What Is Depression?
Plaguing 15 million people in the U.S. alone — and more than 350 million worldwide — depression is the most common mental health problem. It develops in children and adults alike, and more than 3% of teens aged 13–18 have encountered a seriously debilitating depressive order.
Depression is a chronic sadness that trickles into all aspects of a person’s life. It tends to get overlooked by both the victim and his or her loved ones, and even though it’s manageable with modern treatment, 80% of depressed people don’t receive professional help. Symptoms range from mild to severe. Those who suffer from heavy depression can have trouble getting out of bed in the morning, keeping a steady job, making friends or maintaining relationships.
What Are the Different Types of Depression?
The forms of depression (also known as depressive disorders) vary to a degree. Persistent depressive disorder (or PDD) is defined as a depressed mood that lasts for at least 2 years. Major depression, on the other hand, involves extreme symptoms that affect one’s ability to eat, sleep, work and otherwise function normally, even if only for a single instance (also known as an “episode”). PDD may or may not involve several episodes or major depression — it’s more so defined by the prolonged appearance of any depression symptoms.
Other, less common types of depression include:
- Psychotic Depression – severe depression plus some form of psychosis, such as hearing or seeing imaginary things (hallucinations) or accepting disturbing and unrealistic beliefs (delusions)
- Postpartum Depression – an overwhelming feeling caused by the hormonal, physical and lifestyle changes of giving birth, experienced by 10–15% of recent mothers (in 2013, 273,000 girls aged 15–19 became mothers)
- Seasonal Affective Disorder (SAD) – the onset of depression at the arrival of winter (i.e. less sunlight, colder temperatures), which tends to go away naturally when spring and summer come around again
Depression vs. Bipolar Disorder
Bipolar disorder, which affects nearly 6 million adults in the U.S., is a unique disorder that involves symptoms of depression. A bipolar person will experience drastic and unpredictable swings in their mood, causing them to dip into depression-level sadness at random times. Doctors previously described this as manic-depressive disorder. Around 83% of bipolar disorder cases are classified as “severe.”
More than 2.5% of American teens will be diagnosed as bipolar in their lifetime. Because the “lows” of bipolar disorder share much of the symptoms of depression — these periods are even called “depressive episodes” — it’s common for doctors and loved ones to confuse the two. Nearly 40% of people with bipolar disorder are at first misdiagnosed with a depressive disorder.
Depression vs. Sadness
Life is no pleasure cruise, as they say. We all have bad days, or even bad months, and experience sadness as a result. It’s common for many — perhaps young people more than anyone — to throw labels on these feelings. “I’m so depressed” is a phrase people apply to situations ranging from a bad grade on a test to a favorite band breaking up. But this has the potential to make light of those with diagnosable depression, which is a rather serious illness.
Sadness is a healthy, expected emotion to feel at points across your lifetime. We’re encouraged to feel and embrace sadness momentarily during traumatic events, either in our personal life or on a global scale. But the majority of us will move on in a short while and return to our well-balanced routine. Those struggling with depression don’t have that luxury. Even when someone with depression has reasons to be thrilled, or friends and family showering them with encouragement, they can be inconsolable and stay sunken with their head in their hands. Happiness is often out of reach for someone with a depressive disorder, while it’s just around the corner for someone feeling “sadness.” It’s important to understand this difference.
Causes of Depression in Teens
Depression is rarely traced back to a single cause. Rather than one factor, doctors believe that depression is caused by a combination of elements: genetic, biological, environmental and psychological factors. Depressive disorders take place in the brain — the appearance of which will be different than the brain of healthy individuals — and episodes can develop gradually over time or due to triggers (loss of a loved one, stressful job, etc.).
While depressive disorders often run in families, countless cases pop up in patients with no family history of depression. But experts believe that genetics play up to a 50% role in the general trend of these problems.
Is Depression Genetic?
