Teen depression: Hard to treat, harder to diagnose
The developing teenage brain poses unique challenge for doctors
Adolescence is a period of hormonal havoc and intense change — and the teenaged brain is always in dramatic flux. But for teens who are clinically depressed, the traditional growing pains can be much more severe.
It’s difficult enough for parents, teachers and teens themselves to distinguish depression from typical adolescent behaviour. But it’s not easy for medical professionals, either.
“As a teen actually experiencing depression, it’s hard to be clear on what ‘normal’ is supposed to be,” says Dr. David Armstrong, a psychologist at Hands — The Family Help Network, a Children’s Mental Health Ontario-accredited health provider in North Bay.
According to numerous studies, about 6 to 8 per cent of North American adolescents experience a prolonged depression. Doctors treating this are dealing with patients whose strong emotions often override rational decision-making, and whose brains are more susceptible to the stress of adverse events. Adding to the difficulty of diagnosis and treatment is the fact that the human brain doesn’t finish maturing until roughly the age of 24, and skills like logic and goal-setting are among the last to be developed.
“Depressed adults experience sadness and hopelessness. In teens, it’s more like being angry at the world,” Armstrong says.
True depression manifests itself in “three main clusters” of symptoms, says Dr. Allison Owen-anderson, a psychologist at Toronto’s Centre for Addiction and Mental Health. They occur over a period of several weeks: irritability, numbness, and a shift in weight (either up or down) and appetite.
Armstrong himself experienced severe depression throughout high school. While his symptoms weren’t particularly dramatic, they were persistent and disruptive. He says he avoided friends and family, withdrawing further into himself. Finally, at the age of 20, a family doctor prescribed a selective serotonin reuptake inhibitor, or SSRI, to restore emotional balance. When that antidepressant made Armstrong too anxious, he changed medications and started counselling. After a couple of months, he began to feel better. Now in his mid-30s, Armstrong is no longer in treatment, but his own experience, in part, inspired his current work. After diagnosis, the next challenge for doctors is finding the right treatment for their teen patients. For Owen-anderson, the most effective treatment has been a combination of antidepressant medication and cognitive behavioural therapy, or psychotherapy that helps patients proactively manage negative, unhelpful ways of thinking.
But she also argues that treatment really begins with a teen’s family, who spend much more time with the child than their doctor. Being mindful of a child’s social world, “knowing their norm” in Owen-anderson’s words, is very important so that dramatic changes are caught.
“It’s important that parents don’t ‘normalize’ their child’s behaviour” by chalking it up to the teenager simply being spoiled or manipulative, she says.
In Armstrong’s experience, about half of these depression cases resolve themselves without treatment over about two months, and 90 per cent in 18 months. The remaining10 per cent require medical treatment. And he points out that there has been 15 years of research since he was ill to better determine which treatments work and which don’t.
“We owe it to the youth we work with and their families to offer them the best that science has to offer,” he says, “providing the right level of support for where that youth is in their journey.” For more information on teens and depression, visit http://teenmentalhealth.org/