DEPRESSION

Adolescent depression is a psychiatric condition that significantly impacts a teenager’s thoughts, feelings, and behaviors. Unlike the typical mood swings and emotional changes common during adolescence due to hormonal shifts and life’s pressures, depression is characterized by persistent feelings of sadness and a loss of interest in usual activities that can affect daily functioning.

Unfortunately, depression can ultimately lead to even more negative outcomes like self harm and completed suicide. Tragically, suicide attempts and completed suicides due to depression among adolescents are at an all time high in our country. Therefore, it is crucial that depression be identified and treated to prevent these devastating outcomes. The following are some signs of depression in children and adolescents:

1. Persistent sadness.
2. Feeling “empty” or disconnected.
3. Showing little interest in activities which used to interest them.
4. Trouble falling asleep, staying asleep, or sleeping too much.
5. Changes in appetite: poor appetite, weight loss, or overeating.
6. Feeling tired, fatigued or having little energy.
7. Feeling badly about themselves, believing they are a failure, or feeling they have let themselves or their family down are all signs of poor self-esteem. These are feelings of hopelessness and worthlessness.
8. Trouble concentrating on things like school work, reading, or watching TV.
9. Moving or speaking so slowly that other people could have noticed
10. Feelings of restlessness.
11. Physical symptoms with no clear cause (e.g., headaches, stomachaches).
12. Withdrawal from friends and activities.
13. Suicidal thoughts of ending their life.
    

Diagnosis of Adolescent Depression

The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Fifth Edition (DSM-5) provides specific criteria to diagnose major depressive disorder. A person must exhibit at least five of the following symptoms during the same two-week period, and these symptoms should represent a change from previous functioning. At least one of the symptoms must be either (1) depressed mood or (2) loss of interest or pleasure. The criteria are:

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). In children and adolescents, this might present as an irritable mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting, weight gain, or a decrease or increase in appetite nearly every day. In children, this might manifest as failing to make expected weight gains.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day, which is observable by others and not merely subjective feelings of restlessness or being slowed down.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive guilt nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide.

Additionally, the symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The episode must not be attributable to the physiological effects of a substance or to another medical condition.

Furthermore, it’s important to clarify that these symptoms cannot be better explained by a psychotic disorder, such as schizophrenia. There must also be no history of a manic or hypo-manic episode, which would suggest a type of bipolar disorder rather than major depressive disorder.

Dangers of Adolescent Depression

If left untreated, adolescent depression can have severe consequences, including:

1. Academic Decline: Depression can impair a teenager’s ability to focus and perform well in school, leading to declining grades.
2. Social Isolation: Depression often results in withdrawal from friends and family, contributing to feelings of loneliness and isolation.
3. Substance Abuse: Some teenagers may turn to alcohol or drugs as a way to cope with depressive symptoms.
4. Self-Injury: Engaging in self-harming behaviors, such as cutting or burning, can be a cry for help and a way to manage emotional pain.
5. Suicide: Perhaps the gravest risk associated with untreated depression. It’s essential to take all signs of depression seriously due to the risk of self-harm and suicidal ideation.
   

Treatment of Adolescent Depression

Effective treatment for adolescent depression typically involves a combination of therapeutic strategies:

1. Psychotherapy options include:

• Interpersonal Therapy (IPT): This focuses on improving communication skills and resolving interpersonal issues that may be contributing to the individual's depression. Forgiveness is a crucial component, both in offering forgiveness to others and in fostering self-forgiveness, as unresolved grievances can exacerbate depressive symptoms. Additionally, any instances of bullying or abusive behavior must be addressed and halted to create a positive and supportive environment for the individual. Family therapy engages family members to improve communication, resolve conflicts and promote mutual support.
• Cognitive Behavioral Therapy (CBT), which helps adolescents identify and restructure negative thinking patterns and behaviors.

2. Medication management such as antidepressants may be prescribed.

3. Lifestyle changes are important:

• Regular exercise: this helps mood and energy levels.
• Go outside into nature and marvel at the beauty of creation. Get some sun, but don’t sunburn. Go hiking, canoeing, or swimming.
• Maintaining a healthy diet rich in fruits, vegetables, and omega-3 fatty acids found in fish. Take a daily multivitamin.
• Adequate Sleep: Proper sleep is crucial for mood regulation. Get enough sleep: 8 hours each night. However, this must be done in a proper routine. Get up at the same time each morning. Go to bed at the same time at each evening. Good sleep routines are needed.
• Eliminate alcohol and drug abuse: Substance abuse can make depressive symptoms much worse.

4. Support Systems:

• School Counseling: School psychologists and counselors can provide support and resources.
• Support Groups: Connecting with others experiencing similar issues can reduce feelings of isolation.
• Fellowship of other people.  It is important to connect to other people. Humans are meant to connect and communicate. A counselor can help with one on one communication. Family members can connect. A faith based group can help connect the person suffering from depression in meaningful ways. Reach out to friends. Isolation is like poison to a human being.

5. Get off Social media. Delete Facebook, Twitter and Instagram accounts. Social media is very disturbing to teenagers!

6. Work. There is something very satisfying about doing work and getting paid for it. This raises self esteem and helps promote a daily routine. Don’t overdo work however. Get in a good rhythm.

[The following is spoken directly to the person suffering from depression].

1. Cooperate with the treatment plan outlined above for counseling, medication management, lifestyle changes and support systems. 
2. Think about where you are in life and set some goals for your life. Dream big. God has prepared you for big things. Find your dream, then go for it with all you have.  Do some work.  It is satisfying to be paid and work helps to raise your self esteem. 
3. Get off social media.  This makes depression worse. 
4. Do something fun. Everyday do something that you enjoy. Outdoor activities with friends are best. Soccer, softball, and running are all good sports. What is important is that you enjoy it. If the activity can be outside and with friends you can accomplish other goals simultaneously. Sports participation is protective against depression.
5. If you are being abused or bullied, tell someone in authority. Get the abuse stopped. Stop the bullying. It is possible. Being the bully, or being bullied, causes depression and hopelessness.
6. Most importantly, get your spiritual life right. Read God’s word, the Bible. It is life giving. The Gospel of John is a great place to start. Get right with God and other people you know. Ask forgiveness for what you have done wrong both to God and others. Grant forgiveness to people who have wronged you. Sometimes, this involves the people who are closest to us. If this list is extensive or severe (like divorce of your parents), get a counselor and or pastor involved to help you with this important aspect of your life. If you have been hurt in relationships, forgive them. Let it go. Not forgiving leads to a bitterness, a sourness of soul that causes depression. Counseling can help in this.

Don’t try to do all this in the same day, but build each aspect in gradually and try to incorporate these things in your life as you can. May God bless you greatly with a sound mind. [End]

Adolescent depression is a serious but treatable condition. Awareness and early intervention are vital. If you suspect a teenager might be experiencing depression, encourage them to speak to a trusted adult, such as a parent, teacher, or counselor. Professional help from mental health specialists can provide the necessary tools and support for recovery. Remember, seeking help is a sign of strength, and effective treatments are available.

Should these depression symptoms become noticeable you should bring your child into the office for an office visit. Should your child become suicidal call 911, go the nearest ER or call 1-800-SUICIDE (1-800784-2433).