The Myths of Teenage Depression
Nicole Peradotto
esperanza Spring 2009 Issue
When a child hits adolescence, it's often his parents who look like the proverbial deer in the headlights. They're caught off-guard-stunned by the physical and emotional transformation that accompanies their youngster's march toward adulthood. Even having survived their own teen years doesn't seem like qualification enough for shepherding their kids through such a trying stage.
Consequently, when depression enters the mix of garden-variety adolescent self-absorption and moodiness, it's as misunderstood as the teenagers themselves. That confusion creates a breeding ground for myths-myths that prevent kids from receiving help they desperately need.
"For the longest time we thought that children and adolescents were very resilient and couldn't be affected by depression," notes Amy Cheung, MD, staff psychiatrist at Sunnybrook Health Sciences Centre in Toronto, Ontario, who, in recent years, has made headlines for creating awareness about adolescent depression. The lead investigator of a group of North American researchers who established the first-ever primary-care guidelines for the diagnosis and treatment of teen depression, Cheung believes the stigma of mental illness perpetuates misconceptions about the disorder.
"It is hard to accept that your child can have a condition like depression, so many parents are resistant to the diagnosis. But it's very important for people to learn about it because it's a very common condition and can have serious consequences, such as suicide. Cheung says. "Parents, and educators-such as teachers and guidance counselors-are in a unique position to help these adolescents because they know them best and, therefore, are able to see the signs of depression as they emerge."
As it stands, many youngsters suffer in silence. According to Carol Glod, PhD, a Northeastern University nursing professor and researcher of adolescent depression, only one in five teenagers gets treatment for a major depressive episode. "Essentially, four out of five kids who have symptoms are never treated. It's not getting recognized, and it's not getting treated."
To separate fact from fiction, several experts in the field of teen depression-as well as individuals who have firsthand or family experience with the disorder-agreed to weigh in on 10 of its most prevalent myths. Understanding the true face of adolescent depression, after all, is key to responding to your child's needs with sensitivity, intelligence, and compassion.
Myth No. 1: Teens can't become clinically depressed-they're just moody.
Epidemiological studies tell us that at least 8 percent of adolescents experience more than typical adolescent angst-on top of these mood swings, they experience depression as well.
So, how do you distinguish growing pains from clinical symptoms?
"If it's just sadness, these feelings and moods tend to pass quickly," says Alexandra Barzvi, PhD, clinical director of the Institute for Anxiety and Mood Disorders at New York University's internationally renowned Child Study Center.
"If it's truly a depression, it will interfere with everyday activities, including a teen's desire to participate in things they normally love." It can affect their sleep and appetite. They may care less about their appearance, so you'll see that they're less together in terms of hygiene."
During her sophomore year of high school, Caroline Schepker realized that something "was not quite right" when she found herself going through the motions with friends whose company she had once relished. Indeed, the only thing she looked forward to was taking a nap.
"Music has always been a pretty big part of my life, and I normally would be very excited to get on the violin. So it was frustrating to be playing my favorite songs again and again and not getting anything out of them," says Schepker, now a junior at Brown University. "Happy songs seemed silly to me. They were so out of the ballpark of anything I was feeling."
Myth No. 2: Adolescent depression looks like adult depression.
Teen depression isn't a junior version of the adult disorder. But because we're more familiar with adult depression, we expect depressed adolescents to behave like their older counterparts.
"It's often that teenagers express depression not as a typical down-in-the-dumps mood, but a more irritable, oppositional mood," Glod counters.
Minus the disorder's hallmark melancholy, it can be tricky for parents to detect depression in their child. "Many teenagers tell me they don't feel sad. They tell me they feel nothing-that they're without emotions," says Miriam Kaufman, MD, a pediatrician at Toronto's Hospital for Sick Children and author of Helping Your Teen Overcome Depression: A Guide for Parents (Key Porter Books, 2000).
