Depression

Depression Is Common

Lately Lindsay hasn't felt like herself. Her friends have noticed it, too. Kia was surprised when Lindsay turned down her invitation to go to the mall last Saturday. There was really no reason not to go, but Lindsay just didn't feel like it. Instead, she spent most of Saturday sleeping.

Staying in more than usual isn't the only change in Lindsay. She's always been a really good student. But over the past couple of months her grades have fallen and she has trouble concentrating. She forgot to turn in a paper that was due and is having a hard time getting motivated to study for her finals.

Lindsay feels tired all the time but has difficulty falling asleep. She's gained weight too. When her mother asks her what's wrong, Lindsay just feels like crying. But she doesn't know why. Nothing particularly bad has happened. Yet Lindsay feels sad all the time and can't shake it.

Lindsay may not realize it yet, but she is depressed.

Depression is very common and affects as many as 1 in 8 people in their teen years. Depression affects people of every color, race, economic status, or age; however, it does seem to affect more girls than guys.

How Do People Respond to Someone Who's Depressed?

Sometimes friends or family members recognize that someone is depressed. They may respond with love, kindness, or support, hoping that the sadness will soon pass. They may offer to listen if the person wants to talk. If the depressed feeling doesn't pass with a little time, friends or loved ones may encourage the person to get help from a doctor, therapist, or counselor.

But not everyone recognizes depression when it happens to someone they know.

Some people don't really understand about depression. For example, they may react to a depressed person's low energy with criticism, yelling at the person for acting lazy or not trying harder. Some people mistakenly believe that depression is just an attitude or a mood that a person can shake off. It's not that easy.

Sometimes even people who are depressed don't take their condition seriously enough. Some people feel that they are weak in some way because they are depressed. This is wrong — and it can even be harmful if it causes people to hide their depression and avoid getting help.

Occasionally, when depression causes physical symptoms (things like headaches or other stress-related problems), a person may see a doctor. Once in a while, even a well-meaning doctor may not realize a person is depressed, and just treat the physical symptoms.

Why Do People Get Depressed?

There is no single cause for depression. Many factors play a role including genetics, environment, life events, medical conditions, and the way people react to things that happen in their lives.

Genetics

Research shows that depression runs in families and that some people inherit genes that make it more likely for them to get depressed. Not everyone who has the genetic makeup for depression gets depressed, though. And many people who have no family history of depression have the condition. So although genes are one factor, they aren't the single cause of depression.

Life Events

The death of a family member, friend, or pet can go beyond normal grief and sometimes lead to depression. Other difficult life events, such as when parents divorce, separate, or remarry, can trigger depression. Even events like moving or changing schools can be emotionally challenging enough that a person becomes depressed.

Family and Social Environment

For some teens, a negative, stressful, or unhappy family atmosphere can affect their self-esteem and lead to depression. This can also include high-stress living situations such as poverty; homelessness; and violence in the family, relationships, or community.

Substance use and abuse also can cause chemical changes in the brain that affect mood — alcohol and some drugs are known to have depressant effects. The negative social and personal consequences of substance abuse also can lead to severe unhappiness and depression.

Medical Conditions

Certain medical conditions can affect hormone balance and therefore have an effect on mood. Some conditions, such as hypothyroidism, are known to cause a depressed mood in some people. When these medical conditions are diagnosed and treated by a doctor, the depression usually disappears.  

For some teens, undiagnosed learning disabilities might block school success, hormonal changes might affect mood, or physical illness might present challenges or setbacks.

What Happens in the Brain When Someone Is Depressed?

Depression involves the brain's delicate chemistry — specifically, it involves chemicals called neurotransmitters. These chemicals help send messages between nerve cells in the brain. Certain neurotransmitters regulate mood, and if they run low, people can become depressed, anxious, and stressed. Stress also can affect the balance of neurotransmitters and lead to depression.

Sometimes, a person may experience depression without being able to point to any particular sad or stressful event. People who have a genetic predisposition to depression may be more prone to the imbalance of neurotransmitter activity that is part of depression.

Medications that doctors use to treat depression work by helping to restore the proper balance of neurotransmitters.

Types of Depression

For some people, depression can be intense and occur in bouts that last for weeks at a time. For others, depression can be less severe but can linger at a low level for years.

Doctors who treat depression distinguish between these two types of depression. They call the more severe, short-lasting type major depression, and the longer-lasting but less severe form dysthymia (pronounced: diss-thy-me-uh).

A third form of depression that doctors may diagnose is called adjustment disorder with depressed mood. This diagnosis refers to a depressive reaction to a specific life event (such as a death, divorce, or other loss), when adjusting to the loss takes longer than the normally expected timeframe or is more severe than expected and interferes with the person's daily activities.

Bipolar disorder (also sometimes called manic depressive illness) is another depressive condition that involves periods of major depression mixed with periods of mania. Mania is the term for abnormally high mood and extreme bursts of unusual activity or energy.

