As any parent of a young adult woman knows, change is the only norm during adolescence as the young person’s neurological, biochemical, physical and social universe goes into a sort of developmental warp drive. Because of this, moods vacillate, behaviors can seem erratic, and your relationship with your daughter is likely to change on a daily if not an hourly basis. Even though disruption of mood and behavior is typical of this developmental phase of life, parents should be watchful for signs that normal developmental changes have morphed into something more serious. Depression is one of the most common mood disorders experienced by young adults, and can lead to academic disruption, social isolation or school avoidance, and even suicide if not addressed. So how does a parent differentiate between normal adolescent angst and major depression, and what treatment options are available?
While adolescent depression shares many symptoms with adult depression, there are some differences as well. The main sign of a depressed state is a persistent feeling of sadness, hopelessness or worthlessness. These feelings of despair can manifest in a number of ways that include self-harming behavior, shoplifting, suicidal ideation, gestures or attempts, and isolation. The following are some potential signs of adolescent depression:
- School avoidance (e.g. sleeping in and refusing to go to school, or pretending to go to school but cutting class)
- A change in sleep patterns – either sleeping more or less or changes in sleep pattern
- Apathy or frequent boredom
- Slow or difficult communication
- Somatic complaints such as headaches, stomachaches, back pain, or fatigue
- Difficulty sustaining attention
- Sudden drop in school performance
- Seemingly excessive or inappropriate guilt
- Not attending to responsibilities, being late for classes or work, not doing homework
- Changes in eating patterns or weight – especially not eating or overeating with dramatic weight loss or gain
- Difficulty remembering
- Exaggerated worry about death
- Defiant or non-compliant behavior
- Talk of suicide
- Persistent sadness or hopelessness
- Use of alcohol or drugs and promiscuous sexual activity
- Withdrawal from family (e.g. staying in room with door shut) and/or friends
- Changes in dress without regard to appearance
- Poor grooming or hygiene
If you suspect your child is depressed, a thorough psycho-educational assessment – including testing and an in-person consult with a mental health professional – is highly recommended. This assessment should provide you with information that is critical for selecting the appropriate treatment for your child.
Depression may have environmental and/or biological causes. Fortunately, both environmentally based and biologically based depression can be treated. Treatment options include psychopharmacology, outpatient therapy and in-patient or residential treatment.
Medication has been proven to help certain young adults with depression, though it is generally recommended that medication be used in conjunction with therapy. The only antidepressant that is officially FDA approved for use with adolescents is flouxetine hcl, or Prozac, a well-known SSRI. Antidepressant medication has been linked to an increase in suicidal feelings in certain studies; because of this the FDA has been very careful about approving anti-depressants for use with adolescents and requires warning labels on medications used for this population. But the findings are controversial and physicians generally use their own medical judgment to prescribe flouxetine hcl or other anti-depressants to adolescent patients. Some medications are used to treat the depression itself and others may be used to treat precipitating factors, such as difficulty sleeping. Lack of sleep – which is quite common among young adults, especially those prone to depression – can cause or exacerbate depression. Solving the problem of inadequate sleep medically and/or behaviorally (e.g. through healthier nighttime routines; fewer daytime naps; less access to television, caffeine or other stimulants near bedtime, etc.) can reduce depression in adolescents. If your child does take medication, be sure to follow monitoring protocols carefully, observe your child’s behavior, and insist upon frequent consults with the prescribing physician.
For mild to moderate depression, outpatient talk therapies – either with or without medication therapy – can help you daughter understand and articulate difficult feelings and develop more effective coping mechanisms. Since many young women are resistant to therapy, a depressed adolescent might need to try a variety of options to find the most effective one for him or her. Group therapy can be less threatening for some young adults than individual therapy because the pressure is not solely on them to talk or disclose and because it can be comforting and normalizing to hear that their peers are struggling too. Cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) and other therapies can be effective for young adults struggling with depression. The key to any therapy being effective, however, is the ability of the therapist to bond with the depressed young woman. This can take time and can be the most difficult, but the most productive, part of treatment. The simultaneous involvement of parents in therapy – either separately or in a family therapy setting – can also be a helpful part of a young woman”s healing journey because it addresses more systemic causes of depression. Parental involvement also demonstrates support and can take some of the attention and pressure off of the young woman. It communicates that “we are in this together because we have a problem,” rather than “you are the problem.”
Residential or in-patient treatment is helpful for young adults suffering from moderate to severe depression or from depression that co-occurs with other emotional or behavioral issues. Residential settings, such as therapeutic boarding schools and residential treatment centers, have the advantage of 24 hour observation and care, interdisciplinary – i.e. educational, therapeutic, and medical – staffing, as well as access to milieu and experiential therapies. This means that treatment tends to be both intensive and holistic. Young people suffering from symptoms such as cutting or suicidal ideation can be kept relatively safe because of the 24 hour supervision. Students who are school avoidant tend to miss less school during treatment when they are in a residential setting. Also, the tight link between various departments facilitates well-informed treatment and medication decisions because the child’s response to these therapies can be observed throughout the day from a number of perspectives. While residential treatment is not necessary for every depressed young adult, it can provide a safe and robust option for young people with a persistent or serious depressive struggle. Since residential treatment programs vary in terms of quality and type of care, it is recommended that parents consult with their therapist or an educational consultant to select the appropriate program for their child.
- Outpatient Therapy
- Residential Treatment