5 things to know about teens and depression


How does depression impact children and teens?


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Depression impacts many youth and families across the U.S. Up to 28% of young people experience an episode of major depression by age 19 with an average onset age of 13 years old. However, only 38% of teens experiencing depression receive treatment. Raising awareness is a key step to addressing depression.

Depression is treatable, and early detection and treatment are effective. With increased awareness and early intervention efforts, both teens and adults can learn to identify the signs of depression and get help sooner.

Left untreated, depression can lead to deteriorating school work, strained relationships with peers and adults, high rates of absenteeism, school dropout, substance abuse and suicide. There is a strong and significant connection between students’ emotional health and their academic progress: students who are battling emotional problems are not able to learn as well as students who can devote their full attention and concentration to their education.

Depressive disorders are the largest single contributor to adolescent suicide risk. Seventeen percent of U.S. high school students report having seriously considered suicide during the previous 12 months.


What causes depression?

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Depression is caused by a combination of factors, not a single factor. Depression is not just a phase and is nobody’s fault. It is a medical illness that includes a combination of biological, psychological and social components. Everyone’s experience with depression is different— there is no formula that can predict the influence of each factor in the development of depression. It is important to meet with a professional who can assess the teen and provide an accurate diagnosis.

  • Biological—Depression is a medical illness with chemical and genetic links. One factor that is linked to depression is a difference in the structure and functioning part of the brain that affects mood. Children and teens with a family history of depression are 25 to 45 percent more likely to develop depression. Youth with chronic illnesses such as diabetes or cystic fibrosis may be at increased risk for depression.
  • Psychological—Cautious or pessimistic thinking does not mean a person suffers from clinical depression. The negative thoughts that people who struggle with clinical depression have are significant, debilitating and limit functioning. A few examples are: jumping to conclusions (They didn’t say hi to me because they don’t like me.), focusing only on negative feedback (Even though the teen gets a good grade on a paper, she only focuses on the negative comments the teacher made.), negative judgments about self (I should be smarter, I shouldn’t make so many mistakes, I will never amount to anything.) or personalizing everything (It’s my fault, I did something wrong.).
  • Social—There are many different environmental factors that can have a positive or negative impact on a teen’s depression. Relationships with family and peers, school experiences and community connections can impact a teen’s depression.


What are the signs and symptoms of depression? 


Everyone experiences some symptoms of depression at times—and that is normal. Clinical depression is diagnosed when multiple symptoms occur daily, last most of the day, are persistent over time, and interfere with the teen’s ability to function at school, with friends and with family members. Symptoms of depression include:

  • depressed or irritable mood most of the day, nearly every day
  • decreased interest or pleasure in all or almost all activities
  • significant weight loss or gain
  • sleeping too much or sleeping too little
  • agitated, can’t stay still, restless
  • fatigue or loss of energy
  • worthlessness or excessive or inappropriate guilt
  • difficulty concentrating or thinking
  • recurrent thoughts of death

In teens, mood change is more often characterized by irritability than sadness. Irritable teens are often quick to snap back at people and tend to argue a lot. Teens can be depressed if they are irritable at home but seem to be happy with their friends.


What other problems might depressed teens have?


 Children and teens who struggle with depression often experience other difficulties. Sometimes teens don’t have the language to express what they are experiencing with depression. Many don’t realize they are experiencing depression. Sometimes depression shows in other ways.

You might see:

  • symptoms of anxiety (frequent worries and fears, nervousness, edginess, nightmares, panic attacks)
  • physical symptoms (headaches, stomachaches, numbness, difficulty breathing, heart pounding)
  • change in day-to-day functioning (Perhaps a typically outgoing and active teen becomes more silent and withdrawn.)
  • acting out behavior (being rebellious, breaking rules, being defiant, threatening to run away, delinquent acts)

Most teens may experience one or a few of these difficulties. This is common in response to stress, and it does not mean that they necessarily indicate clinical depression. It’s the combination of several symptoms, their severity, duration, frequency and impact on functioning that determines if a teen has depression.

If you notice these symptoms in your teen, don’t worry about having to make the distinction between what is or is not clinical depression. The important action is to report this to a medical doctor, psychologist, psychiatrist or guidance counselor so your teen can be assessed.


How does depression differ from stress and grief?


The main differences between stress and clinical depression are:

  • Symptoms of stress (irritability, stomachaches, headaches, lack of focus) generally go away once the source of stress (family stressors, tests, deadline) is resolved.
  • Symptoms of clinical depression (irritability, lack of motivation, lack of focus, hypersomnia, insomnia, hopelessness) persist for weeks and months, even when stressors are no longer present and even when happy things happen in the person’s life.

An example may be an adolescent who experiences stress might display crankiness, insomnia and loss of appetite during final exams, but these symptoms quickly disappear after the exams are over. On the other hand, the teen who experiences clinical depression displays these same symptoms in a sustained way before the final exams, throughout the final exam period and beyond.

The American Psychiatric Association states, “The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such stressful situations. Those experiencing trying times often might describe themselves as being depressed. But sadness and depression are not the same.” Grief is in response to an incident of loss or change whereas depression is a pervasive disorder that is the result of a combination of factors.

If you are concerned about your teen, there is help available. Contact your teen’s pediatrician, or if you feel that your teen is at immediate risk, call 911 or the suicide hotline at 1-800-273-8255.

In next week’s blog, we will talk about levels of depression and treatment, how to talk to your teen if you are concerned and how to promote healthy coping skills.

Learn more about depression at bostonchildrens.org/breakfree.

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Learn CPR. Save lives.

Last week, an 11-month-old baby in our community accidentally fell into the bathtub.

The family called 9-1-1 and while they waited for an ambulance, nearby workers from local power company Eversource stopped to help. The baby was not breathing, and her lips were turning blue.

The Eversource workers administered CPR, and the baby started breathing. She recovered at Boston Children’s Hospital and ultimately survived because of the efforts of CPR-trained passersby.

Dr. Claire McCarthy, Boston Children’s general pediatrician, offers tips on preventing drowning.

Accidents can happen at any time and place. We never know when we will need the help of a stranger. Or when we will be put in a position to help. Please consider taking a lifesaving CPR class.

Find out more about the Boston Children’s Hospital Basic Life Support program.

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Overcoming IBD obstacles…and traveling the world

I was diagnosed with ulcerative colitis on December 23, 2009—a day my life changed forever. I went from a healthy and active 14-year-old to a teen with some very concerning symptoms: frequent and sudden onsets of stomach pain, exhaustion and the constant urge to use the bathroom. The diagnosis of a blistered, swollen, large intestine was both a relief and an added stressor.

But my diagnosis was just the beginning of my journey.

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My 14-year-old daughter is addicted to social media, what should I do?

Michael RichQ: My 14-year-old daughter is seemingly addicted to her smartphone, particularly social media (Instagram and Snap Chat) and texting with her friends. I’ve never seen it this bad before. During the school year, she had no problem leaving her phone in her backpack while at home, and she’s always been a good student, with plenty of friends I approve of. As soon as this summer hit, though, she’s been driving our family crazy with her constant texting, picture taking and giggling over whatever is on her phone. It came to a head last week on our family camping trip when she had a meltdown over the lack of cell service. We eventually got her to go, but she fumed and pouted the entire time, and since back, seems more attached to her phone than ever. I’m worried that she’s missing out on quality family time, but every time we force her to be with us phone-free, she seems miserable. What can I do?

~ Dysfunction at Disconnection, NH

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