"For every sign of depression, the opposite is true. Your appetite can increase; your appetite can decrease. You can pay no attention to your hygiene, but if you have OCD with the depression, you'll get more obsessed with it. While you find decreased energy in many depressed teenagers, there is certainly a significant minority who become agitated with depression. They're pacing around-they just can't sit still."
Myth No. 3: The depressed teen tends to be a loner.
With his disarming smile and great sense of humor, Andy Gatson was a social magnet in high school. He was so popular with the girls that one year he attended four proms.
After he killed himself, 500 people attended his funeral.
"Everybody loved him," says his mother, Joyce Gatson, MA, a counselor and clinical manager in Phoenix, Arizona. "No one would have said Andy suffered from depression."
In retrospect, Gatson figures that Andy socialized to distract himself from his dark moods. "He loved to have friends at the house, but it was almost like he was afraid to be alone. It's like you're so uncomfortable with your skin that you don't want to be by yourself."
Although Andy Gatson exhibited many symptoms of depression-including agitation and sleeplessness-he was far from a social misfit. But then, neither are many depressed teens.
"I'd always been a fairly popular kid and had always had really good friends I could turn to. But I still had that 'I'm all alone' feeling," says Natalie DeJohn, a 26-year-old spokesperson for the Depression and Bipolar Support Alliance. Recalling her bouts of depression during junior high and college, she adds: "I knew intellectually that I had a support system, but that overwhelming feeling of loneliness was still there."
Myth No. 4: Discussing depression with your child only "gives him ideas."
The reason this myth persists is that it allows parents to avoid not only the topic of depression, but also any subject that makes them uncomfortable. "Parents worry that if they talk about something difficult it might make it worse," Barzvi says. "They're afraid if they talk about sex, their kids will go out and have sex. Or if they talk about drugs and alcohol, their kids will go out and use it.
"The parent thinks, 'If I talk about depression, she'll cry, and it'll make things worse.' But studies show that parents have the greatest influence helping their kids make difficult decisions. You have more power with your teens' decisions than you think you do."
Daniel Reidenberg, PsyD, chair of the American Psychotherapy Association's executive advisory board, points to research dispelling the notion that discussing suicide with children makes them more likely to contemplate it.
In the 2005 study, published in the Journal of American Medical Association, more than 2,300 high school students took part in a two-part mental health questionnaire. While half of the students received questions about suicide on both surveys, the other half were only asked those questions on the second survey. Although about 50 percent of the youngsters said they'd had suicidal thoughts, those who were asked about it twice reported fewer thoughts about suicide.
"In reality, when asked about it, kids feel a sense of relief and having been understood," Reidenberg says.Erinn Ridge can attest to that. After a suicide attempt during her junior year of high school, she spent a week at a psychiatric hospital. During her stay, doctors urged her to articulate her bottled-up feelings. "Once I talked about them, I realized that I felt better," says Ridge, a junior at University of Southern Maine. "Once I started talking, I couldn't stop."
Myth No. 5: You can improve a depressed teen's behavior by strictly enforcing consequences.
Using consequences to modify misbehavior is a time-honored parenting technique. For the most part, the strategy works for kids of all ages. The same child who stopped acting up to avoid being sent to the time-out chair when he was 3 years old will shape up at 13 if the alternative means an earlier curfew.
Depressed teens are another story. Taking away privileges tends to fuel their despair.
"If you tell your child that you can't trust him with the car and he has to earn your trust, he thinks: 'I'll never earn her trust. I'm a loser and I have no friends,'" says Michigan psychologist Laurie Assadi, MA, author of Waking from the Nightmare: Giving Our Children Optimism (CCLD, 2007).
"Remember, kids are driven to be normal. So if they can't do those things that they normally do, they feel more and more alienated. What you need to do is acknowledge and remind yourself that if your child could do better, he would do better."
At the same time, parents shouldn't drop all expectations of their child. Instead, you need to choose your battles wisely.
"Ask yourself: 'How important is this to me? Is this something I can let go?' If everything your child does is not OK with you, you have no negotiation power," Barzvi says. "But if you say, 'I'm going to let you do a, b, c, and d-but not e'-they'll know you're not on their back for everything."