What Are the Symptoms of Depression?

Symptoms that people have when they're depressed can include:

• depressed mood or sadness most of the time (for what may seem like no reason)
• lack of energy and feeling tired all the time
• inability to enjoy things that used to bring pleasure
• withdrawal from friends and family
• irritability, anger, or anxiety
• inability to concentrate
• significant weight loss or gain
• significant change in sleep patterns (inability to fall asleep, stay asleep, or get up in the morning)
• feelings of guilt or worthlessness
• aches and pains (with no known medical cause)
• pessimism and indifference (not caring about anything in the present or future)
• thoughts of death or suicide

When someone has five or more of these symptoms most of the time for 2 weeks or longer, that person is probably depressed.

Teens who are depressed may show other warning signs or symptoms, such as lack of interest or motivation, poor concentration, and low mental energy caused by depression. They also might have increased problems at school because of skipped classes.

Some teens with depression have other problems, too, and these can intensify feelings of worthlessness or inner pain. For example, people who cut themselves or who have eating disorders may have unrecognized depression that needs attention.

How Is Depression Different From Regular Sadness?

Everyone has some ups and downs, and sadness is a natural emotion. The normal stresses of life can lead anyone to feel sad every once in a while. Things like an argument with a friend, a breakup, doing poorly on a test, not being chosen for a team, or a best friend moving out of town can lead to feelings of sadness, hurt, disappointment, or grief. These reactions are usually brief and go away with a little time and care.

Depression is more than occasionally feeling blue, sad, or down in the dumps, though. Depression is a strong mood involving sadness, discouragement, despair, or hopelessness that lasts for weeks, months, or even longer. It interferes with a person's ability to participate in normal activities.

Depression affects a person's thoughts, outlook, and behavior as well as mood. In addition to a depressed mood, a person with depression can also feel tired, irritable, and notice changes in appetite.

When someone has depression, it can cloud everything. The world looks bleak and the person's thoughts reflect that hopelessness and helplessness. People with depression tend to have negative and self-critical thoughts. Sometimes, despite their true value, people with depression can feel worthless and unlovable.

Because of feelings of sadness and low energy, people with depression may pull away from those around them or from activities they once enjoyed. This usually makes them feel more lonely and isolated, making the depression and negative thinking worse.

Depression can be mild or severe. At its worst, depression can create such feelings of despair that a person thinks about suicide.

Depression can cause physical symptoms, too. Some people have an upset stomach, loss of appetite, weight gain or loss, headaches, and sleeping problems when they're depressed.

Getting Help

Depression is one of the most common emotional problems in the United States and around the world. The good news is that it's also one of the most treatable conditions. Therapists and other professionals can help. In fact, about 80% of people who get help for their depression have a better quality of life — they feel better and enjoy themselves in a way that they weren't able to before.

Treatment for depression can include talk therapy, medication, or a combination of both.

Talk therapy with a mental health professional is very effective in treating depression. Therapy sessions can help people understand more about why they feel depressed, and ways to combat it.

Sometimes, doctors prescribe medicine for a person who has depression. When prescribing medicine, a doctor will carefully monitor patients to make sure they get the right dose. The doctor will adjust the dose as necessary. It can take a few weeks before the person feels the medicine working. Because every person's brain is different, what works well for one person might not be good for another.

Everyone can benefit from mood-boosting activities like exercise, yoga, dance, journaling, or art. It can also help to keep busy no matter how tired you feel.

People who are depressed shouldn't wait and hope it will go away on its own because depression can be effectively treated. Friends or others need to step in if someone seems severely depressed and isn't getting help.

Many people find that it helps to open up to parents or other adults they trust. Simply saying, "I've been feeling really down lately and I think I'm depressed," can be a good way to begin the discussion. Ask your parent to arrange an appointment with a therapist. If a parent or family member can't help, turn to your school counselor, best friend, or a helpline to get help.

When Depression Is Severe

People who are extremely depressed and who may be thinking about hurting themselves or about suicide need help as soon as possible. When depression is this severe, it is a very real medical emergency, and an adult must be notified. Most communities have suicide hotlines where people can get guidance and support in an emergency.

Although it's important to be supportive, trying to cheer up a friend or reasoning with him or her probably won't work to help depression or suicidal feelings go away. Depression can be so strong that it outweighs a person's ability to respond to reason. Even if your friend has asked you to promise not to tell, severe depression is a situation where telling can save a life. The most important thing a depressed person can do is to get help. If you or a friend feels unsafe or out of control, get help now. Tell a trusted adult, call 911, or go to the emergency room.

Depression doesn't mean a person is "crazy." Depression (and the suffering that goes with it) is a real and recognized medical problem. Just as things can go wrong in all other organs of the body, things can go wrong in the most important organ of all: the brain. Luckily, most teens who get help for their depression go on to enjoy life and feel better about themselves.

Reviewed by: Michelle New, PhD
Date reviewed: October 2007

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