Sept. 28, 2000 -- Every parent worries about the future of his or her child. Parents of a depressed teen-ager are likely to be even more concerned -- and they should be, according to new research.
"Having a depressive episode as a teen more than doubled the risk of having another depressive episode in young adulthood," says Ian H. Gotlib, PhD, co-author of the study. The study also found that only about one in four people who had been diagnosed with depression as teens said they remained free of psychiatric illness in early adulthood.
"As a general rule of thumb, depression in adolescence seems to be underdiagnosed and underappreciated," says Robert L. Findling, MD, of Case Western Reserve University in Cleveland, who commented on the study for WebMD. "We are quite aware that this is a malignant and potentially lethal disorder. The leading cause of death in young people is suicide. But the earlier the disorder is caught, the less malignant it is, just like any disorder in medicine.
"There's a lack of appreciation that depression is a dysregulation of mood, just as diabetes is a dysregulation of blood sugar," Findling says. "We see youngsters with profound disturbances in function who suffer needlessly because parents or other well-meaning adults say it's part of being a teen-ager or it's just a phase."
Depression should be distinguished from common sadness, says Gotlib: "Some warning signs are loss of interest, sadness, fatigue, concentration difficulties, sleep disturbances, and appetite problems that last for at least two weeks." But, he cautions, "it's important not to overreact if you see sadness for a few days in an adolescent."
For more than 10 years, doctors have been studying a group of 1,700 Oregon teen-agers, aged 14 to 18, who were randomly selected from nine high schools. The doctors originally wanted to find out how common depression and other mental disorders were in this group of "normal" teen-agers. In this study, published in the American Journal of Psychiatry, they focused on teens who originally were found to be depressed but had recovered when questioned again a year later to see what happened to them as they got older. These subjects were interviewed by phone around the time of their 24th birthdays.
Of the 274 formerly depressed patients, only about 30% said they were free of psychiatric disorders, while about 45% said they had had at least one recurrence of depression. According to Gotlib, the risk of having had a depressive episode at age 24 for people who did not have depression as teens is 18%.
The authors also analyzed a host of factors to try to determine what contributes to an increased risk of having depression return.
"As you might expect, we found having multiple episodes during adolescence increased risk," Gotlib says. Other things that increased the risk were having a family member with recurrent major depression, being female, having some antisocial or abnormal personality characteristics, emotional dependency, and family conflict.
"Conflict with parents is not uncommon in families in which there's a depressed parent or adolescent. This is not the mopiness or withdrawal that we think about when we think about depression. It's often irritability, anger, and conflict on the part of the adolescent and/or the parent," Gotlib says. He urges parents to recognize their own psychological limitations and to be aware that their personal histories may make their children more vulnerable to depression.
Gotlib says that depressed teens who may have some of the risk factors for recurrence should be seen by a doctor every six months or so to make sure things are going OK.
Findling adds that parents should find a mental health professional who is proficient in caring for depressed adolescents. "We're fortunate in Cleveland to have a center of experts in pediatric mood disorders," he says. "But every community is different. Even if there is no specific program available, your doctor can probably tell you who is good at seeing young people with depression within your community."
Almost half of the group of formerly depressed teens developed another type of problem, such as substance abuse or anxiety, between the time they were 19 and 23 years old.
Preventing new problems is another reason to treat depression early, the doctors say. "The earlier the disorder is caught, the less malignant it is, like any disorder in medicine," Findling says. "Because a disturbance in mood can affect a youngster's ... social, academic, and [family] functioning ... we know the longer we let the disorder go on, the more the 'tumor' grows. I wish I had a dime for every parent who said, 'I wish we had done this [gone for treatment] sooner.'"
Findling says he knows some parents are reluctant to bring their children in for treatment because of possible side effects of medications or uncertainty that the treatments will work. "There may be risks of treatment, and there may be some knowledge gaps," he says. "But more important is the fact that we know there are profound and pronounced risks associated with depression that should never go unaddressed. ... You need to find an expert who's comfortable and familiar and expert at this to assure the best for your youngster."
For more information from WebMD, visit our Diseases and Conditions Center on Depression.