Myth No. 6: When a depressed teen refuses help, there's nothing you can do.
If your child won't keep an appointment with the therapist, don't abandon the idea. For starters, go in her place.
"There are other things you can do, too," notes Kaufman. "Say to your kid: 'You don't think you're depressed, but I think you are. So humor me. I'm your parent, and I'm worried. If you're not depressed, the doctor will say you're not depressed. But let's give it a try.'"
"The best advice I give is to keep trying," Glod says. "If your child had asthma or a really bad infection, you wouldn't accept it if he didn't want to go to the pediatrician."
Parents should also consider casting their net wide in the search for help. "You can coordinate a plan with your child's school. You can engage your child's friends to be part of their support team," Reidenberg says.
"You can spend time with your teen, listen to them, and plan activities with them. You can encourage them in healthy living skills. You can keep a regular routine at home. You know your teen better than anybody else does, even the best psychologist or doctor. It is your job to do something."
Myth No. 7: Antidepressants are unsuitable for teenagers.
In 2004, the U.S. Food and Drug Administration (FDA) ordered that antidepressants carry a "black-box" label warning consumers of their association with an increased risk of suicidal thinking, feeling, and behavior in children and adolescents. Other countries, including Canada, took similar measures.
What followed was a steep drop in antidepressant prescriptions for youngsters-and, at the same time, an unprecedented spike in child and teen suicides.
"Teen suicide was going down for years-steadily down. Then there's this big spike up. Is it coincidence? We don't really know, but it's very interesting," says Kenneth Duckworth, MD, medical director of the National Alliance on Mental Illness (NAMI).
While antidepressants pose some risks for a small percent of teenagers, Duckworth argues that they shouldn't be categorically ruled out as a component of treatment.
"You never start with meds-you start by looking at every aspect of the child's life," he advises. "Maybe you can get results from therapy and family work, and there are no side effects from those. But if you let that risk [of side effects] drive your decision-making, then you may put your child at greater risk."
Ultimately, if the teen, his parents and his doctor agree that he should take antidepressants, the decision must be coupled with a commitment to monitor his progress.
"The FDA's recommendation is that a child or adolescent should be seen once a week for the first four weeks when they start antidepressant treatment or anytime there
is a dose adjustment," says Cheung.
"Once the teen's dosage of medication is stable, parents should continue to remain vigilant to any changes in their child's behavior. It's critical that parents monitor for side effects from treatment and worsening of the depression in between follow-ups with their physicians."
Myth No. 8: Depression affects teenage boys and girls equally.
"The prevalence is two to one girls to boys, and we don't know why that is," Glod says.
A recent study of teenagers at 18 different Chicago-area schools sheds some light on the issue. Researchers at the University of Illinois at Chicago and the University of South Carolina asked students to record their "worst event" of the day in their diaries every day for a week, at three different dates: the study launch, and six and 12 months later.
They later evaluated how stressful the events were and classified them as "interpersonal"-involving an interaction with a family member, teacher, peer, or romantic partner-or "achievement," involving academics or athletic performance.
What did they find? Girls in the study experienced twice as many interpersonal stressors as boys, and reacted more strongly to those stressors than did their male counterparts.
Myth No. 9: Depressed teens will get better if they resume their normal routine.
Parents often assume that their teen is out of sorts because she stopped following her daily routine. But in this case, they're confusing the cause of depression with the effect. The truth is, depression can make it too trying for youngsters to keep up with everyday rituals and once-cherished pastimes.
"Obviously, activities that kids love doing are great for their emotional, spiritual, and social well-being," Duckworth says. "But a child can't always do sports when he's depressed, and if he's become isolated from his peers you can't make him call his friends."
Although the goal of treatment is to get teens back to their routine, pushing ill children to maintain them only aggravates their condition, says Cheung. "When they fail to meet these standards, it will reinforce their already negative self-view. Just like any other illness, teens should be given accommodations based on what their limitations are."
