Teen DepressionTeen depression: If you are reading this webpage, you, your teen, or someone close to you is probably suffering from depression. It can be debilitating and even life threatening. It is recommended that you read through this entire article to gain a better understanding of depression. Understanding depression, its underlying causes and effects, and treatment, will help you better cope with this often crippling mental disorder. However, a quick topical link table is given here:
IntroductionDepression is one of nature's ways of telling us we need to make some changes in our lives. What we've been doing is not working for us. To paraphrase Bob Dylan, our times/lives are a'changing. Depression is usually brought on by stressors in our lives. Maybe changes have been brought into our lives by a tragic life incident (e.g. death of a loved one, divorce, job loss, etc.). Loss of a dream can bring on depression? Maybe we are overwhelmed by events in our lives? Dr. Y spent several days down on the Mississippi coast helping with relief work from Hurricane Katrina, his second trip to help out. Two years after the hurricane, many people were still overwhelmed and depressed from their experience and loss. Many had lost everything they owned and were still living in temporary shelters and FEMA tents--and FEMA was trying to kick them out! They had no place to go, no jobs, no money. At any rate, no matter how you or your teen got here (in this depressed state of mind), the positive side is that it is telling you that you or your teen want to move on with your life but are stuck. Now, how to do it? The more you know about depression, the greater your ability to overcome it. Some people deal with depression life long. For some, it occurs only once after a major setback or stressful event. Symptoms of DepressionThe diagnostic "bible" for psychiatric disorders is what we refer to as the DSM IV, now in its 4th text revision. It gives the following definition for major depression disorder: Presence of one or more depressive episodes. A depressive episode is defined as follows: Five of the
following
depression symptoms must be present--
The symptoms cause clinically significant distress or impairment in social, occupational or other areas of functioning. The symptoms are not better explained by grief Signs of teenage depressionMany times teen depression will be masked as anger or irritability as opposed to sadness. Although irritability is a symptom of depression, in teens this is all you may be seeing on the surface. So dig a little deeper with him or her. So in addition to the above symptoms, if your teen is angry and irritable a lot, this could be a sign of depression. Is you or your teen depressed?
Causes of depressionIn general, there are three things that often cause depression. These can act singly or in combination.
Suicide or self harm?Are you having thoughts of suicide? Do you have a plan, then get help immediately!Go to the nearest hospital Emergency Room Dial 911 and get off the web, talk to someone Call National Hopeline Network: 1-800-Suicide (1-800-784-2433) On
the web: click here
LOCALLY (Pickens, Seneca, Anderson, or Greenville counties) in South Carolina: Crisis
Ministries: call 1-800-868-4878 The psychobiology of depressionThis section will help you understand depression a little better and its underlying causes and affects.Maybe your teen has wrestled with depression before but gotten over it. There are both short-term and long-term consequences of depression. Here is a little on the underlying psychobiology of depression. Of special interest are changes in the brain that may be associated with depression, especially long term depression. Depression involves the hypothalamus-pituitary-adrenal axis. The hypothalamus is located deep within the brain and is part of the limbic system. The limbic system is the emotional part of our brain. Emotions and feelings are important and have high survival value. This is true not only in today's world but was certainly true for our ancient hunter-gather ancestors. Emotions are often the real basis on how we make decisions. The hypothalamus controls the hormones released from the pituitary gland, which sits right below it. The pituitary gland is our master control endocrine (hormonal) gland, controlling the other endocrine glands of our body, including the adrenal gland. The adrenal gland sits atop the kidneys and manufactures and releases the hormone adrenaline and the neurotransmitter, norepinephrine. Adrenalin and norepinephrine (a.k.a. noradrenalin) help control our level of arousal and alertness among other things. Neurotransmitters control all the nerve impulses between our nerve cells (neurons). Neurotransmitters are biochemicals that transmit nerve impulses between nerve cells (neurons). The simplest, most primitive, and those most important in depression are derived from simple amino acids, the building blocks of protein. Each neurotransmitter has it own specific receptor type. Receptors are the molecular sites on the cell's membrane that bind with or receive the neurotransmitters. On the membrane of nerve cells there are millions of receptor sites. Neurotransmitters are released from the neuron through which the nerve impulse is traveling (called the pre-synaptic neuron), move across the space between it and a neighboring neuron (called the synaptic space), and then binds to their receptor sites on the neuron across the synapsis (the post-synaptic neuron). Then the neurotransmitter is released back into the synaptic space between the neurons where they are reabsorbed back into the pre-synaptic neuron. This reabsorption process is called, reuptake. If the neurotransmitters were not reabsorbed, then they would continue to stimulate (bind to their receptor sites) on the post-synaptic neurons and stimulate unwanted nerve impulses.
