Depression in teenagers

Adolescence has been referred to as a period of “storm and stress” and the various biological, psychological, and social transitions taking place during this time have been associated with increased vulnerability to depression. Teenage depression looks slightly different from depression in adults. In teenagers, one may see more of cranky behaviour, irritability and isolative behaviour towards adults in their lives. The teenager may also have failure to gain weight appropriately rather than a loss of weight. Despite these differences, it remains important to be aware of the symptoms of depression so that parents can reach out for professional assistance as soon as possible. The general symptoms of depression are:

• Depressed most of the day, nearly every day as indicated by subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful)
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation)
• Significant weight loss when not dieting or weight gain (e.g., change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
• Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Treating depression in teenagers

There are various approaches to treating teenage depression. Research has found that antidepressant medication and psychotherapy may be effective treatments; a combination of these is frequently optimal. It should be noted, though, that while antidepressant medication is one option, antidepressant use in children and teens must be monitored carefully as there can be severe side effects such as causing or worsening suicidal thinking or behaviour.

Psychotherapy

Psychotherapy for depression is as effective as medication in many cases and is the recommended first-line intervention for mild to moderate depression in teenagers. Psychotherapies are also empowering for the recipient as the process of therapy validates their experience and also equips them with skills to navigate life’s challenges. Three types of psychotherapies, or “talk therapies”, have been identified to be most effective:

Cognitive-Behavioural Therapy (CBT): CBT is based on the theory that our thoughts, feelings, and behaviours are interlinked. By challenging and changing unhelpful cognitive distortions and behaviours, the individual can improve emotional regulation and develop more positive personal coping strategies. Common CBT interventions include psychoeducation, mood monitoring, pleasant activities, behaviour activation techniques, and cognitive restructuring. Generally, CBT is directive, time-limited, structured, problem-focused, and goal-oriented.

Interpersonal Therapy (IPT): IPT was originally developed specifically for adults, but in 1994 it was adapted for adolescents (IPT-A). IPT-A aims to improve communication and problem-solving skills to increase interpersonal effectiveness and relationship satisfaction in teenagers. IPT posits that focusing on interpersonal relationships is very important during adolescence, as relationship issues are related to the onset or ongoing occurrence of depressive symptoms. The goals of IPT-A are to: 1) help adolescents to recognize their feelings and think about how interpersonal events or conflicts might affect their mood; 2) improve communication and problem-solving skills; 3) enhance social functioning and lessen stress experienced in relationships; and 4) decrease depressive symptoms.

Dialectical Behaviour Therapy (DBT): DBT was originally developed to treat Borderline Personality Disorder, but it also has been adapted to treat other mental health conditions including depression. DBT can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviours. In DBT, one would be taught how to effectively change their behaviour using four main strategies: 1) mindfulness; 2) distress tolerance; 3) interpersonal effectiveness; and 4) emotional regulation.