When Erinn Ridge returned to high school after her hospitalization, the principal gave her permission to leave class and call her parents for a ride home whenever the depression overwhelmed her. "There were many instances when I would do that," she says. "It gave me a chance to collect myself and get back to my routine at my speed."
What's more, it reassured her parents that the school's staff was sensitive to their daughter's circumstances. "They were just amazing about the whole thing," says Joe Ridge. "She had a few teachers she was close to, and she spent a lot of time with them. I wouldn't say they sheltered her, but they knew the situation and knew not to put her under any undue stress."
Myth No. 10: Parents will know if their teen is depressed.
Unlike other mental health concerns, like panic attacks or nervous tics, the signs of depression aren't so obvious.
"Teens are very good at disguising their problems, especially around their parents, whom they spend little time with," Reidenberg says. "Parents too often ignore or minimize their child's symptoms, instead believing it to be 'normal adolescence.' "
For her part, Joyce Gatson can sympathize with parents who have a hard time demarcating the line between normal teen angst and clinical depression. She did, too. Even the two therapists who evaluated her son didn't diagnose him with depression.
"I felt that something was wrong with his behavior, but everyone assured me that he was being a typical adolescent," says Gatson, who explored her only child's life and death in the memoir Andy, Why Did You Have to Go? (Ralph Tanner Associates, 2000).
"Now I know to listen to my inner voice. If I had listened, I feel I would have been able to help him." e
Nicole Peradotto is the editor of esperanza and managing editor and contributor for bp Magazine.
Myth vs. Fact: Teen Depression
MYTH: You're better off not discussing depression with your child.
FACT: Communication is key to understanding what's going on in your teen's head. Even if he doesn't show it, he'll appreciate that you care enough to ask how he's feeling. Remember, you still can influence your child during adolescence.
MYTH: Teens are just moody.
FACT: The National Institute of Mental Health reports that up to 8 percent of adolescents experience depression. That's why it's critical for parents to learn to distinguish between typical teen moodiness and behavior that could indicate depression.
MYTH: Depressed kids are loners.
FACT: Depression can affect punks, perfectionists, popular kids-it doesn't distinguish. The only common thread is that depressed teens tend to feel alone-even when surrounded by friends.
MYTH: You should strictly enforce limits with your depressed child.
FACT: It's wiser to choose your battles. Taking away privileges from a depressed teen may fuel her despair. Make her accept responsibility for her behavior, but don't punish her for the way she feels.
MYTH: You can't do anything if your teen refuses help.
FACT: You don't have to take "no" for an answer. If she's adamant about refusing help, consult a therapist for parenting tips and advice on how to coax her into therapy.
MYTH: You'll know if your child is depressed.
FACT: The signs of depression aren't always obvious. Some kids mask them so they won't worry their parents. What's more, parents may shrug off warning signs, confusing them with typical adolescence.
MYTH: Depression isn't an inherited condition.
FACT: It runs in families. Frequently, if a teen has depression, one or more parents may also.
It's important that other family members get treatment, too. The data shows when a mother gets treatment for her depression, her child often gets better.
MYTH: Depressed teens look like depressed adults.
FACT: Adolescent depression manifests itself differently. Rather than appearing blue, teens may become defiant and irritable. Some get labeled troublemakers because they challenge authority. This, in turn, prevents them from getting the help they need.
MYTH: Adolescent depression affects both sexes equally.
FACT: It's twice as prevalent in girls. Researchers think the inequality may have to do with the different way boys and girls experience and respond to stress.
MYTH: Resuming normal routines helps depressed kids get better.
FACT: If a teen is depressed, the everyday can seem overwhelming. That's why parents should try to make reasonable accommodations rather than pushing their child to "keep up."
MYTH: Teens shouldn't take antidepressants.
FACT: While antidepressants pose risks for a small percent of youngsters, they shouldn't be ruled out. If they are prescribed, both doctor and parents should closely monitor the teen's behavior.
