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Adolescent Angst or a Deeper Disorder?
By Jane E. Brody - 12/24/02 Science Section of the NY Times

Teenagers — one minute they're on top of the world, the next they're down in the dumps. One minute you're the best dad or mom there ever was. The next you're the world's worst, and they're threatening to leave home.

As their lives, bodies and hormones change, teenagers can find themselves on an emotional seesaw with no way off. Not all teenagers, of course. Some are rather even-tempered, always up or always down or somewhere in between.

So what's normal? And how can you tell if an adolescent is just momentarily unhappy or truly depressed and in need of professional help?

These are questions that troubled teenagers and every parent of a child from, say, 10 to 18, should seriously consider. Depression, which affects as many as one in five adolescents by age 18, is not readily recognized in adolescents because its manifestations usually differ from those in depressed adults.

Someone looking for traditional signs of adult depression — lethargy, weepiness and overt expressions of sadness — may be misled by the irritable or angry adolescent.

Causes and Consequences
Many environmental factors can bring on depression in young people: parents' divorce, family poverty, experiencing a natural disaster, being subjected to physical or sexual abuse or witnessing it, or having a parent who is addicted to alcohol or drugs.

Some children become depressed because they fail to achieve particular academic or extracurricular goals or because they have trouble making friends, are snubbed or are relentlessly ridiculed by peers or rejected by special friends.

Then there are internal factors: underlying feelings of inadequacy or unattractiveness, depression that runs in the family, or confusion or distress about sexual identity.

Unrecognized and untreated, teenage depression can have long-lasting consequences that affect a child's future, at school and at work.

A national study assessing levels of teenage depression involving 4,648 boys and girls ages 10 to 18 was published this fall in The Archives of Pediatric and Adolescent Medicine. The authors, Dr. Sherry Glied of Columbia University's Mailman School of Public Health and Dr. Daniel S. Pine of the National Institute of Mental Health, found higher rates of absenteeism, smoking and binge-eating among those with depressive symptoms, even after taking into account factors like poverty and traumatic events.

In the worst situation, depressed teenagers may take their own lives. Since 1995, the number of suicides among teenagers is estimated to have tripled, to as many as 2,500 each year.

Suicide is the third-leading cause of death among people 15 to 24, behind accidents and homicides. In the 1999 Youth Risk Behavior Surveillance Survey, nearly one student in five of high school age had seriously considered suicide in the previous year.

Recognizing Trouble
It is easy to dismiss the signs of teenage depression as merely a phase or the mood swings of adolescence. And teenagers may be reluctant to admit they're depressed, seeing the disorder as a sign of weakness, notes Dr. Alice R. McCarthy in her excellent book, "Healthy Teens: Facing the Challenges of Young Lives" (Bridge Communications, $14.95).

Even their closest friends may fail to notice the subtle or masked signs of serious teenage depression, or, if they do notice, they find other explanations, like having a bad teacher or losing a boyfriend.

Depression can cause fatigue or interfere with the ability to concentrate. Or the teenagers may become irritable, angry, bored, excessively guilty or anxious. There may be frequent outbursts of shouting, complaining or crying, and talk of leaving home.

In some depressed adolescents, the emotional turmoil shows up in physical complaints like chronic or frequent headaches, muscle pains, tiredness or stomachaches.

Sometimes a teenager may exhibit more classical signs of depression, like a significant change in eating habits, appetite or body weight, difficulty sleeping or oversleeping (12 to 14 hours a day), a persistent sad mood, loss of energy, feelings of worthlessness, withdrawal from friends and previously enjoyed activities, or thoughts or talk of death or suicide.

If five or more of these symptoms persist for two weeks, professional attention is warranted. Such attention is mandatory for anyone who attempts or threatens suicide.


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