Depression and Teens - Some Basics

Patient Expert

Teen years are difficult -- for both the teens and their families. Add depression to the situation, and it can be especially difficult to know where to turn, and what to do. Just as there are misconceptions about depression and adults, there are misconceptions about teens and depression. Some basics about depression and teens are in order.

It can be particularly difficult to differentiate between depression and typical teen behavior because that "typical" teen behavior is usually already marked by ups and downs in moods. A teenager can go from "Life rocks!" to "Life sucks!" in a period of hours. Their hormones are raging, and a pimple or a perceived snub by a classmate can send them into hysterics, brooding, or hibernation.

Signs of depression in teens:

There are signs of a serious depressive episode that are more or less classic:

  • persistent depressed mood
  • faltering school performance
  • failing relations with family and friends
  • substance abuse

Depression in adolescents, however, can manifest in very different ways. These behaviors are especially telling in teens:

  • excessive sleeping
  • change in eating habits
  • criminal behavior such as shoplifting
  • obsession with death, which may take the form either of suicidal thoughts or of fears about death and dying

In addition, teens my be experiencing depression if they exhibit:

  • depressed or irritable mood
  • temper, agitation
  • loss of interest or reduced pleasure in activities, apathy
  • inability to enjoy activities which used to be sources of pleasure
  • change in appetite, usually a loss of appetite but sometimes an increase
  • unintentional change in weight
  • persistent difficulty falling asleep or staying asleep
  • excessive daytime sleepiness
  • fatigue
  • difficulty concentrating
  • difficulty making decisions
  • memory loss (amnesia) episodes
  • preoccupation with self (beyond the usual teenage egocentrism)
  • feelings of worthlessness, sadness, or self-hatred
  • excessive or inappropriate feelings of guilt
  • acting-out behavior (missing curfews, unusual defiance)
  • excessively irresponsible behavior pattern

Adolescent girls are twice as likely as boys to experience depression. Risk factors include stressful life events, particularly loss of a parent to death or divorce; child abuse - both physical and sexual; unstable caregiving, poor social skills; chronic illness; and family history of depression. Depression is also associated with eating disorders, particularly bulimia.

If teens exhibit any of those behaviors for two weeks or more and cause significant distress or difficulty functioning, diagnosis and treatment should be sought.

Treatment of depression in teens:

Treatment options for teenagers with depression are similar to those for adults -- therapy, medications, or both. Family therapy may be helpful if family conflict is contributing to the depression. Support from family or teachers to help with school problems may also be needed. Occasionally, hospitalization in a psychiatric unit may be required for individuals with severe depression, or if they are at risk of suicide.

A combination of psychotherapy and antidepressant medication appears to be the most effective treatment for adolescents with major depressive disorder--more than medication alone or psychotherapy alone, according to results from a major clinical trial funded by the National Institutes of Health's National Institute of Mental Health (NIMH). The study was published in the October 2007 issue of the Archives of General Psychiatry. However, care should be taken when choosing an antidepressant for teenagers as some have been shown to increase rates of suicidal thinking, especially among children.

Because of the behavior problems that often co-exist with adolescent depression, many parents are tempted to send their child to a "boot camp", "wilderness program", or "emotional growth school."

These programs often use non-medical staff, confrontational therapies, and harsh punishments. There is no scientific evidence to support such programs. In fact, there is a growing body of research which suggests that they can actually harm sensitive teens with depression.

In addition to antidepressants, sometimes other medications are prescribed off-label for depression. There are always many questions to be answered when considering medications. Below is a chart of medications prescribed for various mental health conditions, along with the age range for which they're approved.2

Type of Medication

Brand Name

Generic Name

Approved Age

Stimulant Medications

Adderall

amphetamines

3 and older

Concerta

methylphenidate

6 and older

Cylert*

pemoline

6 and older

Dexedrine

dextroamphetamine

3 and older

Dextrostat

dextroamphetamine

3 and older

Ritalin

methylphenidate

6 and older

Antidepressant and Antianxiety Medications

Anafranil

clomipramine

10 and older (for OCD)

BuSpar

buspirone

18 and older

Effexor

venlafaxine

18 and older

Luvox (SSRI)

fluvoxamine

8 and older (for OCD)

Paxil (SSRI)

paroxetine

18 and older

Prozac (SSRI)

fluoxetine

18 and older

Serzone (SSRI)

nefazodone

18 and older

Sinequan

doxepin

12 and older

Tofranil

imipramine

6 and older (for bed-wetting)

Wellbutrin

bupropion

18 and older

Zoloft (SSRI)

sertraline

6 and older (for OCD)

Antipsychotic Medications

Clozaril(atypical)

clozapine

18 and older

Haldol

haloperidol

3 and older

Risperdal (atypical)

risperidone

5 to 16 years (for irritability associated with autistic disorder); 18 and older (for schizophrenia and bipolar mania)

Seroquel (atypical)

quetiapine

18 and older

(Generic Only)

thioridazine

2 and older

Zyprexa (atypical)

olanzapine

18 and older

Orap

pimozide

12 and older (for Tourette's syndrome). Data for age 2 and older indicate similar safety profile.

Mood Stabilizing Medications

Cibalith-S

lithium citrate

12 and older

Depakote

divalproex sodium

2 and older (for seizures)

Eskalith

lithium carbonate

12 and older

Lithobid

lithium carbonate

12 and older

Tegretol

carbamazepine

any age (for seizures)

*Because of its potential for serious side effects affecting the liver, Cylert should not ordinarily be considered as first line drug therapy for ADHD.

Summary and comments:

Recognizing and diagnosing depression in teens is far from easy. What seems like depression may be "normal" teenage behavior. If signs and symptoms of depression continue for two weeks or more, they should be evaluated by a mental health professional. If there is any doubt, err on the side of caution by getting a professional evaluation.

There is help available for teenagers experiencing depression and their families. Through therapy, medications, or both, teenage depression can be addressed, allowing teens and their families relief and improved quality of life.


Resources:

1 National Institute of Mental Health. "Depression in Children and Adolescents." Last updated June 27, 2008.

2 National Institute of Mental Health. "Treatment of Children with Mental Disorders." Last updated June 26, 2008.

3 National Institute of Mental Health. "Treatment for Adolescents with Depression Study (TADS)." Last updated April, 2008.