When is a Teenager Depressed?

“I’m really worried about him.  He seems to be acting strange and is always angry.  I think he might be depressed!”

Comments like this are not uncommon from parents of teenagers. Given the emotional roller coaster that is adolescence, knowing how to distinguish between normal teenage angst and genuine clinical  depression can be very confusing.

It can also be quite worrying when considering the prevalence of depression amongst teenagers and the impact it has on their lives. It is estimated that at any one time up to 5% of teenagers are experiencing depressive episodes severe enough to warrant treatment.  Sufferers of depression are highly represented amongst those who commit or attempt suicide. Given suicide is one of the highest killers of teenage males in the western countries, teenage depression deserves to be taken seriously.

Normal Life and Depression

A good place to start is to determine what depression isn’t. Negative emotions are a part of life, not an illness to be diagnosed.  As with all stages of life the teenage years are filled with ups and downs. Teenagers will feel down, they will behave in odd ways, and they may develop bad habits.  This is normal.  Be advised that a teenager is not depressed just because they are:

• Feeling sad or upset about something. (This is a normal part of life!)
• Prone to random angry outbursts or moodiness. (This is a common part of adolescence!)
• Heartbroken about a failed relationship or missing out on selection for a sporting team.
• Sulking or not talking to parents
• Sitting up late surfing the internet or playing computer games.
• Wearing dark coloured clothes all the time.

All of the above are behaviours can be exhibited by teenagers with no serious emotional or psychological problems at all. While a teenager who is experiencing any of the above could be depressed, those traits alone do not constitute having depression.

What is Depression?

In order to diagnose depression most medical authorities have a criteria that aid in a diagnosis of depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines a depressive episode as one in which a person experiences at least 5 of the following 9 symptoms for the same two week period or more.

1. Depressed mood most of the day nearly every day.  Note for adolescents, this may be an irritable mood.
2. A significantly reduced level of interest or pleasure in most or all activities on most days nearly all day.
3. A considerable loss or gain of weight (5% or more change of weight in a month when not dieting). This may also present as an increase or decrease in appetite.
4. Difficulty falling or staying asleep, or sleeping more than usual nearly everyday (or night).
5. Behaving in a manner that is more agitated or slowed down. Others should be able to observe this.
6. Always feeling tired and fatigued.
7. Thoughts and feelings of worthlessness or extreme guilt nearly all the time.
8. Reduced ability to think, concentrate, or make decisions.
9. Frequently reoccuring thoughts of death or suicide, or attempt of suicide.

Obviously a few of the above symptoms will be experienced by everyone throughout a lifetime.  What is important to note is that depression occurs when an individual experiences a majority of these symptoms consistently within a short space of time.

When we focus more specifically on depression in teenagers the following symptoms may also be observed:

• Noticeable increase in destructive or rebellious behaviour.
• Significant drop in school performance.
• Constant commenting about how bad or hopeless they feel.
• Withdrawl from friends and social activity.
• Poorer hygene or standards of personal appearance.

Knowing what to look for is important. But what do you if you think your teenager might be depressed?

In the next post in this series we will look at what might cause depression and what are the likely casues.