Introduction "I know what you can do for your book: ask any teenager to tell you what they think of their lives." This somewhat cynical comment about teens and depression comes from my 15-year-old son. Many people think of adolescence as a time when angst, sadness and despair are normal, and the rebellious or disturbed adolescent has always been a familiar character in books, plays and movies-as long ago as the time of the ancient Greek tragedians and as recently as the latest Winona Ryder film. Movies, books and common wisdom aside, adolescence is not usually a morass of mental illness. Although several studies have shown that, overall, the mood of teens tends to be lower than that of younger children (that is, they are sadder), and that adolescents are more aware of their emotions than children, the majority of young people get through adolescence without major problems. But during these developing years, many teens will experience at least one bout of major depression. Exactly how many young people go through such an episode is difficult to determine. Studies vary in how they define depression-and whom they ask: teens often say they are depressed, while their parents, asked about their son or daughter, say their kids are doing fine. However, it is probably fair to say that fewer than 3 percent of teens are experiencing a major depression at any given time. Three percent may sound low, but that means that in every high school classroom there is probably one teen with a major depression. Another way of putting it is that 15 to 20 percent of teens will have a diagnosable depression at some time during their adolescence. Mild to moderate depressive symptoms are found at any given time in up to 35 percent of teens. What exactly do we mean by depression? As defined by therapists and doctors, it is a complex blend of emotional and physical symptoms and behavior. From a medical point of view, depression always includes depressed mood, but this might be difficult for a teen to put into words. She may not describe this as feeling sad, but more as lacking feeling. Deep despair is another description that some people give of how they feel. The writer Sylvia Plath described the sensation of a bell jar descending around her, making the world seem remote, not really touching her. Most depressed people describe a lack of enjoyment in life (anhedonia). A depressed teenager may notice that things that made him very happy before pass without notice now. He may observe others around him enjoying themselves, but he cannot join in with the feeling, although he may still participate in the activity. Other feelings are associated with depression. One of the most common is a feeling of worthlessness. A teen may talk about not being able to do anything right, or about not being worthy of love, affection or respect. Maybe she tolerates abusive behavior from a friend or romantic partner because she does not think she deserves any better. It could be that she is feeling guilty about things that weren't her fault, were relatively minor or were even imagined. A number of physical symptoms are part of depression. There may be a change in appetite, often decreased appetite. Although in adults a typical problem associated with depression is early-morning awakening, teens are just as likely to sleep more than usual, or to have difficulty both falling asleep at night and waking in the morning. Fatigue is a common problem for depressed people, including teens. It is very worrying for parents if, along with a depression, the teen frequently thinks about death. This may not be thoughts about suicide, but, could involve dwelling on thoughts of people who have died, on events involving death that are reported in the news, or on theological questions about death and the afterlife. Suicidal thoughts or attempts are a clear indication that the teen needs help immediately. Chapter 11 discusses suicidal thoughts, feelings and attempts in more depth. Such a wide variety of sometimes contradictory symptoms may be confusing. A depressed teen may say that he is sad, or he may not. He may eat too much, not enough or the same as always. He may sleep more or less than usual, or not change his sleep patterns. He may seem hyperactive or sluggish. He may ask for help, or angrily reject it. All of the major types and subtypes of depression, and the available treatments, are described in this book. Readers will quickly notice that, except for the question-and-answer section in Chapter 12, which has a section devoted to teens, this book is addressed primarily to parents. I expect that the majority of readers will be parents. Depressed teens often don't have the energy to read or even to go out to a bookstore or library to get a book. Also, many of the chapters are based on questions that parents have about depression. Teens often have only a few questions-"When will I feel better?" "Why do I feel so awful?" and "Will these medication side effects go away?" Of course, any teen who wants to learn more about depression is welcome to read about it here! There are no parental secrets in these pages. As much as possible I have tried to look at the available literature in all the areas I discuss. I have indicated where there is research to support what I say. For many reasons, your teen may not want to get help for depression. Maybe you think she's depressed, but she doesn't think she is. Maybe she isn't depressed. She could be so depressed that she can't imagine that anything would help her. She might have other reasons to be suspicious of health care providers. Unless she is suicidal, you cannot force her to get help, but you can be encouraging and supportive. You can also help by researching treatment options and by presenting some choices to her. You may even want to ask her to read a chapter in this book. Above all, be persistent in your offers of help. My hope in writing this book is that it will be useful to both teens and parents who find themselves in this difficult situation, and to teachers, guidance counselors and other people who work with adolescents. Much of the information comes from my own and my colleagues' experience, the rest from the available medical and psychological literature. The effects of adolescent depression are never restricted to the teen. Family, friends and others may also be profoundly influenced. And just as you are affected, you can help. Parents are especially important to teens, even though teens may not admit it. Parents can help teens get better by helping them find treatment, by supporting them, by being willing to listen and in many other ways. Remember to always have hope. Although teen depression presents a major challenge to everyone in the family, it can be overcome. Excerpted from Overcoming Teen Depression: A Guide for Parents by Miriam Kaufman All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