Nicole Peradotto
esperanza Spring 2009 Issue
When a child hits adolescence, it's often his parents who look like the proverbial deer in the headlights. They're caught off-guard-stunned by the physical and emotional transformation that accompanies their youngster's march toward adulthood. Even having survived their own teen years doesn't seem like qualification enough for shepherding their kids through such a trying stage.
Consequently, when depression enters the mix of garden-variety adolescent self-absorption and moodiness, it's as misunderstood as the teenagers themselves. That confusion creates a breeding ground for myths-myths that prevent kids from receiving help they desperately need.
"For the longest time we thought that children and adolescents were very resilient and couldn't be affected by depression," notes Amy Cheung, MD, staff psychiatrist at Sunnybrook Health Sciences Centre in Toronto, Ontario, who, in recent years, has made headlines for creating awareness about adolescent depression. The lead investigator of a group of North American researchers who established the first-ever primary-care guidelines for the diagnosis and treatment of teen depression, Cheung believes the stigma of mental illness perpetuates misconceptions about the disorder.
"It is hard to accept that your child can have a condition like depression, so many parents are resistant to the diagnosis. But it's very important for people to learn about it because it's a very common condition and can have serious consequences, such as suicide. Cheung says. "Parents, and educators-such as teachers and guidance counselors-are in a unique position to help these adolescents because they know them best and, therefore, are able to see the signs of depression as they emerge."
As it stands, many youngsters suffer in silence. According to Carol Glod, PhD, a Northeastern University nursing professor and researcher of adolescent depression, only one in five teenagers gets treatment for a major depressive episode. "Essentially, four out of five kids who have symptoms are never treated. It's not getting recognized, and it's not getting treated."
To separate fact from fiction, several experts in the field of teen depression-as well as individuals who have firsthand or family experience with the disorder-agreed to weigh in on 10 of its most prevalent myths. Understanding the true face of adolescent depression, after all, is key to responding to your child's needs with sensitivity, intelligence, and compassion.
Myth No. 1: Teens can't become clinically depressed-they're just moody.
Epidemiological studies tell us that at least 8 percent of adolescents experience more than typical adolescent angst-on top of these mood swings, they experience depression as well.
So, how do you distinguish growing pains from clinical symptoms?
"If it's just sadness, these feelings and moods tend to pass quickly," says Alexandra Barzvi, PhD, clinical director of the Institute for Anxiety and Mood Disorders at New York University's internationally renowned Child Study Center.
"If it's truly a depression, it will interfere with everyday activities, including a teen's desire to participate in things they normally love." It can affect their sleep and appetite. They may care less about their appearance, so you'll see that they're less together in terms of hygiene."
During her sophomore year of high school, Caroline Schepker realized that something "was not quite right" when she found herself going through the motions with friends whose company she had once relished. Indeed, the only thing she looked forward to was taking a nap.
"Music has always been a pretty big part of my life, and I normally would be very excited to get on the violin. So it was frustrating to be playing my favorite songs again and again and not getting anything out of them," says Schepker, now a junior at Brown University. "Happy songs seemed silly to me. They were so out of the ballpark of anything I was feeling."
Myth No. 2: Adolescent depression looks like adult depression.
Teen depression isn't a junior version of the adult disorder. But because we're more familiar with adult depression, we expect depressed adolescents to behave like their older counterparts.
"It's often that teenagers express depression not as a typical down-in-the-dumps mood, but a more irritable, oppositional mood," Glod counters.
Minus the disorder's hallmark melancholy, it can be tricky for parents to detect depression in their child. "Many teenagers tell me they don't feel sad. They tell me they feel nothing-that they're without emotions," says Miriam Kaufman, MD, a pediatrician at Toronto's Hospital for Sick Children and author of Helping Your Teen Overcome Depression: A Guide for Parents (Key Porter Books, 2000).
