Notice to our readers and families of PMC:
Contrary to what you might have heard, Dr. Samson is NOT retiring. He is only reducing his office time by 50%. He has no plans to leave the practice of pediatrics and will be there for you. After 59 years of being on call for nights and weekends, from medical school to the current time, he felt it was time to let the younger physicians of PMC fulfill that responsibility. He is looking forward to seeing you and your children in the future.
Psychiatry and psychology have only acknowledged adolescent depression as a reality for the past 20 years. Now, experts in adolescent development and behavior view depression as a major contributing factor to a number of teen problems, including eating disorders, drug and alcohol abuse, truancy and other school-related problems, sexual risk-taking including pregnancy and running away from home. More than one-million teenagers, most under the age of 16, run away from home each year. The rate of suicide in this age group has increased precipitously over the past 20 years. Adolescent depression in today's society can be life changing and even life-threatening. We cannot afford to treat "teenage problems" lightly.
In her book Understanding Your Teenager's Depression (New York, the Berkeley Publishing Group, 1994) Kathleen McCoy states that teenage depression is a "great mimicker" which can fool the most informed parent or astute professional. The purpose of this article is to help parents distinguish the teenager who is clinically depressed from the one who exhibits the "normal" turbulence associated with the adolescent years.
Depressed teenagers may seem irritable, "snappish" or withdrawn. Depression may also be disguised in any number of the "acting out" behaviors mentioned above. Sadness and unhappiness are generally demonstrated as well. The following two scenarios will serve to highlight two of the many possible presentations of this kind of depression.
Case scenario #1: Lisa, at 14, had suddenly become defiant and oppositional at home. Her grades plummeted; an unusual situation in that Lisa had characteristically been an excellent student. She started to defy curfew and other family rules, and withdrew from previous activities (art, dance). After numerous nonproductive discussions with Lisa, her parents decided to seek professional assistance. Several family sessions later, they were shocked to learn that Lisa was depressed.
Case scenario #2: Jack was a bright kid, by all apparent standards. He was popular and handsome. He did extremely well academically, and, at 17, had been accepted to a top notch Ivy League college. During the final months of what should have been the "cap" of a perfect senior year, Jack changed. He ate less and began to sleep excessively. He barely spoke to his parents. He withdrew from his friends, preferring to remain alone in his bedroom when not in school. He told his parents that he felt sad and down. He questioned whether life had purpose. His parents were bewildered by his changes, and at the urging of a friend, consulted a therapist. During treatment, it was learned that the family (both sides) had a strong history of depression. In addition, Jack was beset by feelings of insecurity and fearfulness at the prospect of leaving home. And there was always the possibility that he might disappoint his parents. Ultimately, Jack was diagnosed as depressed, and an appropriate treatment plan was initiated. Although Jack struggled through the completion of his senior year, his symptoms had stabilized by summer of that year, as he and his family confronted these issues. He began college as scheduled. Jack reports that ongoing sessions with a college counselor have been helpful in keeping him "on track".
These cases serve to illustrate how a depressive syndrome in a teen is not always readily identifiable. Instead, depression may be presented by the teenager in a variety of forms. There are certain "signposts" about which an informed parent can be aware. Some hallmark symptoms of clinical depression in the teenager are:
Teens today feel less hopeful, safe and powerful than their parents did. Depression in this age group is usually the result of not one but several factors. In some the onset of depression follows a major loss or setback. In others, the precipitating factors may not be so clear. Nonetheless, there are several stressors that have been definitively identified as placing them at risk for depression; several of these identifiable stressors in combination increase the risk. They include:
The teen with a depressed parent has a major risk factor for the onset of their own depression. Various aspects contribute to this risk, including the genetic risk implied, the probable lack of parent's availability as a result of his or her own depression, and frequently, dysfunctional parent-child interactions and marital conflict.
