Moody or Mentally Ill?

But while he appeared angry, John was actually terrified. He was hearing voices calling his name when no one was around—experiencing what he later learned were the first symptoms of schizophrenia—and was too frightened to confide in anyone, even his mother.

"I thought she was going to kick me out of the house but I finally broke down and told her," said John, who was surprised at how supportive his mother was. He now takes medication to control his symptoms and has become an outspoken advocate for other young people with mental illness.

While schizophrenia is relatively rare, affecting only about 1 percent of the population and usually developing during the college years, depression is common among younger teens. According to a nationwide report by the Substance Abuse and Mental Health Services Administration, 8.5 percent of teens aged 12 to 17—or one in 12—experience depression in any given year, with almost half saying they were so down that they couldn't perform their daily activities.

The report, based on the responses of 67,706 youngsters surveyed between 2004 and 2006, found girls much more susceptible to depression than boys, with 12.7 percent of females and 4.6 percent of males reporting a depressive episode.

One of the SAMHSA report's surprising findings was that only 30 percent of those who had experienced a depressive episode had gotten treatment. The number is even lower for college age adults struggling with personality disorders, according to the Columbia study. Fewer than 25 percent of them receive treatment, researchers found.

Last year, public health officials reported the first increase in teen suicides following a 13-year decline, an 8 percent increase in suicides among young people aged 10 to 24 in the year 2004, with the biggest percentage jump among girls aged 10 to 14.

Irritable and angry
One one reason parents may not recognize depression in their teenagers is because depression expresses itself so differently in teens, experts say. Changes in sleeping and eating habits are a red flag, as with adults. But while depressed adults are sad and melancholy, depressed teens are angry and irritable. Adults may say they don't enjoy things anymore; teens may still enjoy activities but not look forward to them. They often say they're bored, and can be indecisive, giving a lot of "I don't know" answers.

Sharon Fawcett, a mother of two teenagers in New Brunswick, Canada, had struggled with depression herself for almost a decade, so she was always on the lookout for signs of the illness in her daughters. But, she said, she completely missed the disease in her younger daughter.

"Jenna started telling me she was depressed when she was 14, but to me, she was just laying around and being lazy, and using this as an excuse," Fawcett said. "I thought: she's not depressed, she's angry and she's moody. I just thought it was the stereotypical adolescent moodiness and negativity.

"The thing that confused me about my kids—and I've heard other parents say this—is how they can be so happy when they're out with their friends, and as soon as they come home they're depressed and angry and not speaking with us. I've learned since then that kids reserve their anger for the people they know they're safe with."

For a while, Fawcett attributed her daughter's dressing in black, listening to heavy metal music and hiding her face behind long bangs and a hooded sweatshirt to teen fashion and old-fashioned rebelliousness. But by the time Jenna was 16, she had developed acute social anxiety, had difficulty concentrating and was refusing to go to school. She missed 100 days of school one year and failed most of her courses.

The dramatic change in performance for the girl who had been an honor student finally convinced Fawcett her daughter needed help. She consulted the family pediatrician, who referred her to a psychiatrist for a combination of talk therapy and medications, which have been very effective.