Norepinephrine regulates daily levels of energy, promotes socialization, vigilance, and the ability to concentrate. Imbalance in levels of norepinephrine results in attention deficit-hyperactivity disorder (ADHD, ADD), obsessive-compulsive disorder (OCD), and most types of depression. Serotonin is thought to play the critical role in depression because of its effects on mood (sadness, happiness) and on thought (cognitive) processes. Serotonin influences the initiation and then gradual "relaxation" of thoughts. Imbalance in serotonin results in ruminating negative self-talk (worry), that is, negative self-talk thoughts that keep reoccurring and will not go away, a major problem in depression. Most of the antidepressants work by inhibiting serotonin reuptake (SRI's). Some of the newer antidepressants developed work by affecting both serotonin and norepinephrine reuptake (SNRI's). This is discussed below in the "Antidepressants" section. Dopamine is our pleasure/reward neurotransmitter. It is released when we fill pleasure. Experiments with rats with electrodes to stimulate the pleasure/dopamine centers in the brain have shown that the rats will starve to death. They will stay there and depress the little lever that stimulates the dopamine pleasure centers in their brain as opposed to eating. This is what many addictive drugs do. They hijack the brains pleasure/dopamine pathway. Although dopamine should be a primary pharmacological target for treating depression, it is not because chemicals that affect the dopamine receptor tend to be addictive, e.g. cocaine, heroine and its derivatives, nicotine, etc. (see rat story above). GABA, for gamma-aminobutyric acid, is an inhibitor of the brain. Unlike the other three neurotransmitters, depression causes an increase in GABA. Increasing its level in the brain, causes a sedation effect. Alcohol and other sedative type drugs (e.g. barbiturates) increase GABA's inhibitory effect by interfering with the GABA receptors. For a healthy, non-depressed person, these neurotransmitters are around in a homeostatic balance. With depression they get out of balance. So the strategy of treatment from a psychobiological perspective is to re-establish this balance. Genetics. Twin studies indicate that there is a strong genetic component for depression. This means that if you have history of depression in your family, there is a higher chance of you having depression because you carry related genes. However, it is not a simple gene effect. Rather depression is a polygenic trait, meaning it is affected by several genes. It is also strongly affected by environmental stressors, just as are most psychopathological disorders studied to date. More common environmental stressors include early childhood traumas, major life losses (e.g., death, loss of a job, and divorce), environmental traumas (the recent hurricanes, floods, tornadoes, earthquakes, fires, etc.), and personal traumas such as rape, mugging, and other violent acts of crime. Brain growth and changes and changes with depression.One new theory on depression involves depression causing a lack of normal brain growth. (Vogel, 2000, p 258). This is based on the observation that depressed patients have 12-15% less volume in their brain's hippocampus, another part of the limbic system that is involved in encoding new experiences (Sheline et al., 1996). The hippocampus converts short term memory into long term memory.Other research has supported this loss of volume (see Rossi, 2002, pp 119-121). Normally the brain grows as we learn and experience new things. The data indicate that in the important emotional part of the brain, the limbic system, that the brain size actually decreases with depression. In our Psychobiology section, you can find information on countering this loss of brain matter under the Neurogenesis page (coming soon). Exercise, a variable environment, and novelty have all been found to stimulate brain growth. The depression- cycle:
Antidepressants:Prescriptions:In depression
the primary
neurotransmitter that is affected is
serotonin, although norephinephrine and dopamine are also affected. A
partial list of prescription drugs used in treating depression are
given below in Table 1. The more modern SRI's and SNRI's have fewer
side affects than older treatments such as the monoamine oxidase
inhibitors, but still have side effects.
