Finding and helping teens for whom sadness is a disease

Life can be challenging for teens. They must juggle schoolwork, family life and friends. Feelings of sadness, frustration and irritability are common. But for some teens, those emotions take a more extreme turn. Their negative feelings don’t come and go, punctuated by periods of satisfaction or happiness. Instead, those intense feelings can point to a disease called depression — one that may require treatment. The American Academy of Pediatrics, or AAP, has now asked its member doctors to start screening for signs of this in all preteens and teens.

It’s easy to think that depressed people simply feel sad or hopeless. For many teens that may be true. But depression in teens can be hard to spot. Some kids withdraw from friends and family. Others respond with angry outbursts. Some teens may skip school or stop eating or sleeping. Some may start abusing alcohol or drugs. Teachers, parents or even a teen’s close friends may find it hard to tell whether these behaviors are just part of being a teen or signs of something truly serious.

How serious?

Each year, an estimated 5,000 Americans between the ages of 15 and 24 take their own lives. “The rate of suicide for this age group has nearly tripled since 1960,” according to Mental Health America, or MHA. Indeed, it says, suicide has become “the third leading cause of death in adolescents and the second leading cause of death among college-age youth.” Founded in 1909 and based in Alexandria, Va., MHA describes itself as “the nation’s leading community-based nonprofit dedicated to addressing the needs of those living with mental illness.”

There is a link between mental illness and suicide in teens. That’s according to the American Academy of Child and Adolescent Psychiatry, based in Washington, D.C. “The majority of children and adolescents who attempt suicide have a significant mental health disorder,” it says — “usually depression.” And as a disease, depression can last for a decade or longer.

Even depressed teens may not realize they have this problem. And the share of those affected is high. More than three million Americans between the ages of 12 and 17 experienced depression in 2016. However, most likely went untreated. A 2001 study by researchers at Harvard and Yale universities found that half of all teens with depression don’t get help until they become adults. And only one in three will have been diagnosed by their primary care doctor, another study reported.

The new guidelines aim to improve those numbers. AAP is asking pediatricians to undertake mental-health training. It wants them to become more aware of the signs of depression. It’s also asking these doctors to screen for mental-health problems at regular annual check-ups of every teen. Where depression is suspected, doctors can then work with mental-health professionals to find out how to treat any disorders so that their patients can feel good again.

The AAP’s new guidelines were published in AAP News on February 26.

Peers can help

“It’s a great start,” says Teri Langan Dee. This mental-health professional in Lincoln, Neb., sees many adolescents with depression. “I have had very few pediatricians reach out to me to coordinate treatment,” she says. The new guidelines should change that by making it easier for doctors and mental-health professionals to work together. That means more cases of depression likely will be caught and treated, Dee notes.

Teens concerned about giving embarrassing answers in front of their parents need not worry. The AAP guidelines ask doctors to interview their patients alone.

Teens should be honest with their answers. “I can only work with what you give me,” Dee says. “If you’re not honest, you won’t benefit.”

Dee says peers should also scout for signs of depression. Keep an eye on your friends, she recommends. Watch for symptoms of isolation or hopelessness. Or irritability, anger and excessive drama. That last issue can be hard, because drama affects most teens. But here, the symptom to worry about is drama that emerges when interacting with almost everyone. Even skipping classes can be a sign that something serious is going on. Any of these behaviors could be a symptom of depression.

So how can people tell what behavior reflects mental growing pains and what’s a sign of disease? One key is a sharp change in behavior, Dee says. Another warning sign: a persistence in that new behavior — meaning that it sticks around for two weeks or more.

Researchers at the University of Michigan in Ann Arbor support the idea of friends helping friends. They trained teens from 10 high schools in a peer-to-peer program on depression awareness. These teens then took what they had learned into their schools to educate the rest of the student body. At the end of the study, students in all 10 schools were more understanding of mental-health problems. And — more importantly — they were better able to identify people who might be suffering from depression.

Are certain people at higher risk of depression?

Yes.

Some individuals seem to have a family history of depression. It can show up in parents and their children. If these people have an imbalance in certain brain-signaling compounds, they may need medicines to correct the problem.

Other people may find themselves as social outcasts owing to physical or mental traits that make them appear different from most of their classmates. Such people often experience bullying. They can develop low self-esteem. This can include girls who may enter puberty at a young age. Because their bodies don’t match their emotional development, people who mature early often experience depression that can last into adulthood.

Overall, knowing who — and how — to help is essential for successfully treating depression in teens, therapists say.

“Mental health is often overlooked by parents and other adults in the teen’s world,” Dee says. The new guidelines should make it easier for teens to get the help they need.

Suicide was the second leading cause of death among U.S. teens ages 15-19 as of 2016. If you or someone you know is suffering from suicidal thoughts, please seek help. In the United States, you can reach the Suicide Crisis Lifeline by calling or texting 988. Please do not suffer in silence.