Decoding Depression: Causes and Signs of Depression in Teenagers

Rahul used to live with his parents in a joint family. But following his mother's job transfer, they had to move to a new town where Rahul was admitted to a new school in class IX. The 16-year old had been a topper till class VIII and he managed to get decent grades in class IX too.

However, the next year, his grades dipped and he started losing confidence in himself as a student. Feelings of hopelessness gradually set in and he started criticising himself for his failures. His morale took a further beating when his seniors started ridiculing him for his sense of dressing and body language. Consequently, Rahul lost his appetite, suffered sleepless nights and grew weak. He also started skipping school and avoiding participation in social activities.

A week before the start of his final exams, Rahul started showing signs of agitation and grew increasingly upset. His change of behaviour raised concerns in the minds of his parents and they checked his room. They were shocked to find that he was abusing sleep medications prescribed for his father. His parents took him to see a psychologist and psychotherapy was initiated. Rahul also started receiving treatment from a psychiatrist for addiction to drugs, and symptoms of sleeplessness and suicidal ideation. After a prolonged treatment, Rahul's condition improved and he started attending school again. He began to use better-coping strategies to deal with the pressures at school.

In order to help parents deal with teenagers like Rahul, this article gives an outline of clinical depression and its symptoms. It also discusses when and why parents must watch out for warning signs of depression.

Depression: The danger that lurks in the mind

Nowadays, depression has become a familiar word. It is a mental health condition that is not restricted to a particular age group and is experienced by children, teenagers and adults. How widespread depression is among teenagers was revealed in a study entitled 'Improving recognition of adolescent depression in primary' conducted by Zuckerbrot and Jensen published in Archives of Pediatrics and Adolescent Medicine in 2006. Their research revealed that 3-9 per cent of teenagers meet the criteria for depression at any one time, and towards the end of adolescence, almost 20 per cent teenagers report a lifetime prevalence of depression. One of the reasons for the spread of depression is its late detection. Depression is often detected late, as its symptoms closely resemble normal teenage issues related to changing hormone levels, developing bodies, identity crisis (Who am I?), academic stress and relationship problems.

The paper "Study of prevalence of depression in adolescent students of a public school" by Bansal et al published in Industrial Psychiatry Journal, 2009, discusses the effects of untreated depression. if left untreated, depression may result in serious academic problems, increased hospitalisations, family conflicts and relationship difficulties, recurrent depression, psychosocial impairment (e.g., dropping out of school, lack of social ties), alcohol abuse, antisocial behaviour and even suicide, as the children grow up. Therefore, it is important to recognise the causes and warning signs of depression in teenagers.

Teenage depression and its causes

Some common factors that cause depression in teens are as follows:

• Traumatic early life events such as physical or sexual abuse, loss of one or both parents
  
• Environmental factors such as peer problems, long-term bullying or academic problems, parental fights, shifting to a new place, parental expectations, academic pressure etc.
  
• Genetic vulnerability - inherited traits from parents or blood relatives
  
• Learned patterns of negative thinking from parents - learned helplessness
  
• Biochemical disturbance and hormones
  

Red flags to watch out for

• Appearing sad and feeling hopeless
  
• Feelings of guilt and helplessness
  
• Poor self-esteem and feeling of worthlessness, overreaction to criticism and negative thoughts
  
• Tearful/frequent crying
  
• Irritability, anger or hostility
  
• Fatigue or lack of energy
  
• A decreased interest in activities that the teen once found pleasurable
  
• Withdrawal from friends and family
  
• Difficulty in concentrating, thinking and decision-making
  
• Changes in weight (5 per cent decrease/increase in weight in a month)
  
• Feeling restless and agitated
  
• Major changes in appetite (eating more/eating less)
  
• Major changes in sleeping habits (sleeping excessively, difficult to wake up/unable to sleep)
  
• Feeling incapable of living up to parental expectations
  
• Unexplained physical aches and pains (stomach ache, headache, lower back ache, etc.)
  
