Identifying and Treating Depression in Teens

Have you noticed that your teenager has been more down recently, has been irritable, has had worsening grades or is ignoring extracurricular activities?  If so, consider depression as a possible cause.  Depression is common, affecting up to 10 to 20 percent of teens at some point in their adolescence.  It can be difficult to identify because it is, by its nature, a very internal process and normally teens are not sharing their feelings with their parents. However, it is important to recognize because untreated depression can have serious consequences, including social and academic problems, substance abuse and rarely even suicide.

Many teens will have short periods of low mood that go away on their own.  A diagnosis of depression requires continued symptoms for at least two weeks which include:

• low mood or irritability
• loss of interest in sports, activities or friends
• changes in sleep, including difficulty falling asleep or staying asleep or increased sleep
• change in appetite, either increased or decreased
• decreased energy or fatigue
• difficulty concentrating, which can affect school performance
• feelings of guilt or low self-esteem

Keep in mind that children and teenagers with depression may not have the typical “depressed” mood that is usually thought of with depression; they may instead be irritable or angry.  Symptoms like headache, stomach ache or muscular pain may also be present in depressed teens. 

Depression is more common in girls than boys and also in those with family history of depression or anxiety.  Often there is no identifiable cause, but stressful events like the death of a loved one or the breakup of a relationship can trigger an episode of depression. 

If you think your teen may have depression it is important to have this evaluated.  Start by speaking to your child’s pediatrician so that he or she can help you determine the best next step.  Many cases of depression can be managed by your pediatrician.  Whether or not a referral to a psychiatrist is needed will depend on individual circumstances.  The diagnosis of depression is made by interviewing the teen and caregivers.  A medical evaluation may be indicated depending on the specific symptoms.

Treatment for depression will depend on its severity but includes the following:

1. For all teens but especially those with depression, it is important to engage in a healthy lifestyle.  This means keeping a regular sleep schedule with at least 8 hours of sleep at night, eating a balanced diet, drinking plenty of water and exercising regularly. 
2. Therapy, particularly cognitive behavioral therapy and interpersonal therapy, has been shown in studies to be helpful for teens with depression.  Encourage your teen to be open to therapy.  Consider describing the therapist as a “coach” who they will work with to develop tools and strategies for dealing with stress and other problems.  
3. Medication may be prescribed depending on how severe the symptoms are and how much they are interfering with school and family life.  The most common class of medications prescribed is known as the SSRIs (selective serotonin reuptake inhibitors) and include Prozac and Lexapro.  These medications are in general well-tolerated and considered to be safe.  They are not a quick fix – it takes 4-6 weeks to see full effect at any given dose.  Once started they are usually continued for a minimum of six to nine months at which time their use is re-evaluated.     

Suicidal thoughts or other thoughts of self-harm can accompany depression.  It is important to speak to your pediatrician urgently if your teen expresses any of these thoughts to you.  If your teen shows or expresses intent to hurt themselves or has a plan in which to do so, then seek emergency care in order to keep them safe.       

Depression is common and can be dangerous if not treated, but there are successful treatments available.  Please contact your pediatrician if you have concerns about your teen. For health resources for depression and other topics, please visit our Health Resources section at www.EsseHealth.com.

By Dr. Lora Collier, Pediatrician at Esse Health Creve Coeur Pediatrics

11630 Studt Avenue, Suite 200
Creve Coeur, MO 63141
Phone: 314-567-7337