Teen Depression By Lisa Glickstein, Ph.D, Triplet Mom Originally printed in December, 2005 Most of us are familiar with the stereotype of the angry, sullen teenager. This week, there is a seminar offered at my work about pre-teens entitled, “What happened to my cute cuddly child?!” Yikes! In some cases, pre-teen can mean your 9-year old. So, when is teen angst just a normal stage in development, and when should you consider seeking medical advice? When is my child going to enter puberty? Signs of puberty (hair growth, breast development, increased height, and acne) occur long before the age when most girls get their periods. In African-American girls, signs of puberty can begin as early as age 9, with a delay of about one year for other girls. The average age for the first period is 12.5 years, but can range from 9-16 years. For boys, the onset of signs of puberty (testicle and penis growth, body hair, voice change, increased height and muscle growth) is similar, and also earlier on average for African-American boys, but puberty itself (signified by acne and facial hair) occurs in a fairly small window, between 13-15 years. What are the mood changes of puberty? As pre-teens and teenagers continue to separate themselves from their parents, conflicts and arguments can normally arise. Social changes, such as arguing with a good friend, breaking up with a boy- or girlfriend, getting a bad grade or performing poorly at a sporting event, can lead to crying, sadness, or anger. These changes should normally be transient, and punctuated by times of feeling joy, pride, and self-confidence. Pre-teens and teenagers may have any of the mood changes that characterize depression in adults, including sleeping a lot more or less, eating a lot more or less, or feeling sad, anxious, or irritable. In teens and pre-teens, depression can also lead to chronic headaches or stomachaches. In some individuals, radical changes in behavior, dress and appearance, and mood, occur along with puberty. What causes these mood changes? Mood changes in puberty are both physical and situational. Hormonal changes are known to affect mood, for example in girls who experience PMS. In boys, increased testosterone can lead particularly to irritability and aggression. In boys and girls, thyroid dysfunction can cause extreme irritability and mood swings. Alcohol and drug use and abuse, including steroids to enhance sports performance or appearance in boys, can lead to depression or anger. Situations that particularly affect mood in teens and pre-teens are greater sophistication and understanding of family problems, fear of growing up and leaving home, anxiety about sexuality, changes in social groups at school, bullying, peer pressure, anxiety about developing too slowly or too quickly, and increased pressure to perform at school or sports, among others. Issues surrounding sexuality are particularly likely to affect mood, including homosexual self-identification, sexual harassment or abuse. It is important to note that homosexuality is not itself a medical or psychiatric disorder. How can I tell if my child’s mood changes need intervention? If the mood changes are pervasive, meaning they affect many areas of the child’s life, such as school, sports, and hobbies, and persistent, meaning that they last for more than two weeks at a time, intervention is indicated. Ask yourself or your child some questions: Can he enjoy favorite activities? Does she have friends at school and home? Is he missing school frequently due to headaches, stomachaches, or fatigue? Has she recently dropped out of all sports or extracurricular activities? Are there any signs of drug or alcohol use or abuse? Drug and alcohol abuse – along with overeating and anorexia - are now recognized as attempts by depressed or anxious individuals to self-medicate. Importantly, they can also trigger depression or even more severe psychotic disorders such as schizophrenia in susceptible individuals. Don’t just write off difficult teen behavior as a stage or right of passage. If you aren’t feeling happy with your teen most of the time, then chances are your teen isn’t feeling happy enough with himself. What can I do to help my child? First, try to engage your child in a discussion of what he is feeling, experiencing in and out of school, and if he is concerned about his moods. Try not to be judgmental or angry; the sullen uncommunicative stare or temper flare can be due to forces beyond your child’s or your control. Explain to your child honestly any concerns that you have, and that you believe that she can feel better, and that you want to help her to feel better. If your child will not cooperate, speak to teachers and coaches, school counselors, your child’s friends or former friends, or others that may help you uncover a situational trigger for the mood change. Ask and look for signs of drug and alcohol use, bullying, or sexual harassment or abuse by adults or peers. Don’t assume that your child would never use drugs or be sexually active. As the saying goes, denial ain’t just a river in Egypt. Once you have gained your child’s cooperation, or have an idea of the symptoms or triggers of the problem, bring your child for a physical exam with his or her pediatrician. If your child is no longer comfortable with that doctor, it may be a good time to change to a primary care or family practitioner who specializes in health issues of teenagers. A blood test can rule out thyroid problems, and may uncover drug or steroid abuse. The pediatrician or primary care doctor can prescribe treatment, or refer your child or your family for therapy, if indicated. There are different treatment approaches for teenagers than adults, and for depression than anxiety. In cases of moderate to severe depression, the benefits of treatment with antidepressant therapy seem to outweigh the risks of possible suicidal behavior that have recently been associated with the drugs. However, children taking antidepressants need to be monitored closely for worsening mood or suicidal ideation. There is help available, and teaching your child to recognize and cope with depression and anxiety is a lifelong gift of better mental health.