Depression has long been thought of as something only adults suffer with. In recent years, though, psychiatrists have discovered that there is a high rate of depression in teenagers as well. Moody behaviour that was frequently attributed to adolescent hormonal ups and downs is now more closely scrutinized and considered as possible early-onset depression.

Overlooking the disorder
In fact, according to Dr. Amy Cheung, Adolescent Psychiatrist at Sunnybrook and Women's College Health Sciences Centre, many doctors admit signs of depression are a reality in children as young as the age of two. Attention deficit disorder in children under seven is linked to bipolar affective disorder (also referred to as manic depression) in many adults. Around 50 per cent of adults suffering with depression experienced their first bout of it when they were teenagers, but didn't seek help until their adult years. The lack of awareness resulted in their depression being overlooked, only to resurface later.

"In the past we thought that teenagers couldn't get depressed," says Dr. Cheung, who sees teenagers between the ages of 13 and 21 with depression. "Teenagers tend to be moody. They tend to be kind of cranky and irritable, they withdraw from their families; they don't want to talk to them, they don't want to participate, they want to be independent. And a lot of these [behaviours] are sometimes the signs of depression. When the teen has depression it goes beyond that. Their problems are more extreme."

Warning signs of depression
If your teen exhibits one or more of the following warning signs for longer than two weeks, you should ask your doctor to be referred to see a psychiatrist or other mood disorders specialist. (Your family doctor should run tests for medical conditions that can mimic depression, such as anemia, infectious mono and low thyroid.)

1. Frequent sadness, tearfulness or crying
2. Feelings of hopelessness, worthlessness or excessive guilt -- common comments are: "I'm not good at anything"; "It's all hopeless anyway, what is the point in going on?”; "Everything is terrible, there is nothing good in my future."
3. Withdrawal from friends and activities

Page 1 of 3 -- Learn about other symptoms of depression in teens on page 2

4. Lack of enthusiasm or motivation
5. Decreased energy level
6. Major changes in eating or sleeping habits -- teens tend to overeat, but some undereat. Girls tend to crave carbohydrates. Will oversleep or undersleep and complain of fatigue.
7. Increased irritability, agitation, anger or hostility -- sometimes teens will act out or delve into risky behaviour to draw attention to the fact that they have depression.
8. Frequent physical complaints such as headaches and stomachaches
9. Indecision or inability to concentrate -- school grades will drop
10. Extreme sensitivity to rejection or failure
11. Journals and drawings will reflect dark images and/or thoughts
12. Behaviour that involves excessive aggression directed toward oneself or others, or involves persistently sad themes -- sometimes teens will dabble in risky behaviour such as unprotected sex, hanging out with a bad crowd, cutting, or experimenting with drugs and alcohol to mask their pain.
13. Recurring thoughts or talk of death, suicide or self-destructive behaviour

The importance of early diagnosis and treatment
Kate Scowen, a former youth worker and author of My Kind of Sad: What It's Like to Be Young and Depressed (Annick Press, 2006), describes depression as "anger turned inward". In her book, she includes interviews with 15 teens suffering from mood disorders such as manic depression, depression, anxiety disorder and anorexia nervosa. She says that depression can be a lifelong, episodic illness and therapy will help identify triggers to depression. The sooner teens seek treatment, says Scowen, the more resilient they will be when faced with subsequent episodes of depression.

Treatment includes either talk therapy (also known as psychotherapy) or medication such as antidepressants, or a combination of both. Dr. Cheung says that roadblocks that prevent teens from getting help still exist. Parents especially are reluctant to seek help because of the stigma attached to mental illness. No one wants to believe that their child is "crazy." Consequently, denial sets in. There is a refusal to recognize the depression for what it is, and a belief that the problem will just go away. Another common roadblock to seeking help, Dr. Cheung says, is that it's too easy to find excuses for feeling sad or angry and for justifying these feelings.

"It's not physical pain, so it's hard for people to understand," says Cheung. "But it's emotional pain, so they're really going through a tough time. You treat them now because they're suffering. And the teens will tell you that it's suffering as great as having a broken leg or a broken arm, except no one notices it. So, it's a very difficult illness to have."

Page 2 of 3 -- Find professional advice on treating teen depression on page 3

Stopping the progression of depression
Another reason for early treatment, says Dr. Cheung, is that the teen years are a critical time in a person's life for academic and social development. "If you go through two years of untreated depression where you're not motivated, you're in conflict with your family, you don't feel connected to your friends and you're doing poorly in school, that in the future will definitely affect all of your relationships, what kind of job you end up doing, and your self-esteem." Add to this that 35 to 50 per cent of teens with depression will have thoughts of suicide and it brings home the importance of becoming an "advocate for your teenager," says Dr. Cheung.

Dr. Cheung explains that because teens with depression have a 60 per cent chance of experiencing another depressive episode as an adult, they need to be given the tools to help them effectively manage their depression, and possibly even prevent a more serious breakdown from occurring.

What may appear to be teenage angst or adolescent moodiness could actually be symptoms of a more serious illness that should be addressed as early as possible. By being a proactive parent you will ensure the best quality of life for your teen, now and in the future.