Teen Depression

Dr. Carol Glod

Is alcohol and drug abuse a symptom of underlying depression?
Undiagnosed and untreated depression often leads to alcohol and substance abuse and dependence. On average, in teens that develop drug and alcohol problems, the depression precedes the drug and alcohol problems by about five years. Teens may turn to drugs and alcohol in an attempt to self-medicate. They may feel so bad that they want to get high or get drunk to feel numb.

So, it is critical to intervene early. Also, at least 70% of teenagers who have depression will have a recurrence within five years, or at some point in adulthood. Teen depression predicts depression in adulthood. So even if somebody goes through a period of depression, and they get better, it is likely to recur.

How does a parent determine the difference between typical teen rebellious behavior and depression?
Parents typically think that adolescence is a stormy time, with hormonal shifts, so a lot of what gets attributed to normal adolescence can be depression. If you suspect that a teen might have a problem with depression, you need to get a professional evaluation. A teenager may look fine on the outside, but have a lot going on inside. It can be hard for parents to tell. Keep in mind that depression isn't one symptom, it is a group of symptoms, you need to see at least a few signs of depression. Again, if a teen talks of death or suicide, the person needs immediate professional help.

How are teens normally screened for depression in their community and schools?
High schools are starting to give depression-screening surveys, but they are still uncommon. And usually these surveys are anonymous, so no one follows up to get these teens into treatment. Teens also have to self-identify as having a problem. Since most teenagers don't recognize depression, we know that most of them don't get help. Sometimes, they go to their guidance department; a school nurse, a school psychologist, a primary care doctor, or a parent. More likely, they tell their friends.

What should a friend say to someone who is depressed?
It is important to be supportive and to say things like, "I am very concerned about you. You are saying things that I am really worried about, and we need to tell somebody. Let's talk to your parents, or the guidance department or the school nurse." Somehow, they need to let an adult know.

If a depressed teen doesn't want anybody to know, should a friend break his or her confidence?
Yes, definitely. And this is a very hard thing for a teenager to do. Teens don't want to jeopardize a friendship, but on the other hand, people with depression can end up killing themselves. Or, their depression gets worse and worse and worse, and leads to drug and alcohol problems. It is hard to break the code of silence. But is very important to say to the person that if they won't tell their Mom or Dad, then you are going to need to let them know because you are really worried about the person.