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No Worries

How interpersonal therapy can help depressed adolescents

Elizabeth Baerg Hall, MD, CCFP, FRCPC

Reprinted from "Treatment for Young People" issue of Visions Journal, 2006, 3 (1), p. 22-23

Fifteen-year-old Sam was upset and irritable. He broke up with his girlfriend on a whim and was having trouble fi nding his way again. Fighting shattered his good reputation as a team player on the soccer field. His grades dropped. He couldn’t sleep and lost weight. He just didn’t feel like himself any more. To make matters worse, he had lost many old friends during the time he was with his girlfriend. Rather than reaching out, he withdrew into loneliness and despair.

Depression—a great challenge at any time of life—can feel like too much for an adolescent to bear. Although fi nding a name for the near-constant sadness or bad moods may bring relief to parents, friends and the young person him or herself, there is often confusion about what to do next.

First, it is good to get some information about depression. It is most important to know that depression is a treatable illness. Depression is common among youth, affecting 5% to 8% of adolescents. It is best to get help rather than tough it out alone. Many adolescents experience suicidal ideas during depressive episodes. These ideas need urgent and special attention.

There are things that adolescents and their families can do to help heal depression. To begin with, teens should make sure they are getting enough regular sleep, healthy food and exercise. Omega-3-fatty acids, taken in pill form at 1000 mg daily or by eating fish such as salmon, can also help. Changes in the school program, such as reducing course load or stopping extracurricular activities, may be needed, but it is best to keep going to school regularly. Parents may need to lower their expectations, staying fi rm but loving.

The next thing to consider is where to get help for the depressed mood. The first choice for a young person with mild to moderate, clear-cut depression is counselling. By going to therapy, young people learn a set of skills that will be available to them for life. Sometimes medicines, such as fluoxetine (Prozac) can be helpful in treating adolescents with severe or long-lasting depressions. Medicine and psychotherapy together are best in these more complicated cases.

Among the large number of therapies available for adolescents, two short-term therapies are scientifically proven. Cognitive-behavioural therapy (CBT) looks at how a person’s thoughts, beliefs and behaviour act together to create a depression and it encourages the young person to change these patterns in order to get well. There is a helpful online book based on this approach called Dealing with Depression. CBT is available throughout BC.

Interpersonal therapy for adolescents (IPT-A) is based on interpersonal therapy (IPT) for adults, which has been further developed by Drs. Klerman and Weissman at Columbia University.4,5 Over a period of 12 to 15 weeks, teens examine their feelings and behaviours towards others and learn skills to improve the depression. They become more aware of how everyday things that happen in their lives affect their moods. As well as feeling better, they feel more powerful through applying these new skills to address problems that come up. Parents are involved along the way. BC Children’s Hospital and the Ministry of Children and Family Development are committed to providing youth in this province access to this other effective and helpful treatment for depression.

Using IPT-A, Sam and his therapist reviewed the important relationships in his life to see if there were any things he could change to improve the depression. Together they learned that he did not like talking about his feelings, leading to depression and isolation. He had been unhappy with his girlfriend, but he didn’t talk about these feelings. This led him to feel irritable and, before he knew it, he impulsively broke up with her. Although he knew the relationship needed to end, he had regrets about the way he broke up with her. This led to guilty feelings. He had trouble letting go as he struggled with these mixed feelings.

Next, Sam and his therapist came up with a plan to help him feel better. Sam learned a new way to talk about his feelings that wasn’t so scary and that didn’t leave him feeling overwhelmed. He practised this in his counselling sessions and at home. He remembered how good he used to feel when he would call his friends to go out, and he started making those calls again. He prepared for what he would say when they asked him why he hadn’t been around recently. He dealt with his feelings about the ending of his romantic relationship, and eventually he felt able to move on. He practised what he would say the next time he saw his former girlfriend at school.

Within eight weeks, Sam was feeling much better. By 10 weeks, his depression was completely gone. He was pleased to have made these changes in his life using interpersonal therapy since he had wanted to get better without using medications. Sam spent the last therapy sessions reviewing his depression symptoms so he could seek help more quickly if they came back. He had learned how important it was for him to stay connected to his friends. He felt clearer about what he wanted in his friendships and romantic relationships. In the next relationship, he was sure he wouldn’t let himself get so isolated from his friends. Sam had good and bad days like normal teens, but he was no longer depressed. He was educated about depression and knew a lot more about his strengths and weaknesses as a person.

This is the goal of interpersonal therapy for depressed adolescents. As well as feeling relief from the depression, young people can feel good about their new skills, improved self-understanding and better relationships in the world around them.

 
About the Author

Elizabeth is a psychiatrist with the Mood and Anxiety Disorders Clinic at BC Children’s Hospital (BCCH), specializing in group and individual psychotherapy with adolescents. Together with Ministry of Children and Family Development and BCCH colleagues, she is heading a project to bring interpersonal therapy for adolescents to BC

Footnotes
  1. Ma, J. Lee, K.V. & Stafford, R.S. (2005). Depression treatment during outpatient visits by US children and adolescents. Journal of Adolescent Health, 37(6), 434-442

  2. March, J., Silva, S., Petrycki, S. et al. (2004). Fluoxetine, cognitive behavioral therapy, and their combination for adolescents with depression: Treatment for adolescents with depression study (TADS) randomized controlled trial. Journal of the American Medical Association, 292(7), 807-820

  3. Bilsker, D., Gilbert, M., Worling, D. et al. (2005). Dealing with Depression: Antidepressant Skills for Teens. www.carmha. ca/publications/pages/documents/DWD_PrintVersion.pdf

  4. Mufson, L., Moreau, D., Weissman, M. & Klerman, G. (1993). Interpersonal psychotherapy for depressed adolescents. New York: Guilford Press

  5. Weissman, M.M., Markowitz, J.C. & Klerman, G.L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books

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