Teen depression fits into several patterns:

1. Dropping out: They sleep excessively, miss school, don't complete assignments, stop caring about friends, and drop activities.
2. Angry and irritable: They're frequently angry, brutally self-critical, or seem stuck in a chronic bad mood.
3. Mood fluctuation: Their moods shift and change in ways that seem disproportionate to the circumstances and events.

Lack of motivation is common to all three patterns. "The depressed kid wishes he could make himself work," says Dr. Julie Sullivan, Psy.D., a licensed psychologist in Saratoga Springs. "He simply can't get started or can't sustain theeffort."

Complicating matters, sometimes the depression is the result of an underlying issue such as undiagnosed ADHD/ADD, which can impair a teen's ability to handle schoolwork and meet parental expectations. In this case, medications such as Concerta^TM and Adderall^TM may be very helpful.

TALKING TO YOUR TEEN ABOUT DEPRESSION

When did you first notice your child's situation was spiraling out of control? Write down everything you can remember and then ask your general practitioner or the guidance counselor at your child's school for a referral to a therapist who specializes in teens. You can help to fill in the gaps that your teen may be unwilling or unable to communicate.

"Look for the right moment [to discuss this], when your child appears in a reasonable frame of mind," advises Dr. Sullivan. "Although many teens deny that they're depressed, you need to let your child know you see something is wrong, you don't know what it is, and you don't want to ignore a problem if one exists."

Dr. Gants suggests you avoid a tough-love approach (saying "snap out of it," or "don't feel bad," can be damaging), and tell your teen you support her and know she can be helped.

GETTING YOUR TEEN INTO THERAPY

Here are a few conversation starters to get your teen talking about therapy. Remember, you may need more than one discussion.

1. "Give it a try. If it doesn't work, you won't continue." Just getting them, reluctantly, to agree to one session is a success.
2. "The therapist is an adult with no agenda except your well-being." Stress the fact that the teen can vent, derive support, and bounce off ideas in this relationship.
3. "We feel this is a very serious situation, even if you don't." Emphasize that this is the best way to get relief.
4. "If you don't click with one therapist, together we'll find another." Make it possible for your teen to cooperate.

While establishing a therapeutic relationship can sometimes take a few sessions, "once the teen and therapist have agreed on what problems they are going to tackle," continues Dr. Sullivan, "and how they will work on them, the therapy is off to a strong start."

The use of antidepressant medication, such as Prozac or Paxil is controversial. While it can help many teens, some studies indicate that these drugs can worsen a teen's condition. A psychologist treating your child will refer you to a psychiatrist or psychopharmacologist if medication may be appropriate.

A LIGHT AT THE END OF THE TUNNEL

No one knows exactly why depression develops in one child versus another, or what events may trigger it. The jury is also still out as to what extent brain chemicals and genetics are involved in depression. It does seem that a child's basic personality and personal strengths and weaknesses, affects what the depression looks like. For example, a child who is generally more reactive by nature may seem angry, while a mellow child may be more reclusive.

Fortunately, your input can help identify the correct diagnosis, so your child gets appropriate help. The majority of depressions are self-limiting, which means that for most teens, there is a light at the end of the tunnel.

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Issue: February 2008