Adolescence is a time of emotional upheaval. Hormones run wild, and with the onset of puberty, childhood is left behind forever. It's nearly impossible to create a definition of normal in adolescence, for every emotion is exaggerated, every slight — imagined or real — is fodder for drama, and the sexual drive is struggling for control over social constraints.
It's a difficult stage of life. It's also no wonder that depression can become a serious problem at this time. Many depressive conditions begin to evidence themselves during adolescence, including bipolar disorder and major depressive syndrome.
Is This Normal?
How to tell what is normal and what is not requires well-developed parental powers of observation. Since adolescents tend to avoid parents and demand their privacy at all costs, it can be difficult to determine what's going on in your teenager's mind. Again, look for marked changes in what's been passing for normal.
Many, if not most, teens adopt a form of dress that visually distances themselves from their parents' preferences. Hair also seems to be the vehicle of choice for expressing this emerging independence. Whether hair is dyed, shaved, grown long, or styled into dreadlocks, the new style can almost be counted on to send your blood pressure skyrocketing — and that is the intent.
However, some aberrations are not part of the normal passage into adulthood. Self-mutilation should send those warning signal flares high into the sky. Branding and cutting are visible indicators that your child needs help dealing with some serious issues.
Self-injury is not suicidal behavior — that's the good news. It is, however, a warning sign of depression. Burning the skin with cigarettes or other hot objects results in scarring. This is called branding. In cutting, the skin is sliced with a razor blade, knife, or any sharp object. Long sleeves cover the marks. Shame and guilt follow, but it is a mechanism of release and can be a form of self-medicating in adolescents.
Teachers and school counselors can be good sources of information on how your child is faring at school. Depressed teens tend to let schoolwork slide. Nothing seems to be worth the effort it takes, and that includes sports or other hobbies or activities the teen previously enjoyed.
So, what should you watch for? A teen who now sleeps much more than she did previously or who eats a great deal less or a great deal more than had been the habit — these changes should send out danger signals to the watchful parent. Listlessness, lethargy, or extreme agitation and activity are also clues worth following up.
Ruling Out Other Possibilities
Bipolar disorder in adolescents can be hard to tell apart from other problems that may occur in this age group. Drug and alcohol abuse can produce symptoms similar to bipolar depression in teens. Also, prescription medications may have adverse side effects. Reading the warnings for any prescription drug is enough to make even the most even-tempered parent frantic. Most of the side effects never occur, but if one of them describes what you are witnessing, call your pharmacist and physician to discuss the situation.
People with binge-eating disorder frequently eat large amounts of food and experience loss of control over their eating. This disorder is different from binge-purge syndrome (bulimia nervosa) because people with binge eating disorder usually do not purge afterward by vomiting or using laxatives.
Eating disorders, such as bulimia and anorexia, can result in marked changes in eating patterns. These disorders are most frequently found in females. In anorexia, a person just picks at food, rearranging it on the plate to make it appear most of it's been eaten, or finds excuses to avoid meals or take them in her room. These meals are often flushed down the toilet.
Also, skipping meals and claiming, “I'll pick something up on the way to school,” when accompanied by noticeable weight loss, is common in anorexics. In bulimia, the person eats normally, then induces vomiting to purge the stomach contents. Be suspicious if your teen finds excuses to consistently avoid eating meals with family.
Also, attention deficit-hyperactivity disorder (ADHD), which includes ADHD, inattentive type; ADHD, hyperactive type; or ADHD, combined type, will manifest as inability to focus, difficulty following directions, increased (or decreased) activity, aggression, or irritability. These can also be symptoms of bipolar disorder.
Above all, trust your instincts as a parent. They served you well as your child grew from infancy to nearly adulthood. If you sense something is wrong, you are probably right.
Diagnosis and Treatment Options
Adolescents do not respond to antidepressants in the same way as do adults. The use of antidepressants is generally not recommended for this age group. While taking antidepressants, adolescents may experience suicidal thoughts, and the risk of attempted suicide, or actual suicide, is too great.
Adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine are also used. In a study titled “Trends in the Use of Psychotropic Medications among Adolescents, 1999–2004” that appeared in the January 2006 issue of Journal of Psychiatric Services, researchers found the trend toward increased prescribing of psychotropic drugs for adolescents to be an area of concern, requiring further study. The researchers questioned whether rapid increases in the prescription of psychotropic medications to youths aged 14 to 18 years represented a move toward greater access and more appropriate treatment or whether this represented an overreliance on medications.
What's a psychotropic drug?
Psychotropic drugs are a class of medications that effect changes in behaviors, moods, and perceptions. Antidepressants, antipsychotics, mood stabilizers, and anti-anxiety drugs are included in this category.
This issue has broader ramifications. Our society is increasingly turning to medications, rather than to lifestyle changes, to deal with medical concerns. Often, in the rush to get the quick fix, the long-term dangers or side effects and drug dependency are overlooked.
When medications are indicated, however, they can provide good relief from symptoms of depression. In addition to medications that may be prescribed for your teen, group therapy, individual counseling, and family counseling are helpful in dealing with teen depression.