Family crisis, including divorce, is a major risk factor in teen depression. Remarriage of one or both parents frequently results in emotional crisis for the offspring. Unemployment or significant family financial stress can also result in a sense of profound pressure, as can the illness of a family member. While adolescents often seem removed from their family's system, they actually remain very vulnerable to home-based problems and anxieties.
"Dysfunction" can be extreme, as in the case of physical, verbal or sexual abuse. It may also refer to a family's style, which may be less than optimal for a teenager's needs as a developing young adult. Depression in the teen can occur in response to chronic, poorly functioning family patterns, as well as in response to a specific family crisis.
Some parents convey expectations which seem impossible to reach. These demands sometimes can help a teen strive to do his or her best. A message that parental love is conditional on the teen's achievements can produce an array of intense emotional responses, including depression.
These may include feeling harassed or rejected by one's peers, struggling with learning disabilities,emerging awareness of homosexuality, and growing up as a female! (Teenage girls are at significantly higher risk than teenage boys for depression.)
These may include the loss of a parent or other family member, separation from a loved one as in a divorce, or the onset of a significant illness.
The adolescent years bring a number of changes. All of these changes mean simultaneous growth and loss. The loss of childhood and family-centered life, along with increasing responsibilities can result in a sort of mourning state. Teens may present as mildly depressed, or at least unhappy as they confront the challenges of separating from their families. When this state of flux or change results in depressive symptoms which threaten the teen's ability to continue to function, professional intervention is warranted.
First, tell your teenager what you are seeing or sensing, and ask your offspring to tell you about it.
Second, listen carefully. Try not to interrupt, correct or contradict. A caring, open attitude can signal much needed support and hope.
Third, be supportive. Eliminate or alleviate stressors in their lives to the extent you are able, offer guidance, diminish any criticizing or nagging. Wait and see if the depression is self limiting (normal expressions of teen rebellion and transient depressions are limited in time and scope). Ask yourself how frequent and/or intense the unusual behavior is, how long it has been going on, and whether it represents a true departure from their usual functioning. Transient depression usually lasts a few days or a week. If the symptoms persist, or if you believe that your teen is in any way putting himself or herself (or someone else) at risk, seek professional help.
Fourth, find a way to deal with your own negative feelings (guilt, denial, anger, etc.). Your own feelings have been triggered and parents often feel angry and victimized when their adolescent becomes depressed. They see this child, poised on the threshold of so many wonderful choices, yet, being unable to recognize their good fortune. Your own feelings are normal--express them, to your spouse, a friend, relative or counselor.
Learn good communication skills! Many parents and their teenagers are, literally, strangers to one another. Long periods of silence may be punctured by angry, seemingly incomprehensible outbursts on the part of the teen. McCoy aptly describes Generational Chauvinism and Parental Ownership as contributory to the breakdown in communication between adolescents and their parents.
In Generational Chauvinism, both the parent and the teen believe that the other has little to offer, in the way of wisdom, companionship or humor. Comments which characterize parents guilty of this form of chauvinism include, "What does he know? He's just a kid!" or "Sex! Why should I be talking to my kid about that? She's too young to even think about it!"
In Parental Ownership, parents harbor a belief that they should have total control over their children's choices, values, etc.--literally, over their lives! Such parents tend to view their children as ungrateful and rebellious. Their teens tend to view them as uncaring tyrants. Parents must see their children as separate and valued individuals if true communication is to be established.
Here are some surefire phrases to turn off communication with your adolescent:
It is your job, as the parent in this partnership, to communicate with your adolescent in a way that promotes mutual understanding and respect. Some of the tools for survival include: the development of empathy for your child, spending time with your teen, and helping him or her to develop survival skills. Learning and implementing family stress management techniques such as clear messages, respect for one another's separateness, limit setting and conflict resolution are critical. Most of all, stay in touch with your teen. All of these "tools" can create an environment in which open communication is fostered and maintained. More information on developing and maintaining such a system with your teen will be explored in a future article.