How Do I Recognise if My Child or Teen is Suffering from Depression?

During my time as psychiatry registrar, I met a vast array of depressed patients but one story that struck me most was that of a 16-year-old depressed boy who was referred from a physician for unexplained bodily pains and school refusal. The family was angry that the physician had referred him to a psychiatry hospital. I assessed the boy and he stated that he was bullied in the school and was socially boycotted, couldn't sleep well and couldn't focus on studies. He ruminated about killing the boys who bullied him. He experienced fleeting pain all over the body which worsened in the morning. He expressed wishes of not wanting to live and felt like crying but couldn't do it as it was considered as sign of weakness especially for the boys in his family. He stated that he wanted to become an engineer but his family wanted him to take over the family business and did not encourage higher studies. I diagnosed him with depressive disorder but family did not accept the diagnosis and did not hospitalise him for further assessment as advised. He was taken to see a faith healer who performed some rituals. Two weeks later, the boy committed suicide. 

Teenage – Unique Stage of Development:

Adolescence phase of life development poses a difficult challenge to young persons in the context of major physical and psychological maturational changes as well as complex adjustments within the family and society. It is a very sensitive and critical phase of development with serious psychological, personal, social, relational and economic consequences. 

Young persons are vulnerable to develop severe mental disorders including major depressive disorder and schizophrenia. Much of the disability associated with mental disorders develops in the early years following illness onset and, therefore, this period represents a critical period for early recognition and intervention. 

Understanding Teenage Depression: 

It's common, affecting approximately one in five teens, more commonly females. Below is the list of common depressive symptoms across the lifespan.

• Sadness of mood
• Fatigue or lack of energy
• Lack of interest in pleasurable activities
• Changes in eating and sleeping habits
• Withdrawal from friends and family
• Feelings of worthlessness and guilt
• Difficulty concentrating
• Tearfulness or frequent crying
• Thoughts of hopelessness, helplessness or worthlessness
• Thoughts of death or suicide

It's different: 

• Several young persons do net get diagnosed because their mood changes are often confused with just normal teenage moodiness resulting from hormonal changes or conflict between parents and teens when they start to assert their independence.  
• Making things even more complicated, young persons with depression do not necessarily appear sad, nor do they always withdraw from others. For some depressed teens, symptoms of irritability, aggression, and rage are more prominent. 
• I see school refusal, truancy (running away from school), drop in academic performance, complaints of unexplained pain and over-sensitiveness to perceived criticism as early signs of teenage depression in my clinical practice.
• Teenage boys are generally less likely to seek help or recognise that they suffer from depression - probably due to different social expectations for boys and girls.
• Teen depression can lead to drug and alcohol abuse, low self esteem, self-harm, reckless behaviours leading to pregnancy and even suicide. 
• Occasionally, depressed teens turn violent. There have been over two dozen shootings, massacres, or foiled attacks on schools by students across the United States, including the deadly massacre at Columbine High School in Littleton, Colorado.

It's serious:

Depression increases a teen’s risk for attempting suicide by 12 times. Majority of the depressed teens will not voice out the suicidal thoughts directly and even if they do, many parents do not take it seriously. It's very important to recognise the signs of suicide before it's too late. Some signs are listed below:

• Writing messages on social media about death, glamorizing or romanticizing death
• Writing letters or stories or poems indicating that world would be better without them
• Writing goodbye letters or messages to friends and family 
• Giving away their prized possessions
• Repeatedly talking or joking about committing suicide
• Engaging in reckless behaviors such as driving fast, seeking drugs and inappropriate sex
• Collecting medications or substances that can be potentially used to commit suicide 

It's impairing:

Depressed teens are more likely to have trouble at school, at home and in jobs, and struggle with relationships.

As a parent, it is important that you recognise that your child has depression and, therefore, provide the right help at the right time so that your child grows up to be not only physically but also as a emotionally and socially healthy adult.