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Is It Teen Angst or Is It Depression?

If you or someone you know is experiencing feelings of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255, call 911, or go to the nearest emergency room. Do not attempt to access emergency care through this website.

Palo Alto Therapist Jeffrey Miller Teen Angst or Depression

I recently gave a talk to a local high school about the differences between normal teen angst and clinical depression, and how depression presents differently in girls and boys. Depression is a common form of mental illness, but among adolescents it is often overlooked because sadness, moodiness, and other symptoms of depression are common among teenagers. Hormonal changes along with other pressures of adolescence make this a challenging time in a young person’s life, which often results in mood fluctuations (see my previous post discussing some of the issues facing typical teens). But sometimes this moodiness turns into diagnosable depression, and parents and friends should know when to recognize the signs.

There are two basic types of depression: Persistent Depressive Disorder (Dysthymia) and Major Depressive Disorder. Persistent Depressive Disorder involves long-term low to moderate depression. Some symptoms of Persistent Depressive Disorder are:

  • Depressed mood for most of the day, for more days than not, for at least two years. The depressed mood can either be self-reported or observed by others. In children and adolescents, the mood might be irritable and the period can be reduced to one year.
  • While depressed, two or more of these other symptoms are present: Poor appetite or overeating; insomnia or hypersomnia (sleeping too much); low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.
  • During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the above symptoms for more than 2 months at a time.
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Symptoms of Major Depressive Disorder are:

Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure:

  • Depressed mood most of the day, nearly every day. The depressed mood can either be self-reported (e.g., feels sad, empty, hopeless) or observed by others (e.g., appears tearful). Note: In children and adolescents, this can simply be an irritable mood.
  • Diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
  • Insomnia or hypersomnia nearly every day.
  • Psychomotor agitation (wringing hands, pacing) or retardation (normal physical tasks become too difficult to perform) nearly every day. These changes should be observable by others, not merely subjective feelings.
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt.
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Sometimes symptoms of Persistent Depressive Disorder and Major Depressive Disorder can be attributed to other diseases or conditions, so it is important to rule out the following:

  • There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder (a mood disorder that’s less intense than Bipolar Disorder).
  • The depression is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other schizophrenia spectrum and other psychotic disorder.
  • The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism).

How Can Friends Recognize the Symptoms of Depression?

Teens are often closer to, and will confide in, their friends more than with their parents. Because of this, it is important for a teen’s friends to be able to recognize depressive symptoms. Here are some signs that moodiness has turned into depression:

  • Marked change in typical interests (especially if it’s an intense interest or more than one interest)
  • Sudden excessive sleep or loss of sleep; large increase in fatigue
  • Significant increase in irritability, snapping, restlessness and agitation
  • Feelings of worthlessness and guilt
  • Extreme sensitivity to criticism or feedback
  • Lack of enthusiasm and motivation
  • Thoughts of death or suicide
  • Significant loss of focus; academic, behavioral and conversational
  • Significant shift in home situation (divorce, death or illness of a family member)
  • Use of drugs and alcohol particularly if it seems that such use is to “manage moods”
  • Significant shift in “involvement” with friends; withdrawal
  • Displays of crying, despair

Here are some things you can say to a friend, or things you can do, when you suspect he or she is experiencing depression:

  • “We’re friends and I care about you.  Lately, I’ve noticed _________ and I’m worried about you. Do you want to talk about it?”
  • Add to the above: “Have you talked to your parents about this?  Have you thought about speaking to a school counselor?”
  • Speak confidentially to a school counselor or administrator.
  • Speak to your own parent or other adult and ask for help.
  • Speak directly to the parents of your friend.

How Does Depression Present Differently in Girls and Boys?

Both boys and girls can experience any symptom of Persistent Depressive Disorder and/or Major Depressive Disorder. However, sometimes girls and boys experience depression differently. Here are some possible gender differences in depressive symptoms:

Girls

  • Girls may appear to experience more guilt and body image dissatisfaction.
  • Girls may exhibit more sadness and a depressed mood.
  • Girls may experience more self-disappointment, self-blame and feelings of failure.
  • Girls may have more concentration problems and difficulty working.
  • Girls may experience more fatigue and health worries.

Boys

  • Boys may experience more anhedonia (lack of pleasure or ability to feel it).
  • Boys may experience more morning depression.
  • Boys may have more morning fatigue.

Teenage depression is a serious problem, particularly in Silicon Valley. When you see or hear about symptoms either in your own family or in your interactions with others, it is always important to consult with a qualified mental health professional.

To find out how Jeffrey Miller can help you or your child, adolescent, or teen, call him at (650) 321-0410 or email him at jeff@jeffmillerphd.com.

*** If you think you have a medical or psychiatric emergency, dial 911 or go to the nearest emergency room. Do not attempt to access emergency care through this website. ***

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