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Understanding Teenage Depression
 Read our review of this book!
Each year, thousands of American teenagers are diagnosed with clinical depression. If ignored or poorly treated, it can be a devastating illness for adolescents
and their families. Drawing on her many years of experience as a psychiatrist working with teenagers, Dr. Maureen Empfield answers the questions parents and
teens have about depression, providing detailed information on:
- How Depression is Diagnosed
- Identifying the Different Types of Depression
- Which Teenagers are Most at Risk
- Assessing the Risk of Suicide
- The Drugs Used to Treat Teenage Depression -- What They are and How They Work
- When a Teenager Needs to be Hospitalized for Depression
- The Effect of Depression on other Teenage Problems
Understanding Teenage Depression provides the latest scientific research on this serious condition and the most up-to-date information on its treatment.
Incorporating case studies drawn from Dr. Empfield's clinical practice as well as first-person accounts from teenagers, this is a book that anyone who's been
touched by this disease -- whether parents, teachers, family members, or teens themselves -- will find invaluable.
Teenage Depression: More Common Today Than Ever
Some estimates are that as many as 8 percent of adolescents suffer from depression at some time during any one-year period, making it much more common
than, for example, eating disorders, which seem to get more attention as a source of adolescent misery. This book will tell you what you need to know about
depression -- whether you are the teenager suffering from it, or the parent who loves a depressed teenager.
Even among psychiatrists and other mental health care professionals, the extent of the disability caused by depression is vastly underestimated. The World Health
Organization has found that major depression is the single greatest cause of disability in the world -- more than twice as many people are disabled by depression
as by the second leading cause of disability, iron-deficiency anemia. Other diseases and disorders may get more press or more research money, or more
sympathy and concern from a well-meaning public, but major depression causes more long-term human misery than any other single disease.
When I was a resident in psychiatry, we believed that true depression was rare among teenagers, or that insofar as it existed, it was just a normal phase of
adolescent development with no lasting consequences. It didn't take long after I began treating troubled kids to see that this couldn't possibly be true. Research
over recent decades has confirmed my impression. These beliefs, if anyone still holds them, are false and dangerous. In fact, early onset depression is not normal,
and can predict numerous unhappy life events for youngsters, including school failure, teenage pregnancy, and suicide, attempts.
Although depression is today increasingly common, it is among the oldest diseases recorded in the history of medicine. As early as the fourth century, the
symptoms of "melancholia" were well known and attributed to an excess of "black bile." In other words, depression was first thought of as an exclusively physical
illness -- the loss of appetite, sleeplessness, irritability, and general despondency of depression were believed to have a physical, not a psychological, cause. It
wasn't until the nineteenth century -- when the term depression was invented to substitute for melancholia -- that a psychological understanding of the illness began
to develop. Eventually this psychological explanation of depression would become the only one, although today it no longer is. We now know that depression has
both psychological and physical symptoms, and that both psychological and medical treatments can help to alleviate them.
Depression is a Disease
Depression -- that is, the illness that is often called "clinical depression" -- is not the same as a bad mood, or a feeling of unhappiness. It is a disease. Although
there are some theories about it, no one knows exactly what causes depression in teenagers (or in anyone else, for that matter), but we do know that it is not
caused by poor parenting, and that it cannot be cured by good parenting. Nor is it caused by the victim of the disease, something that is for some people all too
easy to conclude. A "change in attitude" or a willingness on the part of the youngster to "straighten up and fly right" will not relieve the terrible symptoms of
depression. It is a disease that requires the attention of experienced professionals, using both medical and psychological treatments, methods scientifically
established as valuable in relieving the symptoms of depression and allowing a teenager to lead a normal life. These techniques are complex, time-consuming, and
sometimes expensive, and they require not only the conscientious work of medical professionals but considerable cooperation from the teenager being treated, as
well as the dedicated attention of the people who love her. Nor are they 100 percent effective 100 percent of the time. But they do work, and when they do they
provide relief that many patients describe with the most thankful phrases: "I've been given back my life, I'm myself again" or similar words are often heard when a
youngster's depression begins to lift.
Psychiatric Treatment That Saves Lives
Phil was a 19-year-old sophomore at a Big Ten school. He was a serious athlete -- an almost Olympic-caliber ice hockey player -- and a top-notch student as
well, majoring in chemistry. He had had some problems during early adolescence -- for a brief period he was hanging out with a group of daily marijuana smokers
-- but certainly no serious psychiatric illness. In any case, his parents, one of whom had had a depressive episode, were very much invested in his academic and
athletic success and minimized any emotional complaints, which they viewed as a sign of weakness.
No sooner had hockey practice begun, however, than Phil had a serious falling out with one of teammates, whose ex-girlfriend he had begun to date. This boy
turned other players against him, and Phil found himself excluded from the social life of the team, essentially shunned. Gradually he became isolated from his other
friends as well and began having trouble concentrating on his studies. His grades suffered. He started drinking heavily, and one night he told one of his friends that
he was thinking of jumping off the roof of a building, if only he had the guts to do it. This friend called Phil's parents, his parents called me, and I urged them to
either hospitalize him there or bring him home. His father flew to the Midwest to get him, and we hospitalized him immediately upon his arrival home.
Phil's own attitude was that hospitalization wouldn't help, but, feeling despairing or numb, he put up no resistance to the plan. His time in the hospital began with
the quick establishment of an anti-depressant medicine regimen, along with individual group psychotherapy. His family also needed therapy and education to
help them recognize that Phil suffered from a real illness, not from moral weakness.
After two weeks in the hospital and now well established on a drug regimen, Phil came home and worked for several months, then returned to school. Although
he never went back to playing hockey, he has done well in college, and has continued his medication with almost complete relief from symptoms. The treatment
he received in the hospital quite literally saved his life.
Suicide Warning Signs
Although it is almost impossible to predict precisely which teenager will attempt suicide, there are warning signs that parents can look for. The American
Academy of Child and Adolescent Psychiatry has assembled this list of indications. If one or more of these signs occurs, parents should talk to their teenager and
seek professional help.
- Unusual changes in eating and sleeping habits
- Withdrawal from friends, family, and regular activities
- Violent actions, rebellious behavior, or running away
- Excessive drug and alcohol use
- Unusual neglect of personal appearance
- Marked personality change
- Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
- Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
- Loss of interest in pleasurable activities
- Not tolerating praise or rewards
- Complaints of feeling "rotten inside"
Copyright © 2001 Maureen Empfield, M.D., and Nicholas Bakalar, authors of the book "Understanding Teenage Depression". The above article is an excerpt from this book, reprinted with permission.
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