"For every sign of depression, the opposite is true. Your appetite can increase; your appetite can decrease. You can pay no attention to your hygiene, but if you have OCD with the depression, you'll get more obsessed with it. While you find decreased energy in many depressed teenagers, there is certainly a significant minority who become agitated with depression. They're pacing around-they just can't sit still."
Myth No. 3: The depressed teen tends to be a loner.
With his disarming smile and great sense of humor, Andy Gatson was a social magnet in high school. He was so popular with the girls that one year he attended four proms.
After he killed himself, 500 people attended his funeral.
"Everybody loved him," says his mother, Joyce Gatson, MA, a counselor and clinical manager in Phoenix, Arizona. "No one would have said Andy suffered from depression."
In retrospect, Gatson figures that Andy socialized to distract himself from his dark moods. "He loved to have friends at the house, but it was almost like he was afraid to be alone. It's like you're so uncomfortable with your skin that you don't want to be by yourself."
Although Andy Gatson exhibited many symptoms of depression-including agitation and sleeplessness-he was far from a social misfit. But then, neither are many depressed teens.
"I'd always been a fairly popular kid and had always had really good friends I could turn to. But I still had that 'I'm all alone' feeling," says Natalie DeJohn, a 26-year-old spokesperson for the Depression and Bipolar Support Alliance. Recalling her bouts of depression during junior high and college, she adds: "I knew intellectually that I had a support system, but that overwhelming feeling of loneliness was still there."
Myth No. 4: Discussing depression with your child only "gives him ideas."
The reason this myth persists is that it allows parents to avoid not only the topic of depression, but also any subject that makes them uncomfortable. "Parents worry that if they talk about something difficult it might make it worse," Barzvi says. "They're afraid if they talk about sex, their kids will go out and have sex. Or if they talk about drugs and alcohol, their kids will go out and use it.
"The parent thinks, 'If I talk about depression, she'll cry, and it'll make things worse.' But studies show that parents have the greatest influence helping their kids make difficult decisions. You have more power with your teens' decisions than you think you do."
Daniel Reidenberg, PsyD, chair of the American Psychotherapy Association's executive advisory board, points to research dispelling the notion that discussing suicide with children makes them more likely to contemplate it.
In the 2005 study, published in the Journal of American Medical Association, more than 2,300 high school students took part in a two-part mental health questionnaire. While half of the students received questions about suicide on both surveys, the other half were only asked those questions on the second survey. Although about 50 percent of the youngsters said they'd had suicidal thoughts, those who were asked about it twice reported fewer thoughts about suicide.
"In reality, when asked about it, kids feel a sense of relief and having been understood," Reidenberg says.Erinn Ridge can attest to that. After a suicide attempt during her junior year of high school, she spent a week at a psychiatric hospital. During her stay, doctors urged her to articulate her bottled-up feelings. "Once I talked about them, I realized that I felt better," says Ridge, a junior at University of Southern Maine. "Once I started talking, I couldn't stop."
Myth No. 5: You can improve a depressed teen's behavior by strictly enforcing consequences.
Using consequences to modify misbehavior is a time-honored parenting technique. For the most part, the strategy works for kids of all ages. The same child who stopped acting up to avoid being sent to the time-out chair when he was 3 years old will shape up at 13 if the alternative means an earlier curfew.
Depressed teens are another story. Taking away privileges tends to fuel their despair.
"If you tell your child that you can't trust him with the car and he has to earn your trust, he thinks: 'I'll never earn her trust. I'm a loser and I have no friends,'" says Michigan psychologist Laurie Assadi, MA, author of Waking from the Nightmare: Giving Our Children Optimism (CCLD, 2007).
"Remember, kids are driven to be normal. So if they can't do those things that they normally do, they feel more and more alienated. What you need to do is acknowledge and remind yourself that if your child could do better, he would do better."
At the same time, parents shouldn't drop all expectations of their child. Instead, you need to choose your battles wisely.
"Ask yourself: 'How important is this to me? Is this something I can let go?' If everything your child does is not OK with you, you have no negotiation power," Barzvi says. "But if you say, 'I'm going to let you do a, b, c, and d-but not e'-they'll know you're not on their back for everything."
