Teen depression is a serious medical problem that

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1 DEPRESSION IN TEENAGERS MENTAL HEALTH Teen depression is a serious medical problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teen thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although mood disorders, such as depression, can occur at any time in life, symptoms may be different between teens and adults. Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for teens. But for some teens, the lows are more than just temporary feelings they re a symptom of depression. Teen depression isn t a weakness or something that can be overcome with willpower it can have serious consequences and requires long-term treatment. For most teens, depression symptoms ease with treatment such as medication and psychological counseling. SYMPTOMS Teen depression signs and symptoms include changes in your teen s emotions and behavior, such as the examples below. EMOTIONAL CHANGES Be alert for emotional changes, such as: Feelings of sadness, which can include crying spells for no apparent reason Irritability, frustration or feelings of anger, even over small matters Loss of interest or pleasure in normal activities Loss of interest in, or conflict with, family and friends Feelings of worthlessness, guilt, fixation on past failures or exaggerated self-blame or self-criticism Extreme sensitivity to rejection or failure, and the need for excessive reassurance Trouble thinking, concentrating, making decisions and remembering things Ongoing sense that life and the future are grim and bleak Frequent thoughts of death, dying or suicide BEHAVIORAL CHANGES Watch for changes in behavior, such as: TEN TWENTY ADOLESCENT CLINIC Tiredness and loss of energy Insomnia or sleeping too much Changes in appetite, such as decreased appetite and weight loss, or increased cravings for food and weight gain Use of alcohol or drugs Agitation or restlessness for example, pacing, hand-wringing or an inability to sit still Slowed thinking, speaking or body movements Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse Poor school performance or frequent absences from school Neglected appearance such as mismatched clothes and unkempt hair Disruptive or risky behavior Self-harm, such as cutting, burning, or excessive piercing or tattooing WHAT S NORMAL AND WHAT S NOT It can be difficult to tell the difference between ups and downs that are just part of being a teenager and teen depression. Talk with your teen. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming. If depression symptoms continue or begin to interfere in your teen s life, talk to a doctor or a mental health professional trained to work with adolescents. Your teen s family doctor or pediatrician is a good place to start. Or your teen s school may recommend someone. WHEN TO SEE A DOCTOR If you suspect your teenager is depressed, make a doctor s appointment as soon as you can. Depression symptoms likely won t get better on their own and they may get worse or lead to other problems if untreated. Depressed teenagers may be at risk of suicide, even if signs and symptoms don t appear to be severe. If you re a teen and you think you may be depressed or you have a friend who may be depressed don t wait to get help. Talk to a health care professional such

2 as your doctor or school nurse. Share your concerns with a parent, a close friend, a spiritual leader, a teacher or someone else you trust. SUICIDAL THOUGHTS If your teen is having suicidal thoughts, get help right away. Take all talk of suicide seriously. Here are some steps you can take: Call a suicide hotline number in the United States, call the National Suicide Prevention Lifeline at TALK ( ) to reach a trained counselor or encourage your teen to do so. Seek help from your doctor, a mental health provider or other health care professional. Reach out to family members, friends or spiritual leaders for support as you seek treatment for your teen. WHEN TO GET EMERGENCY HELP If you think your teen is in immediate danger of self-harm or attempting suicide, make sure someone stays with him or her. Call 911 or your local emergency number immediately. Or if you think you can do so safely, take your teen to the nearest hospital emergency department. CAUSES It s not known exactly what causes depression. A variety of factors may be involved. These include: Biological chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. When these chemicals are out of balance, it may lead to depression symptoms. Hormones. Changes in the body s balance of hormones may be involved in causing or triggering depression. Inherited traits. Depression is more common in people whose biological (blood) relatives also have the condition. Early childhood trauma. Traumatic events during childhood, such as physical or emotional abuse, or loss of a parent, may cause changes in the brain that make a person more susceptible to depression. Learned patterns of negative thinking. Teen depression may be linked to learning to feel helpless rather than learning to feel capable of finding solutions for life s challenges. RISK FACTORS Many factors increase the risk of developing or triggering teen depression, including: Having issues that negatively impact self-esteem, such as obesity, peer problems, long-term bullying or academic problems Having been the victim or witness of violence, such as physical or sexual abuse Having other conditions, such as an anxiety disorder, anorexia or bulimia, attention-deficit/hyperactivity disorder (ADHD) or learning disabilities Having a chronic medical illness such as cancer, diabetes or asthma Having few friends or other personal relationships Having certain personality traits, such as low self-esteem or being overly dependent, self-critical or pessimistic Abusing alcohol, nicotine or other drugs Being a girl depression occurs more often in females than in males Being gay, lesbian, bisexual or transgender becoming socially isolated or experiencing bullying may increase the risk of depression Family history and issues with family or others may also increase your teen s risk of depression: Having a parent, grandparent or other biological (blood) relative with depression, bipolar disorder or alcoholism Having a family member who committed suicide Having a dysfunctional family and conflict Having experienced recent stressful life events, such as parental divorce, parental military service or the death of a loved one Untreated depression can result in emotional, behavioral and health problems that affect every area of your teen s life. Complications related to teen depression can include: Low self-esteem Alcohol and drug abuse Academic problems Family conflicts and relationship difficulties Social isolation Involvement with the juvenile justice system Suicide PREPARING FOR YOUR APPOINTMENT You may choose to start by contacting your teen s family doctor or pediatrician. In some cases, you may be referred directly to a mental health professional, such as a psychiatrist or psychologist. WHAT YOU CAN DO To the extent possible, involve your teen in preparing for the appointment. Then make a list of: Any symptoms your teen has had, including any that

