Depression in Teens - An Insightful Guide for Parents

by Dr. Wesley C. Sassaman, DNP, MPH, MSN-NE, MBA, FNP-C, CARN-AP

Are you worried about your teenager's sudden change in mood or behavior? Many parents face the daunting challenge of understanding and addressing the complexities of teenage depression. This guide explores various aspects of depression in teens, offering valuable insights and practical advice to help you support your child during these turbulent times.

Understanding Affective Disorders

Affective disorders, such as depression and anxiety, are not just simple diseases but complex phenomena that emerge from various interacting elements. These disorders serve as important messages that alert individuals to underlying problems that need attention. Recognizing and understanding these messages can help parents respond to their children's needs more effectively.

What is an Affective Disorder?

An affective disorder is an emotional disturbance that affects a person's mood and behavior. It can manifest as depression, anxiety, or other emotional states. These disorders are not just diseases but outcomes of complex interactions within the body and brain. They alert individuals to underlying issues that require attention and resolution.

The Role of Systems Thinking

Systems thinking views affective disorders as emergent properties that arise from complex interactions within the body. Instead of focusing on linear cause-and-effect relationships, systems thinking considers the broader context and multiple factors contributing to the disorder. This perspective allows for a more comprehensive understanding of the underlying issues and more effective therapeutic interventions.

Symptoms as Messages

Affective disorders often present as symptoms that serve as messages, urging individuals to attend to underlying issues. For example, feelings of hunger may signal a need for food, while pain may indicate an injury or other issue that requires attention. Similarly, feelings of depression or anxiety can signal underlying emotional or psychological problems that need to be addressed.

What is Depression?

Depression is a common affective disorder characterized by persistent sadness, loss of interest in activities, and other emotional and physical symptoms. It is a reactive response to difficult situations and can be influenced by genetic, environmental, and psychological factors.

Common Symptoms of Depression

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), common symptoms of depression include:

Sadness or depressed mood most of the time
Loss of enjoyment in activities
Significant weight changes
Insomnia or excessive sleep
Physical restlessness or fatigue
Feelings of hopelessness or worthlessness
Difficulty concentrating
Recurring thoughts of death or suicide

Subtypes of Depression

Depression can be classified into several subtypes, including:

Major Depression: Severe symptoms lasting at least two weeks.
Chronic Depression (Dysthymia): Fewer symptoms but experienced over a longer period.
Atypical Depression: Unusual symptoms with positive mood reactivity.
Melancholic Depression: Lack of improvement with positive events.
Postpartum Depression: Occurs after childbirth.
Seasonal Affective Disorder (SAD): Related to reduced sun exposure.
Treatment-Resistant Depression: Failure to respond to at least two treatments.

Factors Contributing to Depression

Various factors can contribute to the development of depression in teenagers, including brain development, neurotransmitter changes, genetics, and chronic stress.

During the teenage years, the brain undergoes significant changes that affect an individual's ability to manage emotions. Excessive loss of gray matter can make it harder to regulate emotional states, increasing the risk of affective disorders.

Neurotransmitters

Changes in neurotransmitters, such as serotonin, norepinephrine, and dopamine, are associated with depression. Reduced levels of these neurotransmitters can contribute to the development of depressive symptoms.

Genetics

Genetic mutations and epigenetic patterns can increase susceptibility to depression. Trauma and other environmental factors can influence gene expression, creating a predisposition to affective disorders.

Social Media, Depression, and Drug Abuse

Social media and peer influences play significant roles in the development of depression and drug abuse among teenagers. Problematic social media use is associated with psychological issues, while peer influences can exacerbate these problems.

The Impact of Social Media

Research indicates that excessive social media use is linked to depression and anxiety, particularly during developmental stages. Lower self-esteem and increased mental health issues are common among teenagers who spend a lot of time on social media.

Peer Influences

Peer influences, often amplified through social media, can promote unhealthy behaviors, including drug abuse. These influences can contribute to the development of depression and other mental health issues.

