JUST THE FACTS

What is a depressive disorder?

A depressive disorder is a disease that affects mood, thoughts and behavior. Without treatment, symptoms can last for weeks, months, or years. The greatest obstacle to treating depression is lack of recognition. When a "bad day" turns into a bad week, month, or more, there may be a medical explanation for this change in behavior or feelings of hopelessness. Fortunately, appropriate treatment can help more than 90% of those who suffer from depression. 

Depression and teens

Experts estimate that 5% of all teenagers will suffer from depression. Unfortunately, only 20% of depressed teens are appropriately diagnosed and treated. When diagnosing a mood disorder, adolescents can be at a disadvantage. The symptoms of depression and bipolar disorder (manic-depressive illness) in young people can differ from adults. Symptoms can be missed if you don't know what to look for. Read on to learn more.

Well meaning parents or teachers may think that a young person is unhappy or moody because it's a natural part of being young. This is especially true for adolescents, who are expected to be "hormonal" and rebellious. Persistent unhappiness or moodiness is not normal for anyone.

Depression is a medical illness

Depression is a medical illness caused by a chemical imbalance in the brain. In the brain, neurons send messages from one nerve ending to another across synapses. Neurotransmitters, such as serotonin, are chemicals that help transfer information. In depression, these neurons do not function normally, which leads to changes in a person’s thoughts, feelings and behavior. Antidepressant medications work to restore proper chemical balance in the brain.

There are two primary types of depressive disorders: major depression (unipolar disorder) and bipolar disorder (also known as maniac depression).

Symptoms of Major Depression

• Irritability and/or depressed mood
• Loss of interest in usual activities
• Low energy and/or restlessness
• Poor concentration
• Sleeping too much or too little
• Weight loss or weight gain
• Feeling hopeless and helpless
• Feeling worthless and guilty
• Thoughts of death or suicide

Symptoms of Manic Episodes

• Significant mood swings
• Too much energy
• Easy distractibility
• Grandiose ideas or overconfidence
• Inability to sleep
• Fast talking, racing thoughts
• Risk-taking behavior

Risk factors for depression

• Children under stress, who have experienced loss, or who have attention, learning, or conduct disorders are at a higher risk for depression
• Girls are more likely than boys to develop depression
• Youth, particularly younger children, who develop depression are likely to have a family history of the disorder

Treating Depression

The good news about recognizing and understanding depression early is that it can be treated. Antidepressant medications are widely used, effective treatments for depression. Antidepressant drugs are known to influence the functioning of certain neurotransmitters (chemicals used by brain cells to communicate), primarily serotonin, norepinephrine, and dopamine, known as monoamines. Older medications – tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) – affect the activity of all of these neurotransmitters simultaneously. 

Their disadvantage is that they can be difficult to tolerate due to side effects or, in the case of MAOIs, dietary and medication restrictions. Newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), have fewer side effects than the older drugs, making it easier for patients to adhere to treatment. Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another. Medications that take entirely different approaches to treating depression are now in development. 

Psychotherapy is also effective for treating depression. Certain types of psychotherapy, cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been shown to be particularly useful. More than 80 percent of people with depression improve when they receive appropriate treatment with medication, psychotherapy, or the combination. 

Recently there has been enormous interest in herbal remedies for various medical conditions including depression. One herbal supplement, hypericum, or St. John’s wort, has been promoted as having antidepressant properties. However, no carefully designed studies have determined the antidepressant efficacy of this supplement. NIMH is currently enrolling patients in a first large-scale, multi-site, controlled study of St. John’s wort conducted in the U.S. as a potential treatment for depression. It is important that you or your teen seeks professional help before trying to self medicate with this or any other over-the-counter medication.

Consequences of untreated depression

• Once a young person has experienced an episode of depression, he or she is at risk for developing another episode of depression within the next five years
• Depression in childhood may predict more severe depressive illness in adulthood
• Depression in children and adolescents is associated with an increased risk for suicidal behaviors

Help is Available

Depression is treatable. Early diagnosis and treatment are essential for teenagers with depression to live normal lives. Teens who exhibit symptoms of depression should be referred to and evaluated by a mental health professional who specializes in treating teens. The diagnostic evaluation may include psychological testing, laboratory tests and consultation with other specialists. A comprehensive treatment plan may include psychotherapy, ongoing evaluation and monitoring, and in some cases, psychiatric medication. Optimally, this plan is developed with the family, and whenever possible, the child or adolescent is involved in treatment decisions. See our reference guide for information on available resources.

*Facts made available by the National Mental Health Association, DRADA, Department of Health and Human Services