Recognizing Depression in the Adolescent
Adolescence can be a difficult period that is often characterised by some degree of emotional instability. Rapid developmental changes, struggling with conflicting identities and unrealistic social expectations, may lead to uncertainty over role behaviour and feelings of inferiority. With all this turmoil and confusion, it may not be easy to differentiate between depression and normal adolescent “mood swings” or what is referred to as labile mood. However, depression in adolescence goes beyond “moodiness”. It is a serious mental health problem that can impact on every aspect of the adolescent’s life. It should also be noted that depression is a major risk factor for adolescent suicide.
RED FLAGS: SIGNS AND SYMPTOMS THAT MAY INDICATE DEPRESSION IN ADOLESCENCE
It is important to have an understanding of what depression is and to recognize the warning signs. These signs are not always obvious. Adolescents with depression do not necessarily appear sad. Irritability, anger, agitation and acting out are often important characteristics.
According to the DSM-V, the classification of mental disorders, depression is characterized by 5 or more of the following symptoms that have been present during the same 2 week period: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood most of the day, nearly every day: feeling sad, empty, hopeless, appears tearful, frequent crying. * In adolescents, this can be can be an irritable mood which may develop rather than a sad or dejected mood.
Loss of interest or pleasure in all, or almost all, activities is nearly always present. The adolescent may report “not caring anymore”, or not feeling any enjoyment in activities that were previously considered pleasurable. Family members often notice social withdrawal or neglect of pleasurable activities (e.g. the adolescent who used to enjoy rugby finds excuses not to practice).
Significant weight loss when not dieting or weight gain. Changes in appetite. Some depressed adolescents report that they have to force themselves to eat. Others may eat more and may crave specific foods (e.g., sweets or other carbohydrates).
Insomnia may also occur (difficulty falling asleep, waking up during the night and then having difficulty returning to sleep, waking too early and being unable to return to sleep) or hypersomnia (prolonged sleep episodes at night or increased daytime sleep nearly every day).
Agitation nearly every day (restlessness or being slowed down, inability to sit still, pacing, handwringing; or pulling or rubbing of the skin, clothing, or other objects) or retardation (slowed speech, thinking, and body movements; increased pauses before answering; not speaking).
Fatigue or loss of energy nearly every day. The adolescent may report constant exhaustion without physical exertion. Even the smallest tasks seem to require substantial effort eg complaints that washing and dressing in the morning are exhausting and take twice as long as usual.
Feelings of worthlessness or excessive or inappropriate guilt nearly every day. This may include relentless introspection, a negative self-concept, guilty preoccupations over minor past failings, often misinterpreting trivial day-to-day events as evidence of personal defects, an exaggerated sense of responsibility.
Difficulties in being able to think, concentrate, or make even minor decisions. They may appear easily distracted or complain of memory difficulties. A decline in academic performance may reflect poor concentration.
Recurrent thoughts of death (not just fear of dying), recurrent suicidal thoughts without a specific plan, or a suicide attempt or a specific plan for committing suicide are common. They may range from a passive wish not to awaken in the morning or a belief that others would be better off if they were dead, to fleeting but recurring thoughts of committing suicide, to a specific suicide plan.
** These symptoms cause significant distress or problems in social, school, or other important areas of functioning.
If you notice that your adolescent displays the above signs for more than two weeks, seek the appropriate help. Even if the threat of suicide does not seem to be part of the symptoms, you may still need to deal with the depression.
Firstly the individual needs to be diagnosed by a mental health care practitioner such as a clinical psychologist or psychiatrist.
If you think that your adolescent has depressive symptoms you can get the General Practitioner to refer.
When depression is promptly identified and treated, its symptoms are manageable.
There are several strategies for treating adolescent depression depending on the individual characteristics and symptoms.
- medications such as antidepressants;
- psychotherapy which includes approaches such as cognitive behavioural therapy, psychodynamic approaches which helps the individual recognize their capacity for change and;
- lifestyle changes which could include improvements in sleeping and eating habits, physical activity and stress reduction to help manage the symptoms.