Digital Interventions

Digital cognitive behavioral interventions (dCBI) have shown promise in addressing depression among adolescents. These interventions can enhance traditional care practices and help mitigate the adverse effects of social media and peer influences.

Effective Therapeutic Strategies

There are various therapeutic strategies for addressing depression in teenagers, including cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), and problem-solving interventions.

Cognitive Behavioral Therapy (CBT)

CBT is a well-established treatment for depression that focuses on changing negative thought patterns and behaviors. It has shown significant effectiveness in reducing depressive symptoms.

Interpersonal Psychotherapy (IPT)

IPT focuses on improving interpersonal relationships and communication skills. It has been shown to be effective in treating depression by addressing underlying social issues.

Problem-Solving Interventions

Problem-solving interventions help individuals develop effective coping strategies to deal with life's challenges. These interventions can be particularly effective in preventing and managing depression.

Innovative Treatments

Emerging treatments, such as the Training for Awareness, Resilience, and Action (TARA) program and remote intensive outpatient programs, offer new approaches to managing depression.

TARA Program

The TARA program focuses on specific physiological mechanisms of depression and has demonstrated initial effectiveness in both in-person and online settings.

Remote Intensive Outpatient Programs

Remote intensive outpatient programs have shown considerable reductions in depression symptoms, particularly benefiting marginalized populations like LGBTQ+ youth.

Digital Cognitive Behavioral Interventions (dCBI)

Digital interventions combined with coaching have proven to enhance depressive symptoms and other mental health outcomes in minority-enriched groups.

Special Clinical Note to Parents

Addressing depression in teenagers requires a comprehensive approach that considers various factors, including neural development, genetics, immune system reactions, gut health, and psychosocial triggers. Relying solely on medication is often insufficient; a combination of treatments is typically more effective.

The Role of Antidepressants

Antidepressants seek to reestablish balance in the neurobiochemical environment. However, they are often more effective when combined with psychotherapy.

Gut Microbiota

The symbiotic bacteria in the gut directly communicate with the brain and can affect brain functions. Imbalances in gut bacteria have been linked to mood disorders.

Inflammatory Processes

Chronic inflammatory processes can contribute to depression. Elevated levels of inflammatory markers, such as C-reactive protein (CRP), indicate the presence of inflammation that may trigger depressive symptoms.

Conclusion

Understanding and addressing depression in teenagers is crucial for their well-being and development. By recognizing the complex interplay of factors contributing to affective disorders, parents can provide more effective support and interventions. If you suspect your teenager is struggling with depression, consider seeking professional help and exploring the various therapeutic options available.

For more information and resources, sign up for our newsletter and stay updated on the latest research and strategies for managing depression in teenagers. Your proactive efforts can make a significant difference in your child's life.

---

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Aitken, M., Durber, C. M., & Goodyer, I. M. (2023). Precision therapeutics—personalizing psychological therapy for depression in adolescents. In M. Hodes & P. J. De Vries (Eds.), Shaping the future of child and adolescent mental health (pp. 205-230). Academic Press. https://doi.org/10.1016/B978-0-323-91709-4.00006-8

Alswedani, S., Mehmood, R., Katib, I., & Altowaijri, S. M. (2023). Psychological health and drugs: Data-driven discovery of causes, treatments, effects, and abuses. Toxics, 11(3), 287. https://doi.org/10.3390/toxics11030287

Bogdan, R., Agrawal, A., Gaffrey, M. S., Tillman, R., & Luby, J. L. (2014). Serotonin transporter-linked polymorphic region (5-HTTLPR) genotype and stressful life events interact to predict preschool-onset depression: A replication and developmental extension. The Journal of Child Psychology and Psychiatry, 55(5), 448–457.

Bowden, G., Holttum, S., Shankar, R., Cooke, A., & Kinderman, P. (2020, October). Understanding depression: Why adults experience depression and what can help. British psychological Society. 59(8), 3391-3403.