If a teen’s parent or sibling has major depression, they are 2–3 times more likely to develop depression (20–30% overall compared to 10% in the average person). Chances are even greater in regards to bipolar disorder. If a parent is bipolar, the child has a 25% chance of experiencing some form of depression, and these odds increased to 50–75% if both parents are bipolar. And if your sibling has bipolar disorder, you’re 8–18 times more likely to develop bipolar disorder and 2–10 times more likely to develop major depressive disorder. Among people diagnosed as bipolar, 50% have a parent with a history of clinical depression. Additionally, the more relatives someone has with major depression, the more likely he or she will develop it at some point and the higher risk of it impairing their functionality.
Studies have also shown a noteworthy correlation in twins. If one identical twin becomes clinically depressed, the other twin has a 76% chance of also developing a depressive disorder at some point. In cases of twins being raised apart from each other, there’s still a 67% chance they will both develop depression.
Who’s Most at Risk?
By the end of the teenage years, 20% will have had at least one episode of major depression, and the average age of onset is 14 years old. An estimated 2.8 million teens in the U.S. aged 12–17 had a major depressive episode in 2014, which amounts to 11.4% of this age group. So while it’s a problem affecting people both young and old, teenagers are especially at risk — the result of an unsettling combination of growing pains, rapidly increasing responsibilities and the tragic first encounters with life’s major stressors (e.g. love, family drama, jobs, etc.).
In general, females are 70% more likely to experience depression than males. Between 2008 and 2010, 12% of girls aged 12–17 had a major depressive episode, compared to only 4% of males. Teens of mixed race are most prone to episodes of major depression, followed by Hispanic, white, Asian and finally African-American teens (although the prevalence across these groups is not significantly different). The highest rate of major depressive episodes is among 15-year-olds.
Social Media and Depression
As a parent, it’s impossible to ignore the younger generations’ fixation on the Internet — particularly, their involvement in social media. This new medium for communication and interacting with others has become omnipresent, with kids now carrying the world at their fingertips. More than 9 out of 10 teenagers in the U.S. use social media, having accounts on Facebook, Twitter, Instagram and the several other major social networks. More than 70% of teens are on Facebook alone. And as of 2015, nearly three-quarters of teens have or have access to smartphones. Tens of millions of American kids are now online on a 24/7 basis, the consequences of which are not always desirable.
The nature of social media allows for users to be bombarded by news (much of which is sad), and allows for them to engage with hundreds — if not thousands — of others in sometimes unflattering ways. The teenage mind is known for self-critique, seesawing self-esteem and comparing oneself to others. In the realm of social media, not only are teens comparing themselves to the images they see, but they are often being judged for the content that represents them.
Being picked on by someone on the Internet — a phenomenon known as “cyberbullying” — now runs rampant, and becomes a bigger problem each day. A 2015 study revealed that 23% of teens have been the target of cyberbullying, and 15% of teens admit bullying someone themselves.
“There were consistent associations between exposure to cyberbullying and increased likelihood of depression,”says Michele Hamm, a University of Alberta researcher involved with the study.
According to the study, the more cyberbullying a teen experienced, the more severe their depression symptoms became. Even during the worst of bullying, though, teens are rarely willing to speak up.
“Kids really are hesitant to tell anyone when cyberbullying occurs,” says Hamm. “There seems to be a common fear that if they tell their parents, for example, they’ll lose their Internet access.”
Over the last decade, a number of teen suicides were linked to cyberbullying. In 2013, 2 Florida girls were arrested and charged with felony aggravated stalking after a girl they bullied online jumped to her death. Across several Facebook posts, they called the girl ugly and encouraged her to kill herself. Even after her death, they talked negatively about her in public posts on the social network.
At the end of 2015, Twitter added stricter enforcements against cyberbullying, emphasizing that they would “not tolerate behavior intended to harass or intimidate.” They promise to suspend or close the accounts of people who appear to abuse others. Even as laws develop, cyberbullying remains a major threat to your teen’s emotional well-being. If your son or daughter uses social media, talk with them about cyberbullying and make sure they’re not already being victimized.
If your teen doesn’t already feel a need to compete, involvement in social media can easily change that. By design, networks like Facebook and Twitter invite friends and followers to “like” your content (i.e. the photos you share, the statuses you post, etc.). Viewers can see how many “likes” their friends are getting, in addition to the ones that he or she is (or isn’t) getting. This can make teenagers feel envious of others who receive a higher number of likes. When a teen sees their friend’s photo receive glowing feedback, their own self-esteem can suffer a blow. Multiply this by the hundreds (or thousands) of people your teen follows, and this can become a glaring issue.
