Typical teen - or a troubled one?
BY SUSAN STEVENS Daily Herald Health Writer
Posted Monday, December 27, 2004

Your teenager comes home, yells at her younger brother and slams her bedroom door. Later, she refuses to eat dinner with the family.

Irritating, yes. But whether it's normal teenage moodiness or a more troubling problem can be hard to tell.

According to a report by the U.S. surgeon general, one in five children and adolescents has a mental or behavioral illness, such as depression, anxiety disorder or attention deficit/hyperactivity disorder

Only one-third of those are being treated.

Part of that is due to the sometimes invisible nature of mental illness. Unlike physical disabilities, mental illnesses can lie hidden.

The difficulty is exaggerated in the adolescent years, when so many signs of depression can be misinterpreted as typical teenage behavior. Increased irritability, odd sleep patterns and low self-esteem can in fact be signs of depression if they are combined with other out-of-character behaviors.

"When there is a 'problem' adolescent at school, there is a cultural tendency to say they're just an adolescent, they're just going through a phase," said Dr. Maxim Chasanov, a general psychiatrist and medical director of Alexian Brothers Northwest Mental Health Center in Palatine. "The key is to keep in mind what is a disorder and what is normal behavior."

During adolescence, teenagers are dealing with puberty, identity and independence. It's natural for teenagers to place a lot of importance on acceptance among their peers and to seek independence from their parents.

Coming home half an hour after curfew and forgetting to empty the dishwasher is normal behavior. Withdrawing from their friends is not.

"Teenagers may be irritable or have weird sleep patterns, but if they're also not hanging out with their friends and their grades are going down, those are signs of depression," said Christina Miksis, a clinical psychologist at Alexian Brothers Northwest Mental Health Center. "It's a picture. It's not just one thing."

In making a diagnosis, counselors look for at least five signs in a two-week period:

• Depressed mood nearly every day.
  
• Diminished interest in activities they usually enjoy.
  
• Significant weight loss or gain, or for younger kids, failure to gain expected weight.
  
• Too much or too little sleep.
  
• Feeling agitated or lethargic.
  
• Fatigue or loss of energy.
  
• Feeling of worthlessness or inappropriate guilt.
  
• Inability to concentrate or make decisions every day.
  
• Recurrent thoughts of death or suicide.

The American Academy of Child & Adolescent Psychiatry recommends first starting a conversation with your child; an open talk about feelings may help.

But unlike adults, children and teenagers are less likely to acknowledge their own depression.

"Adults who are depressed are low-key and talk about being sad," said Shannon Shi, a child and adolescent psychiatrist at Edward Hospital's Linden Oaks Hospital in Naperville. "But kids are not like a small copy of an adult."

Adolescents are more likely to act irritable, angry or impulsive when they are depressed, Shi said. All kids have good days and bad, but drastic changes in behavior that last for two weeks or more are a red flag.

"Irritable sometimes is not a problem. Irritable a great deal of the time is," said Michael Biladeau, general psychologist at Advocate Lutheran General Hospital's counseling center in Park Ridge.

"Most often, they can be very, very angry," Biladeau said. "Grades tend to drop because one of the symptoms of depression is inability to concentrate. They're unable to give energy to things they're supposed to do. They will be less communicative. They will withdraw into their own room."

Behavioral problems - getting in trouble at school or with police - can sometimes mask a mental health problem. Gender might also play a role.

After puberty, research shows girls are more susceptible to depression, though some psychologists believe boys might be underdiagnosed because they tend to act out behaviorally rather than withdraw.

Treatment is easier the earlier a problem is diagnosed.

Some states promote mental health screens for students who come into school health centers for physical ailments. In New Mexico, for example, middle and high school students are asked about alcohol and drugs, whether they've felt sad or depressed, and whether they've thought about suicide.

"There are an enormous number of kids who have mental health problems that are undetected," said Dr. Jane McGrath, a pediatrician and school health officer for the Albuquerque Office of School Health.

"We're very good at identifying kids who act out and who get picked up by law enforcement, but we're terrible at identifying kids who are suffering quietly, whose parents might be going through a divorce, or suffering their first bout of depression," McGrath said. "We want to get these kids upfront before things start to fall apart."

In Illinois, such screenings are fragmented at best. In 2003, the state launched a board to oversee children's mental health services; the group issued a preliminary plan in September. Among other goals, the plan calls for a greater emphasis on prevention and early treatment.

Elsie Mills, executive director of National Alliance for the Mentally Ill of DuPage County, said parents of children with mental illnesses need to be more educated and firm with the school system to get the services they need.

"The parents of special-needs kids, they fought very successfully to have school systems held more accountable," Mills said. "Parents of children with mental illness really need to model our advocacy on them."

Untreated depression is worrisome because it can lead to a teenager looking for relief in alcohol, drugs or suicide. Without intervention, emotional and behavioral disorders can continue into adulthood and lead to failure in school and work.

But even teenagers with less serious issues can often benefit from a few therapy sessions, according to counselors. A painful event such as a death in the family, the breakup of a relationship or a move to a new school can trigger anguish for teenagers.

"It may be useful to have some sessions of psychotherapy and have the child really grow from the challenge," said Dr. Shelley Korshak, a child and adolescent psychiatrist at Linden Oaks.

So far, that doesn't happen, Korshak said. More often, she sees parents delay seeking treatment for very real mental illnesses.

"I think there's a stigma," she said. "They will take their kid to drama class and art class and gym, but they're really reluctant to take the child here, where their happiness is affected, which colors everything they do."

****

May I ask? Distinguishing between teenage moodiness and serious depression
By Patricia Ladew / Daily News Correspondent
Tuesday, February 22, 2005

Q:My 15-year-old daughter has incredible mood swings. One day she's on top of the world, the next day she's in the depths of despair. Is this normal?

A:"It is normal for adolescents to experience extreme mood swings," says Stephen Currier, LICSW, vice president of May Institute's behavioral health services. "The teen years are a time of tremendous physical and emotional changes. Teenagers have to deal with fluctuating hormones, peer pressure, and stressful academic expectations. Also, don't discount the importance of an adolescent's social life on his or her moods. Fickle friends or a breakup with a boyfriend can cause a once happy teen to suddenly feel miserable."

According to Currier, one way to distinguish between normal teenage mood swings and a serious episode of depression is the duration of the moodiness. "If your teen only feels 'blue' for a few days, it's probably a normal mood swing. If her sad or sullen feelings last more than two weeks, it may be indicative of a more serious disorder," he explains. "You must also take into account the severity of symptoms. Feeling out of sorts for a few days is normal, especially for a teenager; not being able to sleep or eat normally for several weeks is outside of the norm."

Moodiness is not depression. Depression is a serious illness that affects about 4 percent of teens in this country; twice as many adolescent girls as boys are affected. Depressed teens are at risk for suicide. According to the American Academy of Pediatrics and the National Institute of Mental Health, suicide is the third leading cause of death for young people between the ages of 10 and 24.

There are two major types of depression: major depression, which causes extreme sadness for an extended period of time, and bipolar depression, which includes a manic phase that makes affected individuals feel "high," behave erratically, and display poor judgment.

Symptoms of major depression in adolescents include:

• pervasive sadness and crying spells
  
  
• significant change in appetite
  
  
• sleeping too much or too little
  
  
• agitation and irritability
  
  
• withdrawal from previously enjoyed activities
  
  
• inability to concentrate; drop in grades
  
  
• thoughts/talk of suicide and death

Symptoms of mania (bipolar depression) in adolescents include:

• elevated, expansive, or irritable mood
  
  
