Depression in Adolescence

Adolescence is a time of profound changes as young people leave childhood and enter a new and challenging phase of life. It is not easy to navigate changing bodies, the mounting responsibilities, trying to make new friends and possibly losing old ones. Transforming into a teenager can be a time of extraordinary pressure. Under the overwhelming demands of this awkward life-stage, young people can find themselves experiencing a range of negative or confusing emotions. If left unacknowledged, these emotions can become acute, leading to depression and in the worst case scenario—to suicidal thoughts and actions. Studies suggest that 10–15 % of young people have depressive symptoms and 3-5% develop serious clinical depression. Moreover, adolescents who experience depression are at a significantly higher risk for substance abuse, recurring depression, and other emotional and mental health problems in adulthood.

The developmental struggles of adolescence confront the young person with a paradoxical dilemma between growth and loss. Physical, emotional, and cognitive changes add complexity to the experiences of adolescence. Teenagers face the arduous task of having to let go of childhood and establish new key aspects of identity, including the adjustment to sexually maturing bodies and feelings, developing and applying abstract thinking skills, and negotiating relationships and roles with adults in parenting roles. One can easily see how the stress and anxiety that result from such enormous changes can lead to depression.

How can Marriage and Family Therapists Help?

As marriage and family therapists, our ability to think systemically is particularly beneficial in treating the complexities of depression in adolescence. By examining the larger context of the challenging transformations, MFTs can comprehensively assess how a young client struggling with depression is affected by various relationships. By coming to understand what is happening at home, at school, or with friends, the therapist is able to map out connections that help examine and treat the root causes, not just the symptoms. The larger-system perspective illuminates the struggles the young person is experiencing, even if she or he does not yet have the words to articulate the processes that are taking places. This contextualization can help prevent an increase—and eventually reduce—the feelings of isolation, which would otherwise only aggravate the depression.

What is the cause of depression?

While the causes of depression in adolescence are difficult to pinpoint with precision, there are a number of contributing factors that can be identified. An adolescent exposed to childhood trauma such as familial violence, divorce, or alcoholism is at a higher risk for depression than peers who experienced a home-life that was emotionally stable and supportive. Other risk factors for young people include a parent or parents with depression or other familial history of depression. Another contributing factor has to do with brain structure and development. Adolescents with depression have different levels of neurotransmitters than those who are not depressed. Neurotransmitters are crucial chemicals in the brain that affect the way in which brain cells communicate with one another. They also play a critical role in regulating moods and behavior. When these transmitters are compromised due to stress or another trigger, a young person becomes vulnerable to depression—through no choice or fault of his or her own. Symptoms of depression in adolescence are similar to depression in adults; however, one should guard against mistakenly dismissing signs such as moodiness, excessive changes in appetite and irritability as merely typical “teen behaviors.” While carefully avoiding hasty conclusions or labelling, it is best to err on the side of caution and be alert to a wide array of symptoms and behaviors.

Indicators of depression in an adolescent include:

  • Moodiness, sadness, irritability, or tearfulness
  • Expression or manifestation of feelings of guilt, worthlessness, or helplessness
  • Talk of suicide
  • Frequent complaints of boredom, visible listlessness, and loss of focus
  • Changes in appetite or weight that appear developmentally inappropriate
  • Major changes in sleeping habits

Detection of adolescent depression may also be facilitated by noticing changes in behavior that may include:

  • Drug and alcohol use
  • Self-mutilation (such as cutting)
  • Initiating fights or displaying defiance
  • Running away from home or school (abruptly worsening school performance)
  • Withdrawal from friends or other previously enjoyed activities
  • Reckless sexual behavior

As the complexity and wide range of these signs and symptoms suggests, guiding the adolescent through a period of depression requires a well-developed skill set and a comprehensive approach. MFTs can address the systemic changes causing the depression through a holistic orientation that seeks to empower, rather than pathologize, the difficult emotions that are part of the human experience.

Resources

AAMFT Products

Cover of Clinical Updates for Therapists: Volume 1   Clinical Update: Adolescent Disruptive Behavior Disorders. By James Alexander. Found in Clinical Updates for Therapists: Volume 1, AAMFT (1999). Accompanies this Consumer Update and is designed to educate therapists on topics such as diagnosis and assessment, terminology, BioMedical and associated considerations, treatment options, professional resources, and new decisions in service delivery. For more information, or to purchase the volume,  here.

Other Books

Parenting Wisely by FamilyWorks, Inc.
This interactive multimedia program, which parents can use at home on a multimedia computer, is based on parenting research and helps parents improve their parenting skills. It addresses three main areas: how to communicate better using active listening and "I" messages; assertive discipline, including contracting, praise, and setting consequences; and supervision, or working with teachers, and monitoring homework and friends. The program features many types of families and different cultures. For more information on the program, contact FamilyWorks, Inc., 20 East Circle Drive, Suite 190, Athens, Ohio 45701-3751, or call (740) 593-9505.

 

This fall AAMFT members will be sharing their unique perspectives, knowledge, and research findings in a crowdsourced effort to update our Therapy Topics. Check out the September 8 eNews for more information on how you can be involved!

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