Depression in adolescents - symptoms, causes, stage, complications

For a long time, it was thought that children and adolescents could not have depressive disorders. Since about the middle of the 20th century, this view has changed dramatically. Psychiatrists came to the conclusion that in some cases even infants can suffer from depression (for example, due to separation from the mother).

Teenage depressive disorders most often begin to develop during the most difficult and vulnerable period of adulthood - ages 13-19. Depression in adolescents has its own features and proceeds differently than in adults. It can be "masked", when somatic or vegetative manifestations are in the foreground.

Definition of the Disease - Teenage Depression

Clinical depression in adolescents is a mental disorder manifested by a permanently low mood, feelings of sadness, longing, despair and other emotional disorders. The prevalence of depression among adolescents is 10-20%.

Rapid growth and hormonal restructuring of the body, fatigue from the educational load, heightened emotionality, and difficulties in relationships with peers and parents lead to the psychological vulnerability of adolescents. They can withdraw into themselves, become irritable, apathetic, and become absorbed in their own inner world and experiences.

It is impossible to independently distinguish between true depression in children and adolescents and a teenage crisis. Only an experienced psychiatrist, who knows the specifics of the course of this illness, and also masters complex diagnostic methods, can do this.

Manifestations of depression in teenage boys and girls are different. Boys suffer from depression less frequently, but become very irritable, aggressive, avoid their former friends, may associate with "bad company," become addicted to alcohol and drugs. In this way they fence themselves off from the outside world and its injustices.

Depression in adolescent girls is more common, but manifests itself somewhat differently. They become sad, withdrawn, lonely, avoid contact with people, concentrate on internal feelings. Tearfulness appears, and self-esteem falls. Often such girls try to alleviate their suffering and "prove" their attractiveness through promiscuous sexual relations.

Although depression in adolescence is considered a treatable illness, only 1 in 5 adolescents suffering from this disorder receives qualified help from a specialist. This is due to the fact that parents and teachers do not pay attention to the child's deviant behavior or attribute it to the difficulties of adolescence.

ICD-10 criteria generally classify depressive conditions that occur during adolescence as a mild to moderate depressive episode (F 32.0; F 32.1), recurrent depressive disorder (F 33.0; F 33.1), bipolar affective disorder (F 31.3) or cyclothymia (F 34.0)

Symptoms of teenage depression

The main signs of depression in adolescents that you should pay attention to first are:

• Depressed mood, sadness, gloom, sadness, longing;
• tiredness, brokenness;
• irritability, excitability, aggressiveness, anger, rage;
• Guilt, low self-esteem, tearfulness;
• anxiety, worry;
• anhedonia (loss of the ability to rejoice);
• loss of familiar interests;
• Avoidance of social contacts, isolation;
• absent-mindedness, decreased concentration, forgetfulness;
• decreased school performance, increased fatigue, and lack of interest in learning;
• memory disorders, difficulties in learning and remembering material.

The following somatic manifestations are also characteristic of teenage depression:

• Unexplained pain in various parts of the body and organs, wandering pain;
• subfebrile temperature;
• muscle weakness
• Changes in body weight (weight gain or loss);
• menstrual disorders in girls.

Autonomic nervous system disorders can include the following symptoms of teenage depression:

• fluctuations in blood pressure, changes in heart rate, heart pain;
• difficult breathing;
• sleep and appetite disorders;
• headache, dizziness.

The clinical picture of teenage depression has a number of features that distinguish it from depression in adults. Its main distinctive features are considered to be excessive vulnerability to criticism because of age, rapid change of mood, negativism, the prevalence of irritability and anger, the occurrence of pain in different parts of the body.

"Somatized" depression with pain in various parts of the body seems to be a manifestation of a severe physical ailment. Parents go around to various specialists hoping to diagnose and cure the child. Doctors look for an ailment, start restricting the children's movement and attendance at clubs, which further aggravates the situation. The teenager sinks into himself, focusing on his "unhealthy" condition.

Causes of teenage depression

The reasons for teenage depression are quite varied and individual:

• Personal psychological reasons. Such traits as hypersensitivity, emotional instability, impulsiveness, and lack of skills in constructive problem solving can lead teenagers to depressive states.
• Macrosocial causes. They consist in the negative influence of the mass media and the Internet on the consciousness of minors.
• Microsocial causes. "Love" conflicts, failed sexual experiences, conflicts with teachers and peers, frequent moves, lack of friends and changing schools can also lead to depression in adolescents.
• Family factors. Violence, destructive relationships, conflicts, lack of support in the family, criticism of the teenager lead to the fact that the child "closes down" in himself and does not feel needed.
• Hormonal factor. The period of puberty is accompanied by serious stress for the body, "hormonal swings", and emotional stress, as a result of which the teenager cannot cope with his emotions.
• Psychotraumatic factors. Sexual and physical violence, bullying, loss of loved ones.
• Youth maximalism. Expresses itself in categoricalness, exaggeration of problems, excessive straightforwardness, which causes conflicts with parents and teachers.
• Excessive study loads. Classes at school and with tutors, attendance of additional circles and sections to the detriment of the child's interests, intensive preparation for exams, lack of free time lead to chronic fatigue, nervous exhaustion, and then to a prolonged depression.
• Genetic predisposition. An adolescent is prone to developing mental disorders if one of his or her close relatives suffered from a similar disorder. However, it is important to note that adolescent depression is more treatable than adult depression.
• Biochemical causes. Disorders of the metabolism of biogenic amines (dopamine, noradrenaline, adrenaline, serotonin, melatonin and others) in the brain.
• Addictions: alcohol, drugs, gambling;
• Hyperprotective parents and inability to make decisions on their own.

Pathogenesis of adolescent depression

Adolescent depression is a multifactorial mental illness involving biological, psychosocial, and genetic causes. The leading link in the pathogenesis of adolescent depression is disruption of biochemical processes in the brain.

There is the so-called catecholamine theory of depression in adolescents. Its supporters explain the appearance of this disease by the presence of deficiency of neurotransmitters in the CNS, namely the content of catecholamines in the brain structures (especially noradrenaline). This disorder can lead to the development of a single complex of emotional, cognitive and somatic symptoms of depressive disorders. Norepinephrine deficiency is manifested by impaired concentration, poor memory, fatigue, and apathy.

Studies have also found that children with the symptom of adolescent depression have other biochemical abnormalities - decreased levels of serotonin in the brain, impaired melatonin and cortisol secretion.

Lack of serotonin is manifested by irritability, sleep and appetite disorders. The hormone melatonin is responsible for the regulation of circadian rhythms, and a decrease in its secretion leads to sleep and mood disorders.

Stages of teenage depression

Depressive states in teenagers are divided into the following stages:

• Mild depression. At this stage, symptoms are poorly expressed and are often latent. When contacting a therapist at this stage, only psychocorrective measures (individual or group psychotherapy) may be sufficient.
• Depression of a medium degree of severity. Symptoms increase, the teenager becomes immersed in himself and his negative thoughts, somatic manifestations become strong (pain in various organs), and withdrawal and aggression become more pronounced. The child may start to have thoughts of death and suicidal tendencies. In this case, psychotherapy is started, and if there are no results, medication is started.
• Depression of a severe degree of severity. The neglected stage of the syndrome of teenage depression. At this stage, various serious complications of the depressive state can arise, up to and including suicide attempt or completed suicide. Urgent hospitalization at a specialized clinic for round-the-clock observation by specialists, as well as complex treatment of the illness, is necessary. Often antidepressants are prescribed, the use of which may continue for a long time (1-3 years).

Classification of depressive states in adolescents

Depending on the characteristics and causes of the disease, the following types of depression in adolescents are defined:

• Reactive depression. Is the most widespread benign type of teenage depression. It arises spontaneously, appearing as a depressed mental state of the child, as a reaction to psychotraumatic events or strong emotional distress.
• Melancholic depression. It is characterized by symptoms such as: sadness, melancholy, despondency, depressed mood, lack of interest in life. Vegetative manifestations become pronounced (tachycardia, headaches, etc.), appetite is lost, sleep is disturbed.
• Severe (major) depression. This form of depression is similar in its manifestations to adult depression. The child is depressed for a long time (from several months to a year), loses interest in his or her surroundings and social contacts. Suicidal thoughts and attempts to commit suicide arise.
• Bipolar disorder. Demonstrates impairment of the emotional sphere in the form of alternating manic and depressive states. Episodes of mania with an elevated mood, clarity of consciousness, a feeling of "omnipotence", acceleration of thinking and speech, motor excitement are replaced by a depression phase - a bad mood, a feeling of detachment, hopelessness, inhibition of intellectual activity.
• Dysthymia in a teenager is a mental disorder with a long period of course (at least a year), during which a bad mood, irritability, fatigue, feelings of despair, sadness, and depression persist. Problems with concentration and memory arise.

Complications of depression in adolescents

Neglected changes in a child's mood and behavior can lead to various adverse effects of teenage depression:

• poor school performance, absenteeism, expulsion;
• alcohol abuse and drug addiction;
• addiction to social networks and computer games, immersion into virtual reality;
• joining sects, destructive organizations, suicide groups in social networks;
• running away from home;
• dangerous and illegal behavior;
• infliction of bodily harm;
• showing violence and aggression toward the people around them;
• eating disorders;
• suicide attempts, suicide.

To avoid such complications of teenage depression, parents should be more attentive to their children, paying attention to their behavior and appearance. After all, at this stage in life, their child must decide for himself the most important tasks: to define personal boundaries and values, to form his own "I" and his self-esteem, to develop skills of communication and entering into contact with the environment. Even an adult, sometimes it is difficult to do this, and a teenager - doubly so. That is why children need so much support during adolescence.

When to see a doctor

If depression is suspected in a teenager and its main signs are discovered, it is necessary to see a specialist immediately.

First, if there is no timely treatment, symptoms of depression can worsen, which will greatly complicate further therapy and may require hospitalization in a hospital. Secondly, it is necessary to remember that depressed teenagers are prone to suicidal tendencies.

Each case of depression is individual. Only experienced doctors correctly assess the patient's condition, determine the stage of the disease and decide on the prescription of one or another type of treatment.

In the initial stages of the disease, psychotherapy is often sufficient, while in more advanced cases, psychopharmacotherapy is required.

Diagnosis of depression in adolescents

Diagnosis of depression in a teenager has certain difficulties due to the fact that the illness is often "masking" in nature and has the symptoms of physical ailment.

To establish a diagnosis, the doctor collects a medical history, talks to the patient and his parents, and evaluates the patient's condition.

The main differences between depression in adolescents and any other illness are:

• Absence of identified changes after clinical investigations on the part of one or another organ complained of by the adolescent;
• specific nature of the complaints (prolonged, persistent pain, no effect of therapeutic agents, migration of pain sensations, temporary disappearance of pain);
• disappearance of pain complaints during the application of psychotropic therapy;
• an increased feeling of anxiety about one's health, accompanied by a fear of death;
• Changes in mood and well-being during the day: in the morning there is a drop in strength, in the evening - a burst of energy and a good mood;
• prolonged falling asleep, nightmares, intermittent sleep;
• violation of contact with peers, displays of aggression.

An experienced child psychiatrist at a specialized clinic can diagnose depression in a teenager based on the complaints of the child and his parents, as well as with the help of various psychological tests (e.g., the Beck teen depression scale).

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders is also used in the diagnosis of adolescent depression. To make a diagnosis of depression in an adolescent, symptoms must occur most of the day, for at least 2 weeks, and cause changes in the child's usual behavior. However, the symptoms must not be caused by a "recent" psychologically traumatic event, a consequence of the use of psychoactive substances, or a thyroid disorder.

Qualitatively conducted diagnostic measures help to understand that the teenager has depression, as well as to determine the further methods of treatment.

Treatment of teenage depression

Treatment of depression in adolescents is not an easy and responsible task for a specialist. This is due to the fact that adolescent depression is often recurrent, has a prolonged character and is associated with a life-threatening complication - suicide attempts.

In addition, there are some psychobiological features of adolescents' response to traditional therapy for depressive disorders. For example, the use of tricyclic antidepressants may show insufficient therapeutic effect in adolescents. In recent decades, there have been many studies of the psychobiological responses of adolescents to medication therapy for depression, which have found that selective serotoninergic drugs may be the drugs of choice.

Today, the following types of antidepressants are used in the treatment of adolescent depression:

• Selective serotonin reuptake inhibitors and stimulants;
• Selective norepinephrine reuptake blockers and inhibitors;
• selective serotonin and norepinephrine reuptake inhibitors;
• tricyclic antidepressants;
• reverse monoamine oxidase inhibitors.

In addition to antidepressants, sedatives, tranquilizers, sleeping pills, neuroleptics, nootropics, B vitamins, and magnesium may also be prescribed.

The prescription of one or another drug depends on the severity and duration of the depressive state and the nature of its course. Some types of antidepressants can be prescribed on an outpatient basis and can be taken by the teenager. They have minimal side effects, are well tolerated, and are safe in case of overdose. Other kinds are used only in conditions of stay in a specialized medical clinic, have a pronounced psychotropic effect and side effects.

An absolute indication for hospitalization in a hospital is suicidal tendencies in a teenager. It is necessary to remember that the suicide risk in itself is high during puberty, so it is necessary to pay attention not only to direct suicide attempts and statements about the desire to die, but also to various "philosophical" reasoning of teenagers about the "frailty of existence and the meaninglessness of existence". Also an indication for hospital treatment is a protracted long-term course of depression, in which there is resistance to traditional medication. Only an experienced psychiatrist can answer the question of how to treat depression in adolescents at a face-to-face appointment.

One of the main problems in the use of psychopharmacotherapy in adolescents is the occurrence of side effects that disrupt cognitive processes and interfere with learning. Dizziness, drowsiness, weakness can be especially strong at the beginning of treatment. However, all of these symptoms are reversible and the patient's condition will gradually improve. The positive effect on mood and mental activity will not begin to show before two weeks after the start of the drug.

An important condition for the successful treatment of teenage depression is the use of an integrated approach. Therefore, in addition to drug treatment, it is advisable to conduct psychotherapy (individual, group).

During psychologically corrective measures, the specialist talks about the causes of the disorder, creates motivation for therapy, helps the patient understand his or her feelings and emotions, and identifies problems that may have led to this condition. These may include conflicts with parents and peers, unsuccessful sexual experiences, bullying at school, etc.

As a rule, improvement is not long in coming. When psychotherapy and psychopharmacotherapy are used together, improvements occur rather quickly. However, medications and psychotherapy sessions should not be stopped abruptly. Quality treatment of depression usually takes at least 6 months. It is important to treat it responsibly and with understanding.

Prevention and recommendations for adolescent depression

To avoid the neglected stages of depression in adolescents, it is important for parents to first learn to pay attention to their behavior and mood. The following signs of an emerging depressive disorder should alert you:

• an abrupt change of habitual behavior, a depressed mood, lack of interest in previously favorite kinds of activity;
• extreme hobbies, self-harm (self-harm);
• Anger outbursts, aggression, negativism;
• guilt and self-injury;
• joining "suicide" groups and communities on social networks;
• change in appearance: a poker face, black eyes, pallor, thinness;
• learning problems;
• denial of existing problems.

Depressive disorders tend to be suffered by teenagers who have no one to share their sadness, fears, longing, loneliness, fears, and other stronger feelings with. Some families don't talk about these things at all.

Therefore, you need to be able to find contact with the child, hear him, try to share his problems and help solve them, showing your love and care.

General recommendations for parents with teenage depression are as follows:

• Take an interest in the child's feelings and share your own. Respond safely to any expression of the child's feelings (even when he yells that he hates his parents).
• Avoid humiliation and punishment for the child.
• Do not keep your teenager under constant supervision and tutelage, let him be on his own.
• Be able to listen to the child, not criticize.
• Don't force you to do anything.
• Set aside time to spend with your teenager: dinners, watching movies, going for walks.
• Encouragement for success, and also to say that the child is proud.
• Respect the teenager's opinion and his or her choices.
• Offer support and help. The child needs to know that parents are always on his or her side.
• Respect the teenager's personal space.
• Don't give ultimatums.

To prevent the development of depression during puberty is also important:

• reduce the impact of stress and school stress;
• optimize the work and rest mode, control complete sleep, proper nutrition, walks in the fresh air;
• Keep your child busy with sports and other extra activities tailored to his or her interests;
• pay attention to his time with his friends;
• control the use of alcoholic beverages and drugs.