Major Depression In Adolescents

GENERAL INFORMATION:

What is it? Major depression is a type of mood disorder. A mood is an emotion or a feeling. Moods affect a person's behavior (how the person acts). Moods also affect how a person feels about himself and life in general. Depression is a sad mood that your child cannot control. If your child feels sad for at least two weeks, he may be depressed. Major depression is a true medical condition, just like diabetes and high blood pressure. Major depression is also called Major Depressive Disorder.

What are the causes of major depression? Depression may be caused by a stressful change in your child's life. It may also be caused by a change in the chemicals in your child's brain. Teenaged girls are more likely to get depressed than teenaged boys. This may be because of changes in their hormones. Your child may be at higher risk for having major depression if:

• Someone else in your family has had a mood disorder, like depression.
  
  
• Your child uses drugs or alcohol.
  
  
• Your child has experienced loss. A child may feel loss caused by divorce or separation of parents. A child may feel loss caused by breaking up with a girlfriend or boyfriend. A child may feel loss or guilt over the death of a friend or family member. He may also feel loss if his family loses the home or a job. These problems can cause a child to feel very insecure about his life. A child may feel guilty or bad for hurting or injuring someone else or for causing a death (like a car accident).
  
  
• Your child has a change in health. A child may have problems handling a sickness or loss of his own health. He may have problems dealing with sickness or loss of health of a family member or friend.
  
  
• Your child has been abused. An abused child may be hit, beaten, yelled at, or hurt by a parent or other adult. The child may be ignored or told that he is not any good. The child may have a parent or other adult who is making him do sexual things. These are forms of physical, emotional, and sexual abuse.
  
  
• Your child has trouble staying focused on school work or tasks. He may have learning problems, or a conduct or anxiety disorder.

What are the signs and symptoms of major depression? It may be hard for you to know the difference between your child's normal teenaged behavior and his depressive behavior. However, there are certain things that you can look for. An adolescent may have major depression if he has five or more of the following, for two weeks or longer:

• Change in attitude, behavior, or mood.
  
  
  • Acts more irritable (bad mood) or grouchy. Your child may be aggressive and have outbursts of anger. He may shout and complain more.
    
    
  • Complains of aches or pains. Your child says he has a headache or stomachache often.
    
    
  • Feels sad or unhappy most of the time. Your child cries more easily.
    
    
  • Feels worthless, hopeless, and discouraged. Your child may hate himself. He may feel very guilty all the time. Your child may be very negative and see only the bad side of things.
    
    
  • Has trouble concentrating (thinking) and remembering things. Your child may have trouble doing his everyday tasks. He may speak or move slower than he used to.
    
    
  • Hears voices that are not really there. These are called hallucinations.
    
    
  • Thinks or talks about death a lot. Thinks or talks about hurting or killing himself (suicide) or killing others (homicide). Your child may show signs of self-harm such as using sharp objects to scratch or carve his skin, or he burns himself. Your child may pick at or pull off patches of his skin and hair. Your child may try to commit suicide.
  
  
• Change in daily patterns and habits.
  
  
  • Abuses drugs or alcohol (uses them too much or too often).
    
    
  • Eats different than usual. Your child may lose his appetite (does not eat). He may gain or lose weight without trying to.
    
    
  • Sleeping habits may change. Your child may have trouble going to sleep or staying asleep at night. He may wake up in the middle of the night or very early in the morning. He may sleep too much, or feel very sleepy all day long. He may have more or less energy than usual. He may say that his arms and legs feel like heavy weights.
  
  
• Change in relationships with family and friends.
  
  
  • Acts without thinking, or acts recklessly. Your child may begin doing things that are against the law or that could harm himself or others. Your child may disobey you more than usual.
    
    
  • Does poorly in school. Your child's grades may go down. Your child may miss school or skip his classes. He may not be able to study or may not care about studying. Your child may have problems with his teachers, or may cause other trouble at school.
    
    
  • Loses interest in talking to or getting together with his usual friends. Your child may be alone a lot, or may begin getting together with a completely different group of friends. Your child may lose interest in doing his usual sports, hobbies, or activities. Your child may tell you that he is bored.
    
    
  • Talks about or tries to run away from home.

How is major depression treated? Your child may be seen in a clinic or caregiver's office. You and family members may have meetings with your child's caregiver. These meetings can help you and your child understand your child's condition. Caregivers will ask you and your child questions about how your child feels and thinks now. Your child may also be asked how he has felt and thought in the past. Caregivers will help your child talk about his feelings. Your child may need to go to the hospital for tests and treatment. Your child may need one or more of the following treatments:

• Therapy: Your child's treatment may include talk therapy. During therapy, your child will talk with caregivers about how to cope with depression. This can be done alone or with a group of other adolescents. Family members also may be asked to attend meetings.
  
  
• Medicine: Medicine is given to decrease or stop the symptoms of depression. Sometimes it may take several weeks before your child begins to feel better. Do not stop giving your child this medicine unless the caregiver tells you to. Caregivers may give your child antidepressant medicine. They may also give your child other types of medicine to treat your child's depression.
  
  
• Hospital treatment: Your child may need to be treated in the hospital if his depression is very bad. He will be able to go home once his medicine begins to work or therapy has been started. He may also need to go to the hospital for treatment if he is trying to harm or kill himself.

How can I help my child at home?

