In it’s mild form, depression is the most common psychological problem for teenagers.
While it was uncommon a generation or two ago, we now see more diagnoses than ever among our youth, and some psychologists predict that depression will become the psychological ‘flu’ of the 21st century – only the effects are longer lasting, and the illness is harder to treat.
We usually describe depression as ‘feeling sad’ but there are other symptoms that are critical for us to recognise and understand in relation to depression. In fact, without these other symptoms, we may be misdiagnosing sadness as depression.
“I hate me. I really hate me. I hate the way I look. I hate the way I feel. I hate the way I talk to people. I hate how I do everything wrong. I have feeling hopeless. The world would be better off without me. My family would be better off without me. I shouldn’t even be alive”
Depression has emotional symptoms (like sadness, and a loss of enjoyment in activities that were once fun), but it also has cognitive symptoms (like pessimism and hopelessness). It has motivational symptoms – things like a loss of interest, and feeling apathetic. And it also has physical symptoms related to eating and sleep disturbance.
According to the psychological model that has been used for the last two decades, adolescent depression requires a person to be:
- Extremely depressed (for at least 2 weeks) – and it is important to note that for teenagers and children, that sadness may be shown through an irritable mood or out and out anger.
- A loss of interest and pleasure in most or all activities
- Significant weight loss or weight gain – and in children, it may simply be that your child is not gaining weight as expected
- Insomnia, or sleeping too much
- Physically, your teen may be agitated, and constantly moving (psychomotor agitation). (To add to the confusion, sometimes people with depression don’t want to move at all).
- Feelings of worthlessness, or feeling inappropriately guilty for anything and everything
- Being chronically indecisive, having difficulty concentrating on anything, or not wanting to think about anything
- Feeling like life would be better if they were dead – experiences of suicidal ideation
Most psychologists would give a diagnosis of depression to your teenager (or you) if they exhibited at least five of these nine symptoms at the same time, consistently during that two week period. But the symptoms cannot be related to grief, and they cannot be due to the direct influence of drugs or a medical condition.
Depression is relatively uncommon in children, although there has been a growing number of diagnoses in the past decade. Typically, studies indicate somewhere around 1-2% of children (prior to adolescence) experience depression. Some research suggests that up to 50% of children do experience several depressive symptoms, but not enough for them to be diagnosed with clinical depression or it’s milder forms.
Adolescents appear to experience depression at similar rates to adults. Close to 20% of us will experience depression at some point in our lives, with around 5-6% of our teens (and us) having a clinically depressive episode in any given year. Our daughters are particularly vulnerable, with research indicating that depression is twice as likely to affect females than males.
There is a wide range of factors that could be causing depression. Most psychological research supports a model that indicates depression has at least some biological roots (or vulnerability), but that the environment makes a significant and important contribution. In short, we suspect depression develops like this:
A biological or psychological predisposition (genetics) combines with stressful life events (environment) to leave us feeling depressed. The stressful life events will vary from person to person, but might include loss, being rejected, failing, or being humiliated. While many of us experience these things regularly with no depressive outcomes, some people (and teens) develop inadequate or ineffective coping strategies, and fail to deal with the setbacks in their lives well. This can spiral into negative cognitions (stinking thinking), and depression occurs.
This is important:
Professor Todd Kashdan, in a recent blog post at Psychology Today, made the following observation:
“Perhaps the greatest book ever to be written on depression…[is] The Depths: The Evolutionary Origins of the Depression Epidemic. In this masterpiece, Dr. Jonathan Rottenberg argues that the “chemical imbalance” theory of depression is wrong. Yes, biological factors are important to understanding depression but it is a mistake to think that these chemicals are what cause, maintain, or exacerbate suffering. Psychology has advanced quite a bit and we now know that our perceptions, expectations, choices, relationship patterns, and strategies for regulating emotions and thoughts influence our psychological health. Fail to acknowledge this, and you are essentially refusing to examine yourself.”
In other words, the central component of our depression (or our teen’s depression) relates to the psychological flexibility and coping strategies that dominate thinking patterns.
Our natural reactions to our adolescent’s depression may be to give them a good shake, tell them to change their thinking, and ‘man-up’. However, only rarely will this be an effective strategy. Instead, I suggest the following:
- Have a good heart to heart. If they are feeling depressed and the symptoms match those above (and have lasted for a couple of weeks), suggest a visit to the GP for more advice. Then get a referral for a psychologist.
- If depression is diagnosed, research generally suggests the best treatment is a combined pharmacological (drugs) and cognitive-behavioural therapy (CBT) approach. If your psychologist doesn’t offer CBT, be cautious. Research indicates other forms of therapy are less effective.
- Research tells us that even if our teenagers get good help they will struggle to work through their symptoms if their parents are depressed. There is a strong intergenerational transfer of depression. Every parent needs to be ok so their children will be.
- Work hard with your children on supporting good friendships. Encourage them to spend time with friends who help them feel good about themselves.
- Make sure their school environment is a positive one. Relationships with parents and friends and school environment are some of the most powerful predictors of our adolescent’s wellbeing.
- Discourage alcohol and drug use – and be clear about it.
- Reduce stress in their environment (but don’t baby them and do everything for them – it’s a fine line).
- Encourage exercise, appropriate sleep, and healthy eating.
- Help them be good at something. Developing competence builds confidence and feelings of worth.
Lastly, if you spot your adolescent slipping into any stinking thinking habits, talk to them about it. Build your relationship with them. Help them know how much you value them by spending time with them. Your relationship with them may be the thing that makes all the difference.