Depression is a medical condition that can cause a wide variety of psychological and physical symptoms. It is estimated that between 4 and 8 percent of adolescents are depressed. However, depression in adolescents is probably underdiagnosed because the symptoms can be difficult to recognize.
Extreme and enduring sadness is the best-known symptom of depression,although adolescents can have a number of other symptoms, including irritability, difficulty at school, changes in sleep habits, and/or feelings of worthlessness. Depression is different than occasional blues and grief because depression is persistent and often interferes with the teen's ability to get along with parents and friends, complete school work, and appropriately participate in other normaldaily activities.
Depression is a treatable condition. Psychotherapy (counseling), drug therapy, and other measures can alleviate symptoms and help the adolescent to succeed in school, develop and maintain healthy relationships, and feel more self-confident. This topic review discusses the causes, risk factors, signs and symptoms, and diagnosis of depression in adolescents. A separate topic reviewdiscusses the treatment of depression in adolescents. Topics that discuss depression in adults are also available..)
CAUSE OF DEPRESSION
The exact cause of depression is not known. Studies suggest that depression is a biologic disorder resulting, at least in part, from an imbalance of neurochemicals in the brain, including serotonin, norepinephrine, and dopamine. These neurochemicals allow cellsin the brain to communicate with each other and play an essential role in all brain functions, including movement, sensation, memory, and emotions. This interaction is supported by studies demonstrating the benefit of antidepressants, which help restore the neurochemical balance in the brain.
DEPRESSION RISK FACTORS
Many adolescents are unsure why they are depressed. Depression sometimes occursin response to a stressful event, such as a recent death or break-up, or it can occur for no apparent reason. Although anyone can develop depression, certain factors increase an adolescent's risk for becoming depressed, including:
• Female sex
• A history of depression in a parent or sibling
• A prior history of depression
• A history of anxiety disorder, attention deficit hyperactivitydisorder, learning disability
• A recent loss (eg, death, divorce)
• Family problems or conflicts with parents
• Difficulties with friends or peers
• Difficulties with school work
• Negative outlook or poor coping skills
• Chronic illness
IMPACT OF DEPRESSION
Many adolescents who are depressed are not aware that depression is the basis for the changes in their emotions, ability to interact withothers, and school performance. These changes can have serious, life-altering consequences that increase the risk for future depressive episodes, especially if the depression is not recognized or treated. Adolescents who are depressed are at increased risk for the following problems:
• Difficulty with school work and relationships with parents and peers, decreased interest and involvement indaily activities and responsibilities.
• Health complaints such as abdominal pain, fatigue, and headaches.
• Engaging in high-risk behaviors such as having sex, smoking, abusing alcohol and other substances, violence against others, and suicide attempts.
Preventing suicide — Suicide is a tragic and preventable consequence of severe depression. Any mention of suicide or self-harm should be takenseriously. Signs that a teen is considering suicide include the following :
• Ideation — Talking about or threatening to kill or hurt oneself; looking for ways to kill oneself; talking or writing about death, dying or suicide
• Substance abuse — Increased substance use
• Anxiety — Anxiety, agitation, or changes in sleep pattern
• Trapped — Feeling like there is no way out...