3 may seem unrelated to the reason you scheduled the appointment Key personal information, including any major stresses or recent life changes your teen has experienced All medications, vitamins, herbal remedies or supplements that your teen is taking Questions that you and your teen want to ask the doctor BASIC QUESTIONS TO ASK THE DOCTOR INCLUDE: Is depression the most likely cause of my child s symptoms? What are other possible causes for my child s symptoms or condition? What kinds of tests will he or she need? What treatment is likely to work best? Are there any possible side effects with the medications you re recommending? Is there a generic alternative to the medicine you re prescribing? How will we monitor progress and effectiveness of the treatment? What are the alternatives to the primary approach that you re suggesting? My teen has these other health conditions. Could they be linked to depression? Are there any restrictions that my teen needs to follow? Should my teen see a psychiatrist or other mental health provider? Will making changes in diet, exercise or other areas help ease depression? Are there any printed materials that we can take home? What websites do you recommend? Don t hesitate to ask questions any time you don t understand something. WHAT TO EXPECT FROM YOUR TEEN S DOCTOR To make the most of the time allotted, make sure your teen is ready to answer questions from the doctor, such as: When did family members or friends first notice your symptoms of depression? How long have you felt depressed? Do you generally always feel down, or does your mood change? Does your mood ever swing from feeling down to feeling extremely happy and full of energy? Do you ever have suicidal thoughts when you re feeling down? How severe are your symptoms? Do they interfere with school, relationships or other day-to-day activities? Do you have any biological (blood) relatives such as a parent or grandparent with depression or another mood disorder? What other mental or physical health conditions do you have? Are you using any mood-altering substances, such as alcohol, marijuana or street drugs? How much do you sleep at night? Does the amount change over time? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What is your diet like? Do you have a history of significant weight gain or loss? TESTS AND DIAGNOSIS When teen depression is suspected, the doctor will generally do these exams and tests. Physical exam. The doctor may do a physical exam and ask in-depth questions about your teen s health to determine what may be causing depression. In some cases, depression may be linked to an underlying physical health problem. Lab tests. For example, your teen s doctor may do a blood test called a complete blood count or test your teen s thyroid to make sure it s functioning properly. Psychological evaluation. This evaluation will include a discussion with your teen about thoughts, feelings and behavior, and may include a questionnaire. These will help pinpoint a diagnosis and check for related complications. DIAGNOSTIC CRITERIA FOR DEPRESSION To be diagnosed with depression, your teen must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. Symptoms can be based on your teen s feelings or on the observations of someone else. For a diagnosis of major depression, the following symptoms must occur most of the day, nearly every day, during at least a two-week period, and be a change or worsening in the teen s usual attitude and behavior. Your teen must have at least one of the following: Depressed mood, such as feeling sad, empty or tearful (in teens, depressed mood can appear as constant irritability) Diminished interest or feeling no pleasure in any or most activities Your teen must also have four or more of the following:

4 Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in teens, failure to gain weight as expected can be a sign of depression) Insomnia or increased desire to sleep Restlessness or slowed behavior that can be observed by others Fatigue or loss of energy Feelings of worthlessness, or excessive or inappropriate guilt Trouble making decisions, thinking or concentrating Recurrent thoughts of death or suicide, making a suicide plan or a suicide attempt TO BE CONSIDERED MAJOR DEPRESSION: Symptoms aren t due to a mixed episode, which is mania along with depression that sometimes occurs as a symptom of bipolar disorder Symptoms must be severe enough to cause noticeable problems in day-to-day activities, such as school, social activities or relationships with others Symptoms are not due to the direct effects of something else, such as drug abuse, taking a medication or having a medical condition such as hypothyroidism Symptoms are not caused by grieving, such as temporary sadness after the loss of a loved one OTHER TYPES OF MAJOR DEPRESSION INCLUDE: Atypical depression. In this type of depression, key signs and symptoms include increased hunger, weight gain, sleeping a lot, feeling that your arms and legs are heavy, and difficulty maintaining relationships. Postpartum depression. This type of depression can occur in new mothers. It can begin shortly after delivery or even several weeks later. Signs and symptoms are more intense and longer lasting than the baby blues, eventually interfering with the ability to care for the baby and handle other daily tasks. Psychotic depression. This is severe depression accompanied by psychotic symptoms, such as delusions or hallucinations. Dysthymia. Dysthymia (dis-thie-me-uh) is a less severe, but more long-term form of depression. While it s usually not disabling, dysthymia can prevent your teen from functioning normally in a daily routine and from living life to the fullest. OTHER CONDITIONS THAT CAUSE DEPRESSION SYMPTOMS There are several other conditions with symptoms that can include depression. It s important to get an accurate diagnosis so that your teen gets appropriate treatment. Your doctor or mental health provider s evaluation will help determine if the symptoms of depression are caused by one of the following conditions: Seasonal affective disorder. This type of depression is related to changes in seasons and diminished exposure to sunlight. Adjustment disorder. An adjustment disorder is a severe emotional reaction to a difficult event in your life. It s a type of stress-related mental illness that may affect feelings, thoughts and behavior. Bipolar disorder. Bipolar disorder is characterized by mood swings that range from the highs of mania to the lows of depression. It s sometimes difficult to distinguish between bipolar disorder and depression, but it s important to get an accurate diagnosis because treatment for bipolar disorder is different from that for other types of depression. Cyclothymia. Cyclothymia (sy-kloe-thie-me-uh), or cyclothymic disorder, is a milder form of bipolar disorder. Schizoaffective disorder. Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder such as depression. Many types of treatment are available. In some cases, a primary care doctor can prescribe medications that relieve depression symptoms. However, many teens need to see a psychiatrist or psychologist or other mental health counselor. A combination of medications and psychological counseling (psychotherapy) is very effective for most teens with depression. If your teen has severe depression or is in danger of selfharm, he or she may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve. Here s a closer look at depression treatment options. MEDICATIONS Because studies on the effects of antidepressants in teens are limited, doctors rely mainly on adult research when prescribing medications. The Food and Drug Administration (FDA) has approved two medications for teen depression fluoxetine (Prozac) and escitalopram (Lexapro). However, as with adults, other medications may be prescribed at the doctor s discretion (off label), depending on your teen s needs. Talk with your teen s doctor and pharmacist about possible side effects, weighing the benefits and risks. In some cases, side effects may go away as the body adjusts to the medication. Antidepressants and increased suicide risk Although antidepressants are generally safe when taken as directed, the FDA requires that all antidepressants

5 carry black box warnings, the strictest warnings for prescriptions. In some cases, children, adolescents and young adults under the age of 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So, people in these age groups must be closely monitored by loved ones, caregivers and health care providers. If your teen has suicidal thoughts while taking an antidepressant, immediately contact your doctor or get emergency help. For most teens, the benefits of taking an antidepressant generally outweigh any possible risks. In the long run, antidepressants are likely to reduce suicidal thinking or behavior. MANAGING MEDICATIONS Carefully monitor your teen s use of medications. To work properly, antidepressants need to be taken consistently at the prescribed dose. Because overdose can be a risk for teens with depression, your teen s doctor may prescribe only small supplies of pills at a time, or recommend that you dole out medication so that your teen does not have a large amount of pills available at once. FINDING THE RIGHT MEDICATION Everyone s different, so finding the right medication or dose for your teen may take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as the body adjusts. If your teen has bothersome side effects, he or she shouldn t stop taking an antidepressant without talking to the doctor first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered off quitting suddenly may cause a sudden worsening of depression. Encourage your teen not to give up. If antidepressant treatment doesn t seem to be working, your teen s doctor may recommend a blood test called cytochrome P450 (CYP450) to check for specific genes that affect how the body processes antidepressants. This may help identify which antidepressant might be a good choice. However, these genetic tests have limitations and may not be widely available. ANTIDEPRESSANTS AND PREGNANCY If your teen is pregnant or breast-feeding, some antidepressants may pose an increased health risk to her unborn or nursing child. If your teen becomes pregnant or plans to become pregnant, make certain she talks to her doctor about antidepressant medications and managing depression during pregnancy. PSYCHOTHERAPY Psychotherapy, also called psychological counseling or talk therapy, is a general term for treating depression by talking about depression and related issues with a mental health provider. Psychotherapy may be done one-on-one, with family members or in a group. Through these regular sessions, your teen can learn about the causes of depression, how to identify and make changes in unhealthy behaviors or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals. Psychotherapy can help your teen regain a sense of happiness and control and help ease depression symptoms such as hopelessness and anger. It may also help your teen adjust to a crisis or other current difficulty. Hospitalization and other treatment programs In some teens, depression is so severe that a hospital stay is needed, especially if your teen is in danger of self-harm or hurting someone else. Getting psychiatric treatment at a hospital can help keep your teen calm and safe until symptoms are better managed. Day treatment programs also may help. These programs provide the support and counseling needed while your teen gets depression symptoms under control. LIFESTYLE AND HOME REMEDIES You are your teen s best advocate to help him or her succeed. Here are some steps you and your teen can take that may help: Stick to the treatment plan. Make sure your teen attends appointments, even if he or she doesn t feel like going. Even if your teen is feeling well, make sure he or she continues to take medications as prescribed. If your teen stops taking medications, depression symptoms may come back. Quitting suddenly may cause withdrawal-like symptoms. Learn about depression. Education can empower your teen and motivate him or her to stick to a treatment plan. It can also benefit you and other loved ones to learn about your teen s depression and understand that it s a treatable condition. Encourage communication with your teen. Talk to your teen about the changes you re observing and emphasize your unconditional support. Create an environment where your child can share concerns while you listen. Pay attention to warning signs. Work with your teen s doctor or therapist to learn what might trigger depression symptoms. Make a plan so that you and your teen

6 know what to do if symptoms get worse. Ask family members or friends to help watch for warning signs. Make sure your teen adopts healthy habits. Even light physical activity can help reduce depression symptoms. Sleeping well is important for all teens, especially those with depression. If your teen is having trouble sleeping, ask the doctor for advice. Help your teen avoid alcohol and other drugs. Your teen may feel like alcohol or drugs lessen depression symptoms, but in the long run they worsen symptoms and make depression harder to treat. Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren t a substitute for professional care. But some mind-body therapies may help. Mind-body connections Complementary and alternative medicine practitioners believe the mind and body must be in harmony to stay healthy. Examples of mind-body techniques that may be helpful for depression include: Yoga or tai chi Meditation Guided imagery Massage therapy Relaxation techniques Music or art therapy Spirituality Acupuncture Relying solely on these therapies is generally not enough to treat depression. But they may be helpful when used in addition to medication and psychotherapy. COPING AND SUPPORT Showing interest and the desire to understand your teen s feelings lets him or her know you care. You may not understand why your teen feels hopeless or why he or she has a sense of loss or failure. Listen to your teen without judging and try to put yourself in his or her position. Help build your teen s self-esteem by recognizing small successes and offering praise about his or her competence. Encourage your teen to: Make and keep healthy friendships. Positive relationships can help boost your teen s confidence and stay connected with others. Encourage your teen to avoid relationships with people whose attitudes or behaviors could make depression worse. Stay active. Participation in sports, school activities or a job can help keep your teen focused on positive things, rather than negative feelings or behaviors. Ask for help. Teens may be reluctant to seek support when life seems overwhelming. Encourage your teen to talk to a family member or other trusted adult whenever needed. Have realistic expectations. Many teens judge themselves when they aren t able to live up to unrealistic standards academically, in athletics or in appearance, for example. Let your teen know that it s OK not to be perfect. Simplify life. Encourage your teen to carefully choose obligations and commitments, and set reasonable goals. Let your teen know that it s OK to do less when he or she feels down. Structure time. Help your teen plan activities by making lists or using a planner to stay organized. Encourage your teen to keep a private journal. Journaling may help improve mood by allowing your teen to express and work through pain, anger, fear or other emotions. Connect with other teens who struggle with depression. Talking with other teens facing similar challenges can help your teen cope. So can learning skills to manage life s challenges. Local support groups for depression are available in many communities. And support groups for depression are offered online, but check them out to make sure they re credible and trustworthy sites. Good places to start are the National Alliance on Mental Illness and the Depression and Bipolar Support Alliance. Stay healthy. Do your part to make sure your teen eats regular, healthy meals, gets regular exercise and gets plenty of sleep. There s no sure way to prevent depression. However, these strategies may help. Encourage your teen to: Take steps to control stress, such as not committing to too many obligations at once. Boost low self-esteem by recognizing small steps toward getting better. Reach out for friendship and social support, especially in times of crisis. Get treatment at the earliest sign of a problem to help prevent depression from worsening. Maintain ongoing treatment, if recommended, even after symptoms let up, or have regular therapy sessions to help prevent a relapse of depression symptoms Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. Used with permission

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