Double Take: Take depression in teens seriously

Dear Dr. Wes and Katie: We used to hear a lot about depressed teenagers. Then there was the concern about too many kids being on antidepressants and that medication might even make things worse. What’s your current view of this? I can’t tell if my daughter is just moody like a normal kid or if there’s something more wrong. I don’t want to label her for no good reason.

Katie: Though treatments may change over time, depression in teenagers has always been and continues to be very real.

If you could spend a day as an invisible observer exploring my high school, you would encounter many teens passing the day in untreated misery, perhaps isolating themselves from peers or silently despairing behind a mask of contentment. Scratched out in restroom stalls you’d find sad notes of self-hatred and suicide so common that the handwriting often becomes recognizable from one stall to the next.

The problem, as you noted, is recognizing the symptoms of depression beyond the normal emotional twists and turns of adolescence. It’s only human to have the occasional “off” day, and for teenagers, those days of sulkiness and irritability usually occur more than occasionally.

Some teens experience more intense emotional growing pains than their peers. The moodiness you mentioned becomes concerning when it appears to permanently affix itself over a teen’s head, engulfing his or her true personality and happiness.

While situational depression may be a temporary stage in a teen’s life, it warrants the same close attention paid to chronic depression. If your daughter’s melancholy seems more like a steady Seattle downpour than a passing drizzle, it’s worth a trip to your primary care doctor to check up on her physical health and ask about local mental health professionals.

Talking regularly to a mental health professional is helpful with or without medication. Before making a decision about antidepressants, try a few therapy sessions. Medication doesn’t need to be the first resort.

However, keep in mind that although the possible side effects sound frightening, antidepressants do often help teens work through depression. I know a few teenagers personally who are open about their prescriptions. If you were to pass these kids in the hallway or sit with them at lunch, you would never guess the inner challenges they had overcome.

Dr. Wes: We’re halfway through Katie’s tenure on Double Take, and every week she makes it harder for me to match her work.

Whether you like “labels” or not, a good diagnosis is crucial. The first thing to consider is whether the symptoms result from normal problems of daily life or are instead present no matter what’s going on.

If there’s a recent divorce, romantic breakup, change in schools, problems in social relationships or academic failure, we presume a change in circumstances may bring relief. While these are common problems for teens, they aren’t easy and may in fact be quite traumatizing.

For many teens, depression is secondary to another mental health issue, typically ADHD or anxiety. For kids who have either, and especially for those with both, despair may follow closely behind.

The third flavor of depression can often be found by looking at family history. If parents or grandparents had chronic depression, diagnosed or not, their descendants may inherit those same genes.

It’s also important to note that while traditional adult symptoms are often present in teens, many express depression with irritability and even anger or aggression.

So, here’s the bottom line: Diagnosis from age zero to 20 isn’t easy, and depression is often misdiagnosed. While antidepressants quite literally save lives, they don’t help young people who don’t need them.

Assessing teens takes time and commitment, and, yes, a good therapist who can connect with your kid and figure out his or her nuances. If after a few sessions and some good dialogue, the therapist recommends a medication referral, don’t freak out. Well-used, I’ve seen meds help many kids in the short and long term.

Katie’s right. Depression remains a big issue, and a tough one. Thankfully, we’re moving past the point where depressed kids feel stigmatized and many candidly refer their friends when they see things getting out of hand. Don’t hesitate to send your daughter down that road to see what you find.