Myth No. 6: When a depressed teen refuses help, there's nothing you can do.
If your child won't keep an appointment with the therapist, don't abandon the idea. For starters, go in her place.
"There are other things you can do, too," notes Kaufman. "Say to your kid: 'You don't think you're depressed, but I think you are. So humor me. I'm your parent, and I'm worried. If you're not depressed, the doctor will say you're not depressed. But let's give it a try.'"
"The best advice I give is to keep trying," Glod says. "If your child had asthma or a really bad infection, you wouldn't accept it if he didn't want to go to the pediatrician."
Parents should also consider casting their net wide in the search for help. "You can coordinate a plan with your child's school. You can engage your child's friends to be part of their support team," Reidenberg says.
"You can spend time with your teen, listen to them, and plan activities with them. You can encourage them in healthy living skills. You can keep a regular routine at home. You know your teen better than anybody else does, even the best psychologist or doctor. It is your job to do something."
Myth No. 7: Antidepressants are unsuitable for teenagers.
In 2004, the U.S. Food and Drug Administration (FDA) ordered that antidepressants carry a "black-box" label warning consumers of their association with an increased risk of suicidal thinking, feeling, and behavior in children and adolescents. Other countries, including Canada, took similar measures.
What followed was a steep drop in antidepressant prescriptions for youngsters-and, at the same time, an unprecedented spike in child and teen suicides.
"Teen suicide was going down for years-steadily down. Then there's this big spike up. Is it coincidence? We don't really know, but it's very interesting," says Kenneth Duckworth, MD, medical director of the National Alliance on Mental Illness (NAMI).
While antidepressants pose some risks for a small percent of teenagers, Duckworth argues that they shouldn't be categorically ruled out as a component of treatment.
"You never start with meds-you start by looking at every aspect of the child's life," he advises. "Maybe you can get results from therapy and family work, and there are no side effects from those. But if you let that risk [of side effects] drive your decision-making, then you may put your child at greater risk."
Ultimately, if the teen, his parents and his doctor agree that he should take antidepressants, the decision must be coupled with a commitment to monitor his progress.
"The FDA's recommendation is that a child or adolescent should be seen once a week for the first four weeks when they start antidepressant treatment or anytime there
is a dose adjustment," says Cheung.
"Once the teen's dosage of medication is stable, parents should continue to remain vigilant to any changes in their child's behavior. It's critical that parents monitor for side effects from treatment and worsening of the depression in between follow-ups with their physicians."
Myth No. 8: Depression affects teenage boys and girls equally.
"The prevalence is two to one girls to boys, and we don't know why that is," Glod says.
A recent study of teenagers at 18 different Chicago-area schools sheds some light on the issue. Researchers at the University of Illinois at Chicago and the University of South Carolina asked students to record their "worst event" of the day in their diaries every day for a week, at three different dates: the study launch, and six and 12 months later.
They later evaluated how stressful the events were and classified them as "interpersonal"-involving an interaction with a family member, teacher, peer, or romantic partner-or "achievement," involving academics or athletic performance.
What did they find? Girls in the study experienced twice as many interpersonal stressors as boys, and reacted more strongly to those stressors than did their male counterparts.
Myth No. 9: Depressed teens will get better if they resume their normal routine.
Parents often assume that their teen is out of sorts because she stopped following her daily routine. But in this case, they're confusing the cause of depression with the effect. The truth is, depression can make it too trying for youngsters to keep up with everyday rituals and once-cherished pastimes.
"Obviously, activities that kids love doing are great for their emotional, spiritual, and social well-being," Duckworth says. "But a child can't always do sports when he's depressed, and if he's become isolated from his peers you can't make him call his friends."
Although the goal of treatment is to get teens back to their routine, pushing ill children to maintain them only aggravates their condition, says Cheung. "When they fail to meet these standards, it will reinforce their already negative self-view. Just like any other illness, teens should be given accommodations based on what their limitations are."
