Reprinted from the Treatments for Young People issue of Visions Journal, 2006, 3 (1), p. 6-7
Depression affects as many as one in 10 teenagers at any time, with one in five developing major depression by the end of their teen years. Twice as many young women develop depression as do young men. Risk factors include genetic vulnerability, anxiety disorders, learning and attention problems, trauma and abuse, and family conflict.
When depressive symptoms are developing, it can be difficult for parents to figure out whether the problem is a clinical depression or simply a teen adjustment problem. Symptoms include ongoing sadness or irritable mood, loss of interest in usual activities, social withdrawal and physical symptoms such as sleep disturbance, changes in appetite, and loss of physical energy. There is a negative impact on concentration, energy and motivation, and school functioning.
By the time clinical depression is diagnosed, secondary problems of relationship conflicts have often developed. Parents and teachers become frustrated by school failure and erratic attendance, and friends may be turned off by the irritable, negative mood of the depressed teen. Hence, the teen’s much-needed support system begins to crumble as a result of the depression.
Evaluation of depression requires a visit to the family physician to rule out physical causes of symptoms, and to facilitate diagnosis and treatment. Treatment resources in this province are provided through the local children’s mental health teams of the Ministry of Children and Family Development. These teams provide psychiatric consultation and have children’s mental health clinicians trained in the treatment of depression. Private psychiatrists, psychologists and trained counselling psychologists are also appropriate resources.
Treatment of depression must address the primary problems of physical and psychological symptoms, as well as the demoralizing effects on academic and social functioning. Basic treatment includes ensuring adequate diet, including essential (omega3) fatty acids, physical exercise, a regular routine including sleep hygiene (conditions and practices that promote continuous and effective sleep), and a practical approach to school, such as a reduced schedule or modified curriculum goals while recovery is occurring. A support system must be put in place to nurture re-socialization and encourage exercise and pleasurable activities. In addition, underlying issues such as trauma, anxiety disorder or family conflict must be addressed.
The specific treatments for depression are psychotherapies and medications. However, during the past few years some disappointing research on antidepressant effectiveness has emerged. At present there is clear evidence for improvement with only one medication, fluoxetine (Prozac). There are unclear or negative results for at least five other antidepressants.1 In addition, negative behavioural and emotional effects occur often enough that these medications now have warnings on the labels to watch for agitation, hostility and suicidal thinking in young people. It is not understood why medication responsiveness appears to be less consistent in young people than in adults.
It should be noted that if a medication is given, the teen is likely to improve more than half the time, but not any more so than with a placebo (sugar pill). This suggests considerable resilience in depressed adolescents. In fact, one community study found that half of the episodes of depression had spontaneously disappeared without specific treatment within two months.2 However, there is a high recurrence rate of 50% to 75% within five years.
The cases of depression that do not remit in a couple of months tend to last for six months or more, which has a significant impact on psychosocial functioning. This can leave developmental ‘scars’ in the form of decreased self-confidence and low academic achievement. At present, medication is recommended for persistent and more severe depression, which has not responded to psychological interventions, and cases where there is also a significant anxiety disorder. Research has demonstrated that anxiety disorders do respond more clearly to medication than depression does.
Psychological treatments in young people focus on changing negative thinking patterns and fostering healthy problem solving and coping skills. Two main types are cognitive-behavioural therapy (CBT) and interpersonal therapy (IPT). At present mental health clinicians in this province are trained in CBT for depression and anxiety disorders, and more are being trained in IPT. As with medication, the response to CBT is greater in anxiety than in depression. Some of the principles of CBT are incorporated into a new self-help guide, Dealing with Depression.
Depressed teens tend to gravitate toward other depressed teens, so supporting access to peers with a healthier outlook can be helpful. However, contact with depressed peers in the context of a therapist-facilitated group can help teens develop skills for coping with depression.
Treatment for depressed teens requires a mixed approach, including practical support, systematic treatment and careful monitoring. The high prevalence, serious impact and residual effects of depression indicate this is a condition that families and schools need to be very aware of. Beyond the Blues, 5 a video produced by the Knowledge Network in collaboration with the Ministry of Children and Family Development, also has an interactive website with helpful information for concerned family members.
Families and school communities can be part of the solution for young people suffering from depression. Relatives can make an effort to have more supportive and non-judgemental contact, encourage exercise, provide tutoring and facilitate healthy social activities such as joining a community centre, church or ethnic community youth group.
About the author
Jane is Clinical Head of the Mood and Anxiety Disorders Clinic and Clinical Professor of Psychiatry, both at the University of British Columbia
Cheung, A.H., Emslie, G.J. & Mayes, T.L. (2006). The use of antidepressants to treat depression in children and adolescents. Canadian Medical Association Journal, 174(2), 193-200.
Lewinsohn, P.M., Clarke, G.N., Seely, J.R. et al. (July, 1994). Major depression in community adolescents: Age at onset, episode duration and time to recurrence. Journal of the American Academy of Child and Adolescent Psychiatry, 33(6), 809-818.
Garland, E.J. (2004). Managing depression in the new reality. BC Medical Journal, 46(10), 516-521.
Bilsker, D., Gilbert, M., Worling, D. et al. (2005). Dealing with depression: Antidepressant skills for teens. Available in PDF format at www.mcf.gov.bc.ca/mental_ health/current_initiatives.htm
Palmer, M. (2004). Beyond the Blues: Child and Youth Depression. Burnaby, BC: Knowledge Network. Depression knowledge kit materials are accessed at www.knowledgenetwork.ca/takingcare/Video can be ordered from www.nfb.ca or by calling 1-800-267-7710.