He sleeps the day away, and is irritable when he's awake. She's moody and mopes around. He eats everything or almost nothing. She hides in her room, shunning even the simplest chores. Does this sound like a teenager you know?
Neuroscientists suspect the adolescent brain is wired for emotional turbulence and retreat from the family. These tendencies may help teenagers separate from their parents and reach out to peers. But those same tendencies can make it hard to tell when the work of growing up is turning into a depression that deserves treatment. Roughly one out of 12 teens suffers significant depression before the age of 18. Girls, once they reach puberty, are twice as likely as boys to become depressed. Approximately half of the teenagers with untreated depression may attempt suicide, which remains the third leading cause of death in this age group.
Important differences separate the growing pains of adolescence from depression. A painful breakup, a rejection by peers, a bad grade or a humiliating disagreement with an adult may cause unhappiness or frustration for a few days. Depression dominates life for weeks or months, and may appear for no known reason. Depressed kids--who may be biologically more vulnerable than others to environmental stress--feel almost constantly miserable and enjoy very little. But depression isn't always expressed as sadness. The teen may be irritable, or complain of headaches or stomach pains instead of describing a bad mood. Energy, sleep and appetite may suffer. Some depressed kids function poorly at school or withdraw from friends and family. And while it is normal for adolescents to think about mortality and the meaning of life, it's not normal to be preoccupied with death or to seriously contemplate suicide.
Antidepressants are neither panacea nor poison, but they do help many kids. The worries about these drugs are famous. Right after starting an anti-depressant, some kids do become more anxious or restless and a few may have an increase in suicidal thoughts. But depression itself carries greater risks. It is much more likely to cause suicide, and it can thwart healthy development. Any teen starting anti-depressant therapy should be seen regularly by the prescribing doctor, and the family should call immediately if the child gets worse instead of better.
Medications are only part of good treatment, though. The measures that promote healthy adolescent growth also are helpful for depression. Moderate aerobic exercise relieved depressive symptoms in almost half of young adults in one recent study. Good sleeping and eating habits, while sometimes a tough sell to adolescents, can also improve mood. Psychotherapy can help teens figure out what makes them feel helpless or self-critical and develop strategies to put things right. And when adolescents latch on to an activity they value that also helps others, their mood improves and so does their sense of self. Imaging studies confirm that altruistic behavior lights up the brain's reward areas.
The future may bring better antidepressants, along with better tools for identifying which medications are best suited to which child. But it's already possible for teens to learn to sustain relationships, to turn back thoughts that spur depression and to contribute to causes larger than themselves. By supporting them in these quests, we can ease the transition out of childhood, and help them build more fulfilling lives as adults.