Depression in Adolescence

The criteria for depression in adolescents are clear and similar to those in adults. A major depressive episode consists of at least five depressive symptoms that have been present for at least 2 weeks and represent a change from previous functioning. Either a depressed mood or a loss of interest or pleasure must be present.

Significant weight loss or marked change in appetite may be present. Insomnia or hyposomnia, psychomotor agitation or retardation, loss of energy, feelings of worthlessness or excessive guilt are commonly seen. Diminished ability to concentrate and recurrent thoughts of death are often associated with the above clinical picture. The symptoms must cause significant distress or functional impairment. In children or adolescents however, an irritable mood may suffice for the depressed mood criterion. Similarly change in weight may be substituted by a failure to make expected weight gains in children or adolescents.

While the criteria are straightforward, diagnosis in an adolescent patient remains fraught with difficulty. Though the teenage brain is able to cognitively internalize external stress, many of the younger depressed teens exhibit a preponderance of somatic symptoms such as headaches, muscle aches, stomachaches or tiredness. It is important to note that some depressed adolescents attempt to compensate for their low self-esteem by trying to please others and be accepted. Because in this effort they may excel academically and behave well, their depression may go unnoticed. Similarly they experience many developmental challenges as they strive to become autonomous and establish their own identities. In this process they depend increasingly on their peer groups. This period of biopsychosocial maturation creates the conditions for adolescents to experience a greater sense of hopelessness and despair at a time when their ability to complete suicide is greater than when they were younger. They also exhibit more anhedonia, hypersomnia, weight change and substance abuse than younger children.

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