Recognizing the Signs

“Sadness is a normal, healthy emotion; depression is a disease. The challenge lies in understanding and recognizing the difference.”—Dr. David G. Fassler.

LIKE most other disorders, depression has telltale symptoms. But the signs are not all that easy to recognize. Why? Because nearly all teens get in a low mood now and then, as do adults. What is the difference between a mere case of the blues and depression? Much has to do with the intensity and duration of the condition.

Intensity involves the degree to which negative feelings afflict the youth. More severe than a minor bout with despair, depression is an all-consuming emotional illness that seriously impairs the teen’s ability to function normally. Dr. Andrew Slaby describes the severity of the condition this way: “Imagine the worst physical pain you’ve ever had—a broken bone, a toothache, or labor pain—multiply it tenfold and take away the cause; then you can possibly approximate the pain of depression.”

Duration refers to how long the listless state continues. According to clinical professors Leon Cytryn and Donald H. McKnew, Jr., “a child who shows no signs of being comforted or of resuming a normal life within a week after falling into a low mood (for whatever reason)—or within six months after undergoing what is to him a severe loss—is at risk of developing a depressive disorder.”

Common Symptoms

Depression is diagnosed only when a youth exhibits a number of symptoms every day, most of the day, for at least two weeks. A relatively brief bout is referred to as a depressive episode. Dysthymia, a more chronic form of mild or moderate depression, is diagnosed when symptoms persist for at least a year with no more than two months of relief. In either case, what are some common symptoms of depression? *

Sudden change in mood and behavior. The previously docile teen suddenly is confrontational. Rebellious behavior and even running away from home are common among depressed teens.

 Social isolation. The depressed adolescent withdraws from friends. Or it may be that friends withdraw from the depressed youth, noticing an undesirable change in his or her attitude and behavior.

Diminished interest in almost all activities. The teen is unusually passive. Hobbies that were just recently considered intriguing are now perceived as boring.

Notable change in eating habits. Many experts feel that disorders such as anorexia, bulimia, and compulsive overeating often coexist with (and may at times be caused by) depression.

Sleep problems. The teen sleeps either too little or too much. Some develop confused sleeping habits, being up all night and sleeping throughout the day.

Drop in academic performance. The depressed adolescent has problems getting along with teachers and peers, and grades begin to plummet. Soon the teen is reluctant to go to school at all.

Risky or self-destructive acts. Behaviors that ‘cheat death’ may show that a youth has little interest in living. Self-mutilation (such as cutting the skin) may also be a symptom.

Feelings of worthlessness or inappropriate guilt. The teen becomes highly self-critical, feeling like a complete failure, even though the facts may indicate otherwise.

Psychosomatic problems. When no physical cause can be found, headaches, back pain, stomachaches, and similar problems may indicate underlying depression.

Recurring thoughts of death or suicide. A preoccupation with morbid themes can point to depression. So can suicidal threats.—See box below.

Bipolar Disorder

Some of these same symptoms may be present in another baffling ailment—bipolar disorder. According to Drs. Barbara D. Ingersoll and Sam Goldstein, bipolar disorder (also known as manic-depressive disorder) is “a condition characterized by depressive episodes interspersed with periods in which mood and energy are excessively  elevated—elevated, in fact, well beyond normal levels of a good mood.”

This elevated phase is called mania. Its symptoms may include racing thoughts, extreme talkativeness, and a decreased need for sleep. In fact, the sufferer may go for days without sleep with no evident loss of energy. Another symptom of bipolar disorder is highly impulsive behavior without regard for consequences. “Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment,” states a report by the U.S. National Institute of Mental Health. How long does the manic phase last? Sometimes just a few days; in other cases, mania lingers for several months before giving way to its counterpart, depression.

Those most at risk of developing bipolar disorder include individuals with family members who have the illness. The good news is that there is hope for sufferers. “Diagnosed early, and treated appropriately,” says the book The Bipolar Child, “these children and their families can live infinitely more stable lives.”

It is important to note that no single symptom on its own indicates depression or bipolar disorder. Most often, it is a cluster of symptoms manifested over a period of time that leads to a diagnosis. Still, the question remains, Why does this baffling disorder afflict teens?

[Footnote]

[Box on page 6]

WHEN A CHILD WANTS TO DIE

According to the U.S. Centers for Disease Control, in one recent year more young people in the United States died from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined. Another disturbing fact: There has been a dramatic increase in reported suicides among people between the ages of 10 and 14.

Can adolescent suicide be prevented? In some cases, yes. “Statistics show that many suicides are in fact preceded by attempts or verbal hints and warnings,” writes Dr. Kathleen McCoy. “When your teenager even hints about suicidal thoughts, it’s time to pay close attention and possibly seek professional help.”

The prevalence of teen depression underscores the need for parents and other adults to take seriously any indications that a young person gives of wanting to take his or her life. “In nearly every case of suicide I have reviewed, clues to the adolescent’s plans were overlooked or downplayed,” writes Dr. Andrew Slaby in his book No One Saw My Pain. “Family members and friends did not understand the enormity of the changes they were seeing. They focused on the consequences and not on the underlying problem, so that ‘family problems’ or ‘drug use’ or ‘anorexia’ became the diagnosis. Sometimes the anger, the confusion, and the irritability were treated but not the depression. The underlying problem remained, torturous and festering.”

The message is clear: Take all clues of suicidal tendencies seriously!

[Picture on page 7]

At times, rebellious behavior is a sign of underlying depression

[Picture on page 7]

Depressed teens often lose interest in activities that once fascinated them