Depresssion in adolescence

Dr Asha Pemberton

teenhealth.tt@gmail.com

THROUGH adolescence it is normal and expected that young people will experience moments of sadness. Life transitions including changes in friendships, ended relationships, parent conflicts and disappointing performances are common and expected causes of momentary sadness. Even more significant changes including family disruption due to loss of employment, divorce and death lead to shifts in mood and attitude. For resilient young people, these periods are generally brief and do not necessarily impact their overall functioning.

Depression is not the same as sadness. Depression is a mood disorder that causes extreme sadness and other related symptoms in an intensity that affects other aspects of life and which lasts for a significant duration of time. Depression can occur without a specific triggering event, which is another feature which distinguishes it from the expected bouts of sadness that occur in life.

Adolescents may have depression if their symptoms, which may include sadness, occur every day. In contrast to depression in adults, tweens and teens often struggle to describe exactly how they are feeling when in the midst of a depressive episode. Some terms including “empty,” “hollow” or “void” are sometimes used. Frequently, irritability and reclusiveness are the first changes noticed by parents.

There continues to be significant stigma and shame surrounding mental health concerns, including depression in our society. For this and other reasons, young people may try to hide their feelings because they feel guilt, shame and worthlessness, or do not want to encumber their parents.

The two most common signs of depression in adolescence are sadness or low mood and irritability that occur most of the day, every day continuously for at least two weeks. Other accompanying symptoms include loss of enjoyment in activities which were previously enjoyed, spending long periods alone, difficulty with sleep and appetite, difficulty concentrating, loss of hope in the future and general loss of functioning. Young people may also have thoughts of self-harm and death and express that the world would be better off without them.

When young people articulate any or a combination of these, they should always be taken seriously and additional support explored. If there are physical signs of self-injury or letters, poems or songs detailing dying or death, parents are encouraged to seek support for further exploration and intervention.

Depression is a common mental health concern in adolescence. Unfortunately, many young people do not access the care needed for a variety of reasons. The presentation of depression, particularly in younger adolescents, can be more subtle and thus more easily missed by parents.

While mood undulation is a characteristic of early adolescent development, a persisting sad mood, particularly when there is a loss of personal care, hygiene and functioning, are important signs to pay attention to. Other indications of concern include medically unexplained symptoms including headaches, abdominal pain and fatigue for which no diagnosis can be made. These very frequently represent physical manifestations of underlying emotional distress.

Middle adolescents, aged 14 to 16, more typically voice their sadness and despair, but may engage in a variety of self-harming behaviour including intentional injury infliction (cutting), substance use, including excessive alcohol consumption or vaping and sexual misadventure.

Older adolescents and young adults, even though more likely to recognise their need for support, frequently lack the personal agency and resources to seek them. They also may have less parental engagement due to their age, being on the border of legal adulthood.

For all of these reasons, it is critical for parents to frequently observe and engage with their adolescents and young adults to assess their mood and functioning. When untreated, depression leads to a significant loss of productivity, under-education, disrupted relationships and social engagement and, most catastrophically, to death.

Depression is amenable to treatment and is very successfully managed with a combination of therapy, medication and family support. All young people who have experiences of mental health concerns deserve the opportunity for intervention. This begins with the awareness and engagement of parents, followed by their willingness to seek help and utilise the resources available.