Serotonin is the primary target of most of the antidepressants used in medicine today. It is the primary neurotransmitter affecting mood and also regulates the initiation and termination of thoughts. Too little serotonin and you are sad and you either have trouble thinking (concentrating) or you ruminate (worry), going over the same thoughts over and over. To help overcome depression, pharmacology trys to increase the amount of serotonin in the synaptic space, primarily by interfering with the reuptake process using what are abbreviated as SRI's for serotonin reuptake inhibitors. Prozac® was one of the earliest SRI's. Zoloft®, Luvox®, Celexa®, and Lexapro® are second generation SRI's with less side effects. Another strategy has been to effect both serotonin and norepinephrine at the same time. Known as SNRI's (serotonin norepinephrine reuptake inhibitors), these pharmaceuticals focus on increasing both serotonin and norepinephrine. This is a double barrel approach that regulates mood by regulating serotonin and energy/alertness by increasing the level of norepinephrine. Table 1. Prescription drugs used in the pharmacological treatment of depression--a partial listing:
Two over the counter (OTC) of promise and widely used in Europe are Herbal and OTC's: Gensing, St. John's Wort, and valerian root, have all been used to treat depression. St John's Wort has proven to be useful sometimes with mild depression in European studies. For additional information on depression and meds, visit the NIMH website. Other related depressive disorders:Here are some
of the
related disorders to clinical depression.
Treatment of DepressionWhile research has shown that treatment that combines antidepressants and psychotherapy is the most effective in treating depression (see references in R. O'Connor's, Active Treatment of Depression, chapter 1), this research is limited. And, we have known for a long time that psychotherapy is much more effective in preventing relapse than antidepressants alone. Of the psychotherapies, cognitive-behavioral therapy has proven most effective. However, part of the reason for this is that cognitive-behavioral therapy can be standardized and so adapts itself to an experimental environment more readily than most psychotherapies. The interaction between therapist and client is highly individualistic, and other research has shown that it is the relationship between therapist and patient that is the most important, not the theoretical approach of the therapist. The better you and your therapist understand depression, the more effective the treatment can be. The better the relationship between you and your therapist, the more effective treatment can be. A multi-discipline approach is usually the most effective in treating depression. Exercise and Depression: exercise, because it releases endorphins, the natural opiates of the body, is a great adjunct for treatment of depression. It also stimulates brain growth. Briefly, although adjusted for each client, Dr. Y's approach for depressed patients includes, exercise, a healthy diet, training in utilizing your body-minds on natural processes, and a variety of psychotherapies, including insight, cognitive behavioral, relationship, and solution-centered therapies. Most depressed patients face real-life problems that require real-life solutions. Dr. Y works with you to develop and carry out an action plan to solve those problems. this apporch combines life-coaching with counseling. And, yes, horses, as in Equine-Assisted Psychotherapy, can be helpful. Horses help the teens 1) get real and 2) find their on solutions. It can be a powerful mix--horse and teenager or adolescent. For one of our recent adult clients, her depression was lifted after three sessions. No, we can't explain it. She felt empowered and clearer about the changes she wanted to make in her life. This somehow evolved out of her interactions with the horses. She became more assertive, stepped out of the Victim role, and got clearer in her life. Self-Help Books and ManualsIf you are interested in self-treatment, or to facilitate your working with a therapist, here are four self-help manuals/books that you might consider:
Websites:Tips and Strategies for
Anxiety Relief and Related Conditions
- Tips & Strategies for Anxiety Relief, Beating Depression and
Stress Relief. Book-titles provides a wealth of articles to help you.
Read reviews of the top related products before you buy.
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