Understanding Teenage Depression

A Guide to Diagnosis, Treatment, and Management

Maureen Empfield, M.D., and Nicholas Bakalar

Holt Paperbacks

Teenage Depression:
More Common Today Than Ever

Some estimates are that as many as 8 percent of adolescents suffer from depression at some time during any one-year period, making it much more common than, for example, eating disorders, which seem to get more attention as a source of adolescent misery. This book will tell you what you need to know about depression -- whether you are the teenager suffering from it, or the parent who loves a depressed teenager.

Even among psychiatrists and other mental health care professionals, the extent of the disability caused by depression is vastly underestimated. The World Health Organization has found that major depression is the single greatest cause of disability in the world -- more than twice as many people are disabled by depression as by the second leading cause of disability, iron-deficiency anemia. Other diseases and disorders may get more press or more research money, or more sympathy and concern from a well-meaning public, but major depression causes more long-term human misery than any other single disease.

When I was a resident in psychiatry, we believed that true depression was rare among teenagers, or that insofar as it existed, it was just a normal phase of adolescent development with no lasting consequences. It didn't take long after I began treating troubled kids to see that this couldn't possibly be true. Research over recent decades has confirmed my impression. These beliefs, if anyone still holds them, are false and dangerous. In fact, early onset depression is not normal, and can predict numerous unhappy life events for youngsters, including school failure, teenage pregnancy, and suicide, attempts.

Although depression is today increasingly common, it is among the oldest diseases recorded in the history of medicine. As early as the fourth century, the symptoms of "melancholia" were well known and attributed to an excess of "black bile." In other words, depression was first thought of as an exclusively physical illness -- the loss of appetite, sleeplessness, irritability, and general despondency of depression were believed to have a physical, not a psychological, cause. It wasn't until the nineteenth century -- when the term depression was invented to substitute for melancholia -- that a psychological understanding of the illness began to develop. Eventually this psychological explanation of depression would become the only one, although today it no longer is. We now know that depression has both psychological and physical symptoms, and that both psychological and medical treatments can help to alleviate them.

DEPRESSION IS A DISEASE

Depression -- that is, the illness that is often called "clinical depression" -- is not the same as a bad mood, or a feeling of unhappiness. It is a disease. Although there are some theories about it, no one knows exactly what causes depression in teenagers (or in anyone else, for that matter), but we do know that it is not caused by poor parenting, and that it cannot be cured by good parenting. Nor is it caused by the victim of the disease, something that is for some people all too easy to conclude. A "change in attitude" or a willingness on the part of the youngster to "straighten up and fly right" will not relieve the terrible symptoms of depression. It is a disease that requires the attention of experienced professionals, using both medical and psychological treatments, methods scientifically established as valuable in relieving the symptoms of depression and allowing a teenager to lead a normal life. These techniques are complex, time-consuming, and sometimes expensive, and they require not only the conscientious work of medical professionals but considerable cooperation from the teenager being treated, as well as the dedicated attention of the people who love her. Nor are they 100 percent effective 100 percent of the time. But they do work, and when they do they provide relief that many patients describe with the most thankful phrases: "I've been given back my life, I'm myself again" or similar words are often heard when a youngster's depression begins to lift.

PSYCHIATRIC TREATMENT THAT SAVES LIVES

Phil was a 19-year-old sophomore at a Big Ten school. He was a serious athlete -- an almost Olympic-caliber ice hockey player -- and a top-notch student as well, majoring in chemistry. He had had some problems during early adolescence -- for a brief period he was hanging out with a group of daily marijuana smokers -- but certainly no serious psychiatric illness. In any case, his parents, one of whom had had a depressive episode, were very much invested in his academic and athletic success and minimized any emotional complaints, which they viewed as a sign of weakness.

No sooner had hockey practice begun, however, than Phil had a serious falling out with one of teammates, whose ex-girlfriend he had begun to date. This boy turned other players against him, and Phil found himself excluded from the social life of the team, essentially shunned. Gradually he became isolated from his other friends as well and began having trouble concentrating on his studies. His grades suffered. He started drinking heavily, and one night he told one of his friends that he was thinking of jumping off the roof of a building, if only he had the guts to do it. This friend called Phil's parents, his parents called me, and I urged them to either hospitalize him there or bring him home. His father flew to the Midwest to get him, and we hospitalized him immediately upon his arrival home.

Phil's own attitude was that hospitalization wouldn't help, but, feeling despairing or numb, he put up no resistance to the plan. His time in the hospital began with the quick establishment of an anti-depressant medicine regimen, along with individual group psychotherapy. His family also needed therapy and education to help them recognize that Phil suffered from a real illness, not from moral weakness.

After two weeks in the hospital and now well established on a drug regimen, Phil came home and worked for several months, then returned to school. Although he never went back to playing hockey, he has done well in college, and has continued his medication with almost complete relief from symptoms. The treatment he received in the hospital quite literally saved his life.

Copyright © 2001 Maureen Empfield, M.D., and Nicholas Bakalar