When Erinn Ridge returned to high school after her hospitalization, the principal gave her permission to leave class and call her parents for a ride home whenever the depression overwhelmed her. "There were many instances when I would do that," she says. "It gave me a chance to collect myself and get back to my routine at my speed."
What's more, it reassured her parents that the school's staff was sensitive to their daughter's circumstances. "They were just amazing about the whole thing," says Joe Ridge. "She had a few teachers she was close to, and she spent a lot of time with them. I wouldn't say they sheltered her, but they knew the situation and knew not to put her under any undue stress."
Myth No. 10: Parents will know if their teen is depressed.
Unlike other mental health concerns, like panic attacks or nervous tics, the signs of depression aren't so obvious.
"Teens are very good at disguising their problems, especially around their parents, whom they spend little time with," Reidenberg says. "Parents too often ignore or minimize their child's symptoms, instead believing it to be 'normal adolescence.' "
For her part, Joyce Gatson can sympathize with parents who have a hard time demarcating the line between normal teen angst and clinical depression. She did, too. Even the two therapists who evaluated her son didn't diagnose him with depression.
"I felt that something was wrong with his behavior, but everyone assured me that he was being a typical adolescent," says Gatson, who explored her only child's life and death in the memoir Andy, Why Did You Have to Go? (Ralph Tanner Associates, 2000).
"Now I know to listen to my inner voice. If I had listened, I feel I would have been able to help him." e
Nicole Peradotto is the editor of esperanza and managing editor and contributor for bp Magazine.
Myth vs. Fact: Teen Depression
MYTH: You're better off not discussing depression with your child.
FACT: Communication is key to understanding what's going on in your teen's head. Even if he doesn't show it, he'll appreciate that you care enough to ask how he's feeling. Remember, you still can influence your child during adolescence.
MYTH: Teens are just moody.
FACT: The National Institute of Mental Health reports that up to 8 percent of adolescents experience depression. That's why it's critical for parents to learn to distinguish between typical teen moodiness and behavior that could indicate depression.
MYTH: Depressed kids are loners.
FACT: Depression can affect punks, perfectionists, popular kids-it doesn't distinguish. The only common thread is that depressed teens tend to feel alone-even when surrounded by friends.
MYTH: You should strictly enforce limits with your depressed child.
FACT: It's wiser to choose your battles. Taking away privileges from a depressed teen may fuel her despair. Make her accept responsibility for her behavior, but don't punish her for the way she feels.
MYTH: You can't do anything if your teen refuses help.
FACT: You don't have to take "no" for an answer. If she's adamant about refusing help, consult a therapist for parenting tips and advice on how to coax her into therapy.
MYTH: You'll know if your child is depressed.
FACT: The signs of depression aren't always obvious. Some kids mask them so they won't worry their parents. What's more, parents may shrug off warning signs, confusing them with typical adolescence.
MYTH: Depression isn't an inherited condition.
FACT: It runs in families. Frequently, if a teen has depression, one or more parents may also.
It's important that other family members get treatment, too. The data shows when a mother gets treatment for her depression, her child often gets better.
MYTH: Depressed teens look like depressed adults.
FACT: Adolescent depression manifests itself differently. Rather than appearing blue, teens may become defiant and irritable. Some get labeled troublemakers because they challenge authority. This, in turn, prevents them from getting the help they need.
MYTH: Adolescent depression affects both sexes equally.
FACT: It's twice as prevalent in girls. Researchers think the inequality may have to do with the different way boys and girls experience and respond to stress.
MYTH: Resuming normal routines helps depressed kids get better.
FACT: If a teen is depressed, the everyday can seem overwhelming. That's why parents should try to make reasonable accommodations rather than pushing their child to "keep up."
MYTH: Teens shouldn't take antidepressants.
FACT: While antidepressants pose risks for a small percent of youngsters, they shouldn't be ruled out. If they are prescribed, both doctor and parents should closely monitor the teen's behavior.
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