How do you know when a teenager is depressed?

Teenage depression can be difficult to diagnose because normal adolescent behavior is marked by both up and down moods, fluctuating over days and even hours.

How do you know if it is just another bout of the blues or true clinical depression warranting treatment?

Symptoms of teenage depression can look very different from classic symptoms in adults. While most adults are able to articulate and recognize feelings of depression, teens tend to internalize or somatize the illness — they express their emotions through their body in the form of headaches, stomach pain and lower-back pain.

Some of the signs and symptoms of depression that tend to be more unique for teens include:

• Acting-out behaviors (missing curfews, unusual defiance or rebellion that becomes extreme, sudden or dangerous.

• Withdrawal from existing friends or hanging out with new friends.

• Talks of or efforts to run away from home — which are often a cry for help.

• Increased irritability, anger, hostility or volatility.

• Promiscuity or drug use (can be the result of growing feelings of despair which often increases his/her need to be loved and accepted.)

• Feelings of worthlessness or self hatred.

• No longer enjoying activities he or she normally would.

• Disrupted sleep patterns, including excessive sleeping, difficulty falling or staying asleep (such as all night television watching).

• Change in eating habits often resulting in unintentional, fairly rapid weight loss or gain.

• Obsession with death, including talking about it, or suicidal statements, such as “I want to be dead.”

• Excessive feelings of guilt or shame.

Communication

Ask yourself how long the symptoms have been present, how severe and how different your teen is acting from his or her usual self. If five of these symptoms last for even two weeks and cause much distress then treatment should definitely be sought.

The following signs are a few of the more significant ones worth acting on immediately:

• Verbal threats of committing suicide, such as “I am going to kill myself.”

• Preparations for death, including goodbye letters, and giving away special possessions.

• Loss of interest in his or her own life.

Where do you start and what type of treatment are we talking about? One of the first places to start is with your primary care physician, who will assess for medical causes of your teen’s symptoms. Then, he or she will be able to recommend or refer you to a behavioral health therapist or psychologist specializing in teenage depression.

Counseling provides your teenager a safe, objective, non-judgmental environment in which to discuss emotions and stresses, and learn how to make more healthy choices.

If the depression is not resolved, then medication may be warranted. Anti-depressant medication should be used in conjunction with other supports and services. Both individual as well as family therapy is often quite helpful in supporting or coping with depression within a family, especially if family conflict is contributing to the current stresses.

It is not easy parenting teenagers. However, one of the most important things that you can do as a parent is to establish good communication with your teenager. This is one of the best ways to ensure that your teen will come to you in the event that he or she is experiencing symptoms of depression. Try to figure out where your teen is coming from.

What are some examples of good communication? Try practicing the following tips:

• Ask a few open-ended questions — not questions that are only answered with ‘yes’ or ‘no.’

• Really listen to the response without judgment or feeling that you have to say something back right away.

• Try to hear his or her feelings behind the words. Acknowledge the pain and sadness they seem to be experiencing.

• Let him or her know what specific signs of depression you have noticed and why they worry you, while also making it clear that you are ready and willing to provide whatever support they need.

Dawn Finney is a licensed independent social worker who practices at the Fall City clinic.