide or death
• Loss of interest in usual activities
• Loss of pleasure or no longer enjoying pleasurable activities
• Difficulty with relationships
• Sleep disturbances (insomnia, hypersomnia)
• Changes in appetite or weight
• Change in activity level -- either increased or decreased energy
• Difficulty concentrating, remembering or thinking clearly
• A decrease in the ability to make decisions
• Suicidal thoughts or attempts
• Frequent physical complaints (headache, stomach ache, fatigue)
• Running away or threats of running away from home
• Hypersensitivity to failure or rejection
• Anger and rage
• Feeling empty inside
• Anxiety

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. The symptoms of major depression may resemble other problems or psychiatric conditions. Always consult your adolescent's physician for a diagnosis.

Because depression has shown to often co-exist with other psychiatric disorders, such as bipolar disorder, substance abuse or anxiety disorders, seeking early evaluation, diagnosis and treatment are crucial to the recovery of your adolescent or child.

A child and adolescent 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, may also be helpful in making a diagnosis.

Specific treatment for major depression will be determined by your adolescent's physician based on:

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

Mood disorders, including major depression, can be effectively 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 is 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
• Consultation with the adolescent's school

Parents play a vital supportive role in any treatment process. For many reasons, many parents of adolescents with depression never seek the appropriate treatment for their adolescent, although, approximately 80 percent of all people with major depression who seek treatment improve, usually within weeks. Continued treatment may help to prevent reoccurrence 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 adolescents is also associated with an increased risk for suicide.

Suicide risk rises, particularly among adolescent boys, when the depression is accompanied by other mental health disorders (conduct disorder, substance abuse). It is crucial for parents and care providers of adolescents to take all depressive and suicidal symptoms very seriously and seek treatment immediately.

Suicide is a medical emergency. Consult your adolescent's physician for more information.