Cataldo, I., Lepri, B., Neoh, M. J.-Y., & Esposito, G. (2021). Social media usage and development of psychiatric disorders in childhood and adolescence: A review. Frontiers in Psychiatry, 11, 508595. https://doi.org/10.3389/fpsyt.2020.508595

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F., III. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: A meta-analysis. World Psychiatry, 13(1), 56–67.

Dantzer, R. (2018). Neuroimmune interactions: From the brain to the immune system and vice versa. Physiological Reviews, 98(1), 477-504.

Ekbäck, E., Rådmark, L., Granåsen, G., Svärling, R., Sörlin, M., & Henje, E. (2023). Clinical effectiveness of training for awareness, resilience, and action for adolescents and young adults with depression: The pilot phase of a multicenter randomized controlled trial. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1130035

Evans-Chase, M., Solomon, P., Peralta, B., Kornmann, R., & Fenkel, C. (2022). Treating depression in adolescents and young adults using remote intensive outpatient programs: Quality improvement assessment. JMIR Formative Research, 7, e44756. https://doi.org/10.2196/4475

Groen, R. N., Ryan, O., Wigman, J. T. W., Riese, H., Penninx, B. W. J. H., Giltay, E. J., Wichers, M., & Hartman, C. A. (2020). Comorbidity between depression and anxiety: Assessing the role of bridge mental states in dynamic psychological networks. BMC Medicine, 18, 308.

Huang, T. T., Lai, J. B., Du, Y. L., Xu, Y., Ruan, L. M., & Hu, S. H. (2019). Current understanding of gut microbiota in mood disorders: An update of human studies. Frontiers in Genetics, 10, Article 98.

John, F., Curry., Allison, E., Meyer. (2020). Evidence-Based Psychosocial Treatments of Depression in Adolescents. 121-136. doi: 10.1007/978-3-030-44226-2_9

Kaltenboeck, A., & Harmer, C. (2018). The neuroscience of depressive disorders: A brief review of the past and some considerations about the future. Brain and Neuroscience Advances, 2.

Kirschbaum-Lesch, I., Holtmann, M., & Legenbauer, T. (2018). Chronotherapy for adolescent major depression. In XX (Ed.), Book Title (pp. 313-334). https://doi.org/10.1016/B978-0-12-812777-3.00013-1

Kristina, L., Metz., Jane, Marie, Lewis., Jade, Mitchell., Sangita, Samadder, Chakraborty., Bryce, D., McLeod., Ludvig, Daae, Bjørndal., Robyn, Mildon., Aron, Shlonsky. (2023). Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression.. PLOS ONE,

Luccarelli, J., Uchida, M., & Henry, M. E. (2022). 2.53 The efficacy and cognitive effects of acute-course ECT are equal in adolescents, transitional-aged youth, and young adults. Journal of the American Academy of Child and Adolescent Psychiatry, 61(10), S200. https://doi.org/10.1016/j.jaac.2022.09.197

McEwen & Akil, 2020 B. S., & Akil, H. (2020). Revisiting the stress concept: Implications for affective disorders. The Journal of Neuroscience, 40(1), 12–21. https://doi.org/10.1523/jneurosci.0733-19.2019

Szigethy, E., Wolfson, D., Sinclair-McBride, K., Williams, K., Jhe, G., Lee, E. H., Bialostozky, M., Wallace, M. L., Bhatnagar, S., DeMaso, D. R., Yealy, D. M., & Hollenbach, K. A. (2023). Efficacy of a digital mental health intervention embedded in routine care compared with treatment as usual in adolescents and young adults with moderate depressive symptoms: Protocol for randomised controlled trial. BMJ Open, 13(3), e067141. https://doi.org/10.1136/bmjopen-2022-067141

Thompson, P., Vidal, C., Giedd, J. N., Gochman, P., Blumenthal, J., & Nicolson, R., Toga, A. W., & Rapoport, J. L. (2001). Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proceedings of the National Academy of Sciences of the United States of America, 98(20), 11650–11655.

Webb, J. (2022). Managing child and adolescent depression. In XX (Ed.), Book Title. https://doi.org/10.1016/B978-0-323-95702-1.00018-x