This need for social media validation can extend into adulthood. Many stories and studies have been written at this point about social media’s effect on self-image and self-worth. A study by the University of Gothenburg in Sweden showed that as Facebook interactions increase, self-esteem decreases. Females subjects in the study who used Facebook reported being less happy and content with their lives. This declining self-esteem — especially as a teen’s involvement with social media grows — can open the door to depressive disorders.
Effects of Depression
As if the teenage years aren’t traumatic enough, a clinical mental problem like depression can turn even the smallest hurdles into gargantuan challenges. Depression has the potential to sideline teens in a number of ways, and introduce risks and dangers that they’re simply unprepared to take on.
Depression and the Brain
Depressive disorders, depending on their severity, can break a teen down at the mental level. They will feel persistently sad, anxious or “empty,” and unable to focus their mind to the positive. Feelings of hopelessness, worthlessness and guilt will pervade their thinking, overshadowing their accomplishments or sense of self-worth. Because of this, they can have difficulty concentrating, remembering, learning new information or making decisions.
They will also spend much of their time on “rumination,” or thinking about how miserable they are. This tendency can sink them further and further into their funk, and also impede their logic and problem-solving abilities. Ruminating also increases activity in the amygdala, the brain’s fear system, and increases avoidant behavior.
The longer depression goes untreated, the more damage it can inflict on the brain, especially during the developmental teen years. Brain scans of depressed individuals show abnormalities in regions like the anterior cingulate (the brain’s conflict-resolution area) and the prefrontal cortex, which is involved with planning and executive activities. An increased level of cortisol (a steroid hormone) caused by high levels of depression can damage the hippocampal neurons, which can lead to memory loss. A particular study of the brain during depression also shows that parts of it can shrink in size following extended periods of depression. This progressive brain damage can leave them vulnerable to far more serious diseases down the road.
Effects on the Body
As the depressed mind lays on the negative feelings, the body can run the gauntlet as a result. People suffering from depression typically report fatigue and notable deficits of energy, making routine tasks like getting dressed and going to school feel insurmountable. A person’s sleep schedule while depressed can become a jumbled mess as well, marked by restlessness, insomnia, early-morning awakening or oversleeping. Over the long-term, depression can often cause shifts in weight as well — whether weight gain and overeating or weight loss and no appetite.
Other known physical effects of depression include headaches, digestive disorders and generalized pain.
The sinking feeling of depressive disorder can cause teens to lose their way. It’s a domino effect that, the longer it goes untreated, can interrupt their entire life. They will start missing out on school or have trouble performing while in class. They’ll lose interest in activities, clubs, sports and any part-time jobs, and will either lose their appetite or eat excessively — which can develop into a diagnosable eating disorder. They’ll have difficulty maintaining friendships and relationships, and may skip out on family time in exchange for sitting in their room. And these pent up emotions can make them irritable, and liable to lash out at loved ones unexpectedly.
It’s common for depression to coincide with another ongoing health problem. Other than eating disorders, depression may result from or be a cause of anxiety disorder, self-harm or a substance addiction — which is what happens when a teen misuses and develops a persistent, destructive reliance on a particular substance.
Depression and Substance Abuse
Teenage depression often goes hand-in-hand with substance use disorders — unhealthy and deep-seated relationships with drugs or alcohol. The causation can be twofold: teens who are depressed will often pick up substance habits to cope, and teens with preexisting substance problems can develop depressive disorders as a side effect. Emotional vulnerability in depressed times, paired with “negative urgency” — a tendency to act rashly during periods of extreme negative emotion — creates a volatile situation that often drives depressed teens to experiment with substances. Whether this develops into a serious problem depends on the circumstances, such as the substance involved and the extent of the teen’s mental illness.
In 2013, 1.4% of adolescents in the U.S.— approximately 359,000 kids aged 12–17 —had a substance use disorder and a co-occurring disorder related to depression. Studies show that 1 in 3 depressed people also have an unhealthy relationship with drugs or alcohol in some fashion.
