How Do We Know when Our Teen Has Major Depression

About 5 percent of children and adolescents in the general population suffer from major depression at any given point in time (American Academy of Child and Adolescent psychiatry www.aacap.org). Major depression, also known as a clinical depression, is not a single symptom but rather a cluster of symptoms. Major depression is most likely to be present if there has been a change in the teen's patterns of thoughts, feelings, and/or behaviors which are manifested with the following symptoms:

• Frequent sadness or "down" mood

• Increased irritability, anger, or hostility (sometimes children exhibit more irritability than sadness with depression)

• Lack of enjoyment (also called "anhedonia") or inability to enjoy activities that the teen previously showed interest in

• Appetite change (either an increase or decrease in appetite)

• Sleep change (difficulty falling asleep, restless sleep, sleeping more or less than usual)

• Low energy

• Low concentration

• Motor agitation (such as restlessness, fidgeting or pacing, or reporting feeling "revved up") or slowing down (such as feeling as if daily activities are hard to get through or to physically complete)

• Guilt or worthlessness (such as feeling or expressing guilt or feeling worthless or "like a loser")

• Suicidally (ranging from questioning the value of life, to actual thoughts, expressions, or gestures of self-harm.

• Depressed adolescents may also abuse drugs or alcohol as a way to make themselves feel better.

A diagnosis of major depression will be made if the teen's feelings of sadness and lack of enjoyment have gone on for at least two weeks and if four or more of the other listed symptoms have occurred almost every day. Suicidal thoughts and - may not occur as frequently as daily. However, if they exist at all, they need to be explored immediately.

There can be a genetic component to depression. One study (Kovacs, 1997) showed that families of depressed teens were five times as likely as those of non-depressed teens to have a person in the family who also suffered from depression. The closer the relative is, the higher the risk.

Depressed children and teens have most of these symptoms for at least a couple of weeks. Briefer mood disturbances sometimes occur in response to stress, but this is not considered true "clinical depression" (i.e., a depression requiring treatment). Everyone has these symptoms sometimes (for example, normal grief), but if they persist and interfere with day-to-day functioning, they constitute a disorder.

Once a disorder is diagnosed, it can happen once (a so-called "single episode" of depression), or several times (called "recurrent depression"). A single episode can last anywhere from a few months to a year. Therefore, it is important that professional involvement continues for at least this length of time. A substantial number of depressed teens (30 to 40 percent) have recurrent depression, so it is important to watch for further mood problems once an episode of depression resolves. Early intervention can minimize the impact of recurrent episodes of depression. Without intervention, a teen's self-esteem and ability to function (in the family, socially academically) can be severely affected.

A teen who experiences a major mood disorder with hallucinations (such as hearing voices) or delusions (such as having unrealistic ideas about a TV show containing a special message for her), but does not have schizophrenia, may be experiencing psychotic depression.



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