Stories about: Depression

5 things to know about teens and depression

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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.

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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.

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What are the signs and symptoms of depression? 

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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.

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What other problems might depressed teens have?

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 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.

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How does depression differ from stress and grief?

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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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Millions of children have mental health disorders while treatment budgets shrink

When feeling stressed out by the hectic pace of modern life, it’s easy to get wistful for the carefree days of youth—when it seemed the only thing we had to worry about was getting along with the other kids in the neighborhood.

But according to a first-of-its-kind report from the Centers for Disease Control and Prevention on childhood mental health, those days are gone or may never even have existed for a huge portion of America’s children.

Analyzing data collected over the past six years, the report shows that millions of kids—as many as one in five—are currently living with some form of mental health disorder. Attention deficit disorder is the most prevalent condition reported, affecting more than 4 million kids nationwide, but other behavioral issues such as anxiety and depression also were heavily documented, affecting 2.2 and 1.8 million children respectively.

While it’s unclear whether or not the numbers in the report mean that these conditions are really more common in kids today, or if parents, clinicians and teachers are just getting better at identifying them, the bottom line is clear: the issue of mental health disorders in American children is too big to ignore.

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The science of stress

Adolescence is a hard time for just about everyone. School pressure, changing relationships, craving the independence of adulthood while clinging to the security of childhood; it can all lead to a lot of emotional turmoil. But while the stress of growing up may be almost universal, how teens handle it varies wildly.

Data shows that poor reaction to stress can lead to the onset of mental illnesses and associated problems like substance abuse or antisocial behavior. In many cases, the first signs of these disorders surface when the person is feeling stressed. Research also shows that adolescents who have experienced trauma or adversity when they were younger, like the death of a close relative or abandonment by a parent, are more likely to have mental health issues triggered by stress, compared to people who have never faced that kind of hardship.

Even though there’s plenty of research linking stress and early adversity to mental disorders, there are very few studies looking at how the two are connected. Why does early life adversity or trauma make some people more prone to mental illness, especially when dealing with stressful situations? And if warning signs are identified early enough, can these problems be avoided? These are questions Boston Children’s Hospital researcher Kate McLaughlin, PhD, is trying to answer. McLaughlin, along with Margaret Sheridan, PhD, are analyzing how teenagers’ brains react to stress. The project involves over 200 adolescents, some with mental health issues and some without, as well as teens who have experienced early life adversity and others who haven’t.

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Above and beyond the ‘Call of Duty’

“Quick, help me or I’m going to die!”

Not exactly the words you want to hear shouted from a room in a children’s hospital. But when the cries are punctuated with laughter and buzzing video game sound effects (as they were when I heard them), it’s a surprisingly welcome sound.

The commotion I heard was coming from the room of Alex Cote, a 14-year-old patient who had been at Boston Children’s Hospital since March, recovering from a bone marrow transplant. His recovery care required him to stay fairly isolated, and for weeks after his operation the only people Alex saw were his care team and immediate family.

It’s a solid support system, but after months in the hospital Alex was really missing his friends.

“There wasn’t a lot he could do while recovering, so it’s no surprise he was getting so bored,” says Alex’s stepmother, Rachel Cote. “But it got to the point where we worried that all this time in the hospital was making him depressed.”

Alex’s doctors agreed. Dan Kohane, MD, Phd, who managed Alex’s overall care while he was in the Intensive Care Unit, noticed his patient’s morale was dropping as the weeks dragged on. It’s no secret that Alex loves video games—the walls of his room are plastered with Super Mario, Angry Bird and Call of Duty posters—so Kohane decided to reach out to some of the younger members of his team to see if they could help cheer Alex up.

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