Teens are notorious for their sudden changes in mood. It’s not unusual for a young teen to swing from feelings of great joy to extreme sadness in a very short period of time. But when a teen has an increasing number of very sombre moods, parents might start to wonder if the “blues” have become something more threatening like depression.
Families have every reason to be worried about depression, which is characterized by persistent feelings of unhappiness, worthlessness, self-blame, disappointment and emptiness. Left untreated, depression can lead to a whole host of serious problems, including use of alcohol and drugs, self-injury, gambling and high-risk sexual behaviours.
Depressed teens may do poorly at school, become aggressive or violent and may consider or attempt suicide.
The statistics about depression are sobering. An estimated one in five people will experience some form of depression in their lives, says Dr. Brian Greenfield, director of the Mental Health Emergency Team at the Montreal Children’s Hospital and associate professor of psychiatry and pediatrics at McGill University.
“When you consider that depression is often associated with dysfunction, that’s a huge number of people,” he says. While some doctors claim to have diagnosed signs of depression in children as young as 2, Dr. Greenfield says he most often treats kids between the ages of 12 and 18.
There’s no one sign or symptom that will indicate if a teen is suffering from depression. Dr. Greenfield says parents should be on the lookout for certain patterns and problems including a change in normal energy and/or appetite levels, a marked drop in academic achievement, disrupted social relationships (for example, withdrawing from family and friends or suddenly taking up with a different group of people), a decrease in personal hygiene, becoming argumentative and having sleep problems.
Dr. Greenfield says that depressed teens probably won’t have all of these symptoms but that two or three of them that last for several days can spell trouble. “We are worried about the teens whose symptoms are starting to affect their everyday life,” he said.
Depressed teens are often struggling with some kind of problem or issue. “You usually find an underlying cause, such as an undiagnosed learning disorder, a parent unable to be empathic with them or a traumatic event,” Dr. Greenfield says. Other stressors include bullying, a divorce or death in the family, problems at school or confronting homosexuality.
Getting a teen to open up about his or her feelings is very difficult, which is often the case even when a young person isn’t depressed. Parents who are worried about their teen might want to seek help from a family doctor, a guidance counsellor or a therapist.
Any child who has attempted or is at imminent risk of suicide should be immediately brought to the emergency room of a hospital, where he or she will be assessed by a team of mental health professionals. Dr. Greenfield has pioneered a successful rapid-response model for suicidal children and teens in which young people are stabilized at the hospital and allowed to return home. They are then contacted for follow up care by health professionals within one to two days after the initial ER visit, rather than the usual 10 days. The model helps keep young people safe, out of the hospital and gives them access to help quickly.
Children or teens who exhibit signs of depression but are not judged to be a suicide risk should be brought to a CLSC, pediatrician or family physician for assessment. They may be referred for a psychiatric consultation through the CLSC, the out-patient department of a hospital or, in more severe cases, admitted to the hospital.
Under Quebec law, adolescents aged 14 and over can seek medical help without informing their parents, and can request that discussions with health professionals be kept confidential from parents. However, families are commonly involved in the assessment and treatment process. If there is a risk of suicide, doctors are compelled by law to notify both parents and authorities.
Dr. Greenfield explains that parents can expect an initial consultation with the teen and his or her family. “I prefer to see the whole family at the first meeting,” he says. “During that time, I will ask several questions. Sometimes a parent refuses to answer and I know something is up. Then I will speak to the child and parents individually.”
Treatment will depend on the underlying cause of depression and any co-occurring problems, such as substance or alcohol abuse. Psychotherapy, either alone or with the family, will always be part of the treatment plan. In some cases, medication may also be prescribed.
“A large part of this is being able to hook the patient up with the appropriate resources and various levels of support. We need to learn the triggers for their depression and how to deal with them,” Dr. Greenfield says. “Sometimes, treatment involves shifting their self-perception.” Instead of being the kid with the learning problems or history of abuse, they can come to see themselves as brave and courageous for overcoming these issues.
These symptoms may indicate depression, particularly when they last for more than two weeks:
- Withdrawal from friends and activities
- Changes in eating or sleeping patterns
- Feelings of being unable to satisfy ideals
- Lack of enthusiasm, energy or motivation
- Poor performance in school
- Sadness and hopelessness
- Anger and rage
- Overreaction to criticism
- Poor self-esteem or guilt Indecision, lack of concentration or forgetfulness
- Restlessness and agitation
- Substance abuse
- Problems with authority
- Suicidal thoughts or actions
(from the Mental Health America’s website, www.mentalhealthamerica.net)