Depression and Suicide
Suicide is the 2nd leading cause of teen among young people, killing 7 in 100,000 kids aged 15–19 each year. And for every reported suicide, 12 people engage in some form of self-harm. The leading cause of suicide is depression that goes untreated.
A severely depressed teenager will feel hopeless, and as the feelings build inside them, they may justify the idea of giving up. They may jump to this conclusion before thinking about reaching out for help. As a parent, it’s vital to stay in tune with your children and keep an eye out for signs of depression. In addition to the common signs of depression (listed below), a teen contemplating suicide may exhibit some other symptoms. These can include:
- Talking about dying, disappearing or other methods of self-harm
- A recent loss (e.g. divorce, death in the family, broken relationship, etc.)
- Fear of losing control, acting erratically or harming oneself or others
- No hope for the future
According to data by the Centers for Disease Control and Prevention, 1 in 5 teens in the U.S. gives serious consideration to suicide annually, and 8% of adolescents attempt suicide. If you have a son or daughter in high school, there’s a chance they’ve either toyed with the idea or know someone who has. Suicide is preventable. By addressing the depression beneath the surface as quickly as possible, and by making sure your teen knows how much they are valued, you can help prevent the depression from escalating into self-harm or suicide.
What Are Symptoms of Depression in Teens?
Depression can materialize in ways both big and small. As symptoms go unaddressed and untreated, your teen’s depression is at risk of growing more severe. Noticing any signs of depression at their early stages can help you and your teen attack the problem before it gets any worse.
Symptoms of depression can include:
- Lack of enthusiasm, motivation or energy
- Sadness or hopelessness
- Withdrawal from friends and activities
- Irritability, anger or rage
- Restlessness and changes in sleep patterns
- Change in appetite and weight
- Poor performance in school
- Indecision, forgetfulness and lack of concentration
- Poor self-esteem or feelings of guilt
- Problems with authority
If you observe a substance problem or suicidal thoughts, depression may be in play. In any case, identifying these issues in your teen demands immediate attention, regardless of the underlying cause.
How Is Depression Treated?
A depressed teenager is in a delicate state. Fortunately, depressive disorders are generally addressable with professional treatment and dual diagnosis rehab options. Treating depression usually involves medication — drugs known as “antidepressants” — and sessions with a therapist or counselor.
Before beginning any treatment, your teen should be carefully and thoroughly evaluated by a doctor. Therapy is often the first course of action in minor cases, and a few meetings with a therapist can help determine the severity and persistence of a teen’s depression and if medication is necessary. If and when your doctor recommends antidepressants for your teen, it’s crucial to follow their instructions closely and monitor your son or daughter’s dosage and progress along the way. These medications are very powerful, and taken improperly can stir a new set of problems.
The most common antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. Popular SSRI medications include:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluvoxamine (Luvox)
Fluoxetine is the only FDA-approved medication for treating depression in children aged 8 or older, but in certain cases, doctors will still prescribe the other SSRIs. One major exception is paroxetine (also known as Paxil), which the FDA recommended in 2003 should not be used for treating major depressive disorder in children or teens.
Only your teen’s doctor and therapist can determine how best to treat their depression. Make sure you trust your doctor, and your son or daughter doesn’t begin any treatment that seems dangerous.
Does Your Child Need Treatment?
If you notice signs of depression in your teen, contact their personal physician and discuss the issue before it gets any worse. Teens who are suffering from addiction and depression tend to benefit from well-rounded dual diagnosis treatment, which addresses both the addiction behavior and the causes behind it. Meet with your family physician to have your child diagnosed, and together discuss which treatment methods are right for them.
Treatment may be done through an outpatient program, where your teen commutes to scheduled meetings while they continue to live at home. But in extreme cases, short-term hospitalization or residential treatment may be recommended to ensure safety, particularly if your teen is overwhelmed by their illness or talking about self-harm.
We at TeenRehabCenter.org are available to answer any questions that you may have about addiction treatment, or dual diagnosis therapies. We can help you sort through the confusion of your family’s painful situation, and devise a plan back to wellness for your child. Call today to speak with a compassionate treatment advisor.
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