The teenage years are years of enormous change and are therefore characterised by some degree of emotional instability. Mood swings are normal and are part of being a teenager. However, 4% of teenagers suffer something more than this - clinical depression that requires treatment.
Take the case of Hazel. Hazel had always been an outgoing, sociable, bouncy sort of girl but, as her mock GCSE's approached, she changed. She became almost constantly low in mood and she seemed to be doing no work whatsoever to prepare for her exams. She said that she felt overwhelmed by all that there was to do - 'like a rabbit frozen in headlights' was how she put it - it all seemed too much to cope with. Hazel became increasingly irritable too, constantly squabbling with her younger brother and hyper-sensitive when her parents criticised her for this. She stopped going to the sports clubs she had previously loved because, she said, she felt too tired. Her only pleasures seemed to be playing computer games and eating sweets and biscuits. Hazel's parents were anxious. They felt unclear about how to help her and they also felt very angry with her - much of the time she was barely civil. When depression was diagnosed it came as an enormous shock - depression was not something that had ever happened in this family - it happened to other families - but at least Hazel and her parents felt that a diagnosis gave them a little more understanding and control, a reason for things being the way they were. Hazel began taking anti-depressant medication and saw a Cognitive Behavioural counsellor once a week. Gradually things began to improve. She managed to sit her mocks - albeit six weeks later than her class-mates - and her reasonable results boosted her confidence to the extent that she was able to sit her GCSE's that summer.
Hazel's story could have had a very different ending. Depression needs diagnosis and it needs treatment. Had Hazel's parents put her behaviour down to normal adolescent growing pains her depression could have escalated and could have ended in a suicide attempt.
So what is it that makes young people vulnerable to depression?
- The teenage years are years of change and change, whilst it is very exciting, inevitably means loss - loss of the safety and security of childhood, loss of childhood friends as different educational paths are chosen, loss of not having to worry about what they look like etc.
- Teenagers are under multiple pressures. There are exams to pass and a career path to be chosen at a time when they may feel they have no real idea what their tastes and strengths are. They must find a girlfriend/boyfriend. In order to fit in with their peers, they must look a certain way, act a certain way, dress a certain way - often, as a result, coming into conflict with their parents. They must take on more responsibility for themselves and start thinking about leaving home.
- Enormous hormonal changes are taking place and the flux of hormones can cause dramatic mood swings that make the teenager feel out of control. One moment they are on a high, madly in love with some music idol, and then the next moment in despair as they contemplate their acne and their puppy fat and their shortage of 'cool' outfits.
How can depression be manifested?
Depression is characterised by significant changes in mood, behaviour or personality that persist over a period of weeks. Symptoms include:
- Feeling sad and perhaps crying a lot
- Feeling no good at anything / having no confidence
- Feeling that life is meaningless or that there is no hope
- Feeling numb or deadened / flat
- Loss of interest in going out / hobbies
- Having trouble concentrating or making decisions
- Being easily angered or irritated
- Having sleeping problems - either excessive sleeping or trouble falling asleep or trouble staying asleep
- Loss of appetite or excessive comfort eating
- Feeling tired all the time
- Feeling restless or anxious
- Being plagued by thoughts about death or suicide
In teenage depression, anger, irritability and extreme sensitivity to criticism are usually particularly noticeable. Some teens also present their depression as physical aches and pains.
Depression can cause extraordinary emotional pain - similar to the pain experienced in intense grief - and young people will often react to this pain by 'acting out' - that is to say, by getting into trouble. They may start drinking, taking drugs, having sex indiscriminately, playing up at school, abandoning friendships and so forth. The message they give is a mixture of 'none of this matters any more' and 'help me'.
So what can be done about depression?
Depression needs treatment at the earliest opportunity - it is not a good idea to just hope that it will go away on its own. If you think that your son or daughter is depressed share your concerns with them and offer support - let them know that you are there for them. Additionally, seek specialist help - your G.P. is a good starting place. Treatment options will usually be a combination of anti-depressant medication and counselling. Be aware that medication takes time to work - up to a month - and that careful monitoring is essential because some anti-depressants can actually increase suicidal feelings in young people. Counselling can help enormously, especially when communication within the family is poor. Cognitive Behavioural Therapy, in particular, has been shown to be effective and is very practical in its approach - identifying and challenging persistent negative thought patterns.
If your teenager is depressed, the fear of suicide may be a real issue for you. Suicide is, after all, one of the leading causes of death in young people, young males especially, and depression is often a key factor in suicide. The main thing to remember is to ALWAYS take it seriously - threats and half-hearted attempts should never be written off as mere attention-seeking. Whilst there probably is an element of attention-seeking, the fact is that most 'successful' suicides have made previous threats or attempts at suicide.
What helps within the family?
- Be understanding and listen without lecturing
- Validate feelings - don't tell your teen that it is silly to feel a certain way
- Tell them that you know they are not doing this on purpose
- Avoid saying 'snap out of it' - it simply doesn't work and may make your teen feel worse
- Encourage physical exercise - the endorphins released when we exercise boost our mood
- Encourage social activity - lack of company reinforces depression - but be gentle - don't force your son or daughter into social situations that terrify them
- Make a point of telling them what they are good at and the things that make them loveable - self-esteem nosedives in depression
- Remind them that you are there for them unconditionally and that their persistent misery will never, ever drive you away
- Ensure that pills are being taken as prescribed and that counselling appointments are being attended
- Give them hope - tell them that depression almost always lifts and that they will get better
It is important, too, to remember your own needs and the needs of siblings who may be feeling that all the attention is on the moody, bad-tempered teenager. Explain to your other children what is happening and what they can do to help - that way they will feel less left-out. And make sure that you have an outlet for yourself. You may feel angry, helpless, overwhelmed, frustrated, guilty, depressed - all of these feelings are entirely natural. Living with someone who is depressed is extremely difficult.
Above all, though, have hope. Within a supportive family and with appropriate treatment there is every chance that your son or daughter will make a complete recovery.