• Thoughts of death/suicide (talking about suicide)
  
• Worsening school performance
  

As mentioned previously, some symptoms of depression like mood swings, low energy or a lack of interest may resemble normal teenage issues. Most parents may mistake such actions by their teen as disrespectful behaviour or a lack of effort. What parents (and the teens themselves) may fail to realise is that these symptoms may be indicative of depression.

However, indicators such as symptom intensity (how severe?), their persistence/duration (how long?) and effects on daily life can help decide whether they really are red flags of a deeper problem or just occasional bouts of teenage angst.

Types of depression

There are various types of depression, each with some symptoms similar to others. The categorisation of depression into different types helps doctors and mental health professionals provide the right treatment, as all types cannot be treated with the same medication.

1. Major depressive disorder (MDD)

A teen may be suspected to have MDD if more than five of the previously mentioned warning signs are present for a period of two weeks. These symptoms can interfere with school, social and everyday activities. MDD requires immediate medical attention. Some of the symptoms of MDD that can easily be observed by people around the affected individual are sadness, decreased energy levels and lack of interest in activities.

2. Dysthymia or chronic depression

With dysthymia, any two of the following symptoms - changes in appetite and sleep habits, lack of concentration, feeling of hopelessness, change in appearance, declining academic performance, irritability (instead of sadness) and, most importantly, lack of energy and low self-esteem- can be present. To be diagnosed as dysthymia, these symptoms should be present for more than a year.

3. Disruptive mood dysregulation disorder (DMDD)

Children aged 6-18 years suffering from DMDD show a pattern of intense and frequent temper tantrums, outbursts of aggression and anger, and a usual mood of irritability. To be characterised as DMDD, these symptoms should be present for at least a year.

4. Bipolar disorder

It is distinguished by mood swings between major depression and extreme elation or mania (emotional highs). Bipolar disorder is divided into two types, type I and II. The mania symptoms of type I disorder that might prompt hospitalisation are abnormally happy moods and energy levels, being over-talkative, diminished need for sleep and feeling high. Bipolar type II disorder is characterised by hypomania (a lesser form of elation). Symptoms of type II disorder are incredible energy, charm and productivity.

Depression can affect anyone, even individuals whose lives are happy and exciting. But the presence of a few risk factors can make an individual more prone to experiencing depression.

Risk factors

• Obesity, chronic physical illness or disability
  
• Having other mental health conditions like anxiety, anorexia, learning disability or Attention Deficit Hyperactivity Disorder (ADHD) etc.
  
• Peer pressure, academic problems or perceived failure in school or relationships, which may negatively impact self-esteem
  
• Unrealistic parental expectations regarding academic achievements
  
• Victims of physical/sexual violence
  
• Being gay, lesbian, bisexual or transgender in an unsupportive environment
  
• Having other mental health conditions such as anxiety, anorexia, learning disability or attention deficit hyperactivity disorder
  
• Having a family member who committed suicide
  
• Having a dysfunctional family, stressful life events such as parental divorce or death of a loved one, or physical or emotional neglect by parents
  
• Financial struggles
  

Don't ignore the problem

Teen depression tends to be episodic. Once an episode of depression is over, it may look like everything is normal. However, once a teenager suffers a bout of depression, it is likely to recur at some point in the future. Untreated depression can have extremely serious consequences and may even prove fatal. Therefore, parents who suspect their teen is suffering from depression should talk to their child and then approach a mental health professional (clinical psychologist/psychotherapist/psychiatrist). Remember, teenagers may not be open to the idea of seeking help, but it is the responsibility of the parents to make him understand that they are there to support him.

A depressed teen would often find even the usual problems overwhelming and the associated pain unbearable. So parents should be vigilant to the symptoms and keep the dialogue channels open.

Dr Chitra Aravind, is a Consultant Psychologist-RCI Certified, Manas.

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