• Give your child depression medicine as directed by his caregiver. If the caregiver instructed your child to take depression medicine, make sure your child takes his medicine every day. Do not stopping giving your child his medicine unless his caregiver tells you to.
  
  
• Watch your child carefully for any behavior changes. Talk to your child's caregiver if you have concerns or questions about the way your child is acting.
  
  
• Take your child to therapy as directed by his caregiver. If your child cannot come to an appointment, call the caregiver or therapist. Schedule another appointment as soon as possible.
  
  
• Make sure your child eats good food and gets plenty of sleep. Encourage your child to get enough sleep each night. Serve him healthy foods. Doing this will help your child's body and mind feel better.
  
  
• Help your child to find some type of exercise that he likes and can do regularly. Talk with your child about playing a sport. If he does not like sports, your child can take regular long walks or hikes. He may bicycle with a friend or go to the gym.
  
  
• Encourage your child to be with other people. Tell your child to spend time with family and friends. Encourage him to talk to you or others about the way he feels. Suggest that he join a club or do after school activities.
  
  
• Tell your child to do things that make him feel good. Tell your child to read books, poetry, or other written things that make him feel good. He may listen to music or play a musical instrument. He may keep a daily journal. Your child can write about things that he does, what he thinks about, and how he feels.
  
  
• Remove all alcohol, medicines, and firearms (guns) from your house. Remove sharp objects such as sharp knives and razor blades from your house. Ask your child's caregiver about other ways to make your home safe while your child is sad or depressed.
  
  
• Call your child's school. Make an appointment to meet with your child's school counselor, nurse, psychologist, or teachers. Tell them that your child is being treated for depression. Make sure they know the warning signs of depression that is getting worse and of suicide. Tell them what they need to do if they have concerns about your child.

What are the warning signs of suicide? An adolescent with major depression may be at higher risk for committing suicide. Be alert. Watch and listen to your child for these warning signs of suicide:

• Your child tells you he wants to commit suicide.
  
  
• Your child talks about his "plan" for committing suicide, or makes a will.
  
  
• Your child starts giving or throwing away his favorite things.
  
  
• Your child becomes suddenly very happy and cheerful after a time of depression and sadness.
  
  
• Your child has tried committing suicide before.
  
  
• Your child cuts himself, bangs his head against walls, or does other things to hurt himself.
  
  
• Your child acts in ways that are dangerous and could kill him. For example, he may drive very fast and reckless or "takes risks" doing things that could hurt him.
  
  
• Your child says things to you that he would not normally say. He may talk about wanting to die. Your child may say things like: "I won't see you again". He may say "Soon I won't be a problem for you", or "I have no reason for living". If your child talks about voices telling him to kill himself, this is a warning sign.
  
  
• Your child is constantly sad and acting different than usual. Different things may be the way your child normally eats, sleeps, or dresses. Also gaining or losing weight or having a lower energy level than usual. Also if your child loses interest in doings the things he usually likes to do such as sports, hobbies, or seeing friends.
  
  
• Your child begins to joke, read, or write often about suicide, killing, and death.
  
  
• Your child is taking medicine for depression, and his depression is getting worse. While using the medicine, your child thinks or talks about committing suicide or starts to behave (act) different than usual. Watch your child very closely when your child begins to take depression medicine. Watch your child very closely when the doctor changes the amount of medicine that your child is to take.

What should I do if my child says he wants to commit suicide?

• Let your child do the talking. Listen very carefully. Tell and show your child know that you take his feelings and thoughts very seriously. Try to find out what is causing his personal pain and sadness.
  
  
• Ask direct questions. Do not be afraid to ask direct questions. Ask "Are you thinking of killing yourself?" or "Are you thinking of ending your life?" You may also ask "Do you have a plan for hurting or killing yourself?"
  
  
• Stay with your child. Do not leave your child alone if he says he wants to commit suicide. By staying with your child, you may be saving his life.
  
  
• Get or call help immediately.
  
  
  • Call your child's therapist or the caregiver who is treating him for depression. Tell the caregiver about your child's thoughts and feelings of suicide. Ask the caregiver what you should do to help your child.
    
    
  • Call 1-800-SUICIDE. This phone number is open all the time to help people who are thinking about suicide. You may also call the National Crisis Hotline at 1-800-999-9999.

For more information:

• American Academy of Child and Adolescent Psychiatry
  3615 Wisconsin Avenue, NW
  Washington, DC 20016
  Phone: 1-202-966-7300
  Web Address: www.aacap.org
  

• National Mental Health Association
  2001 N. Beauregard Street, 12th Floor
  Alexandria, VA 22311
  Phone: 1-703-684-7722
  Phone: 1-800-969-6642
  Web Address: http://www.nmha.org
  

• Suicide Awareness Voices of Education
  9001 E. Bloomington Fwy, Ste 150
  Bloomington, Minnesota 55420
  Phone: 1-952-946-7998
  Web Address: http://www.save.org
  

Call your child's caregiver if:

• Your child is taking antidepressants, and his depression is getting worse. Call if your child is taking antidepressants and starts talking about harming himself or committing suicide. Call if he begins behaving (acting) different than usual.
  
  
• Your child is not taking depression medicine and you think your child's depression is getting worse.
  
  
• You have questions about your child, his depression, or the medicines he is taking.

Seek care for your child immediately if:

• Your child says he wants to commit suicide and has a plan or way to do it.
  
  
• Your child has done something on purpose to seriously hurt himself, or he tries to commit suicide.

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

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