Moodiness, irritability, changes in sleep patterns, overreacting to any little thing — these are well-known characteristics of a normal teenager. They are also well-known signs of depression.
Nearly 6 percent of adolescents between the ages of 13 and 18 are clinically depressed, according to the U.S. Department of Health and Human Services. So what’s a parent to do? How can you know when your teen’s mood swings are just part of being a teenager and not a warning sign that something much more serious is going on?
When to worry
Dr. Elizabeth McCauley, associate director of child and adolescent psychiatry at Seattle Children’s and professor of psychiatry and behavioral sciences at the University of Washington (UW), points out that changes in the adolescent brain can bring about all kinds of changes in behavior, including the unpredictability that parents see in most teens.
“Our sense about when parents should worry is if the down mood persists, perhaps lasting a couple of weeks, and there are more down days than not,” she says. She urges parents to look at whether the moodiness seems to be occurring as part of a cluster of other problems.
Other signs of depression might include a sudden slide in grades, unexplained aches and pains, changes in eating habits, difficulty in thinking and making decisions, and withdrawal from friends and activities.
“Maybe they’re not asking for the keys to the car, or they’ve stopped hanging out with their friends on weekends,” says Casey Ward, a former school psychologist whose Olympia practice now focuses on children and adolescents.
Tacoma dad Nelson Rascon says his daughter, who is developmentally delayed, began to show signs of depression at 15. “It all collided all at once,” he says, “erratic emotion, highs and lows, not following rules. Then her grades started to flip.”
Rascon is assistant director of WaDads, a support group for male caregivers of children dealing with mental or emotional issues. He says his daughter’s condition improved by the time she was 17. “She still has emotional problems, but she’s out of the woods now.”
McCauley cautions that teens may not be able to articulate exactly what they’re feeling. “Some kids will say, ‘I’m depressed,’ but others will say, ‘I’m stressed out,’ ‘I’m overwhelmed’ or ‘I’m really tired.’ If it’s interfering with their ability to lead a productive life, that’s when we want to see an intervention.”
What to do
Concerned parents should first seek an evaluation with their teen’s pediatrician or family physician to rule out any physical causes of the behavior. There is an advantage if the teen has an established relationship with a physician, McCauley says.
“That’s a known person who could begin a discussion,” she says. “It might be an easier way for a family to move forward.”
Some teens recognize on their own that they need someone to talk to about their feelings. “Many high schools and some middle schools have health clinics, and they’re full of kids who are self-referred,” McCauley says.
Ward, who spent 26 years as a school psychologist with the North Thurston School District, says teens often show up confused about what they’re feeling. “They’re full of self-doubt,” he says. “They’re asking themselves, ‘Am I normal? Is this the way I’m supposed to feel?’”
Many teens try to calm their fears and doubts by self-medicating with alcohol, cigarettes or marijuana, Ward says, which only makes matters worse.
“What we know about depression is that it is a physiological disorder. It affects the neurochemistry of the brain,” he says.
In a report issued in March of this year, the U.S. Preventive Services Task Force, the leading independent panel of experts in prevention and primary care, recommended screening adolescents for clinical depression — but only when appropriate systems are in place to ensure accurate diagnosis, treatment and follow-up care.
That screening could begin as early as the second grade, according to a recent study by the UW. The study, which followed nearly 1,000 children from the second to the eighth grades, is part of the Raising Healthy Children study, a long-term investigation into the development of healthy and problematic behaviors among children at 10 suburban schools in the Pacific Northwest.
“We can start to build a profile of children’s mental health in the second grade,” says James Mazza, UW professor of educational psychology and lead author of the study. “This is important, because children who are experiencing depression symptoms early on may be at greater risk for mental health concerns during adolescence, based on other research studies.”
Once a diagnosis has been made and a mental health professional is involved, treatment may include a combination of psychotherapy and medication. The task force also found that, with careful monitoring, treatment with SSRIs (selective serotonin reuptake inhibitors) combined with psychotherapy can successfully reduce symptoms of clinical depression in adolescents.
Ward says simple changes in diet, exercise and getting enough rest, as well as learning “mindfulness skills” (such as breathing exercises), can also help.
At Seattle Children’s, treatment normally includes 12 sessions of psychotherapy, McCauley says. “You’re not signing up for the rest of your life. We’re really teaching them relapse prevention, how they can cope with stresses when they come down the pike.”
McCauley says the good news for parents is that teens typically respond well to treatment.
“Treatment for depression is not foolproof. There are some treatment-resistant kids,” she says. “But most kids do find some substantial relief.”
Elaine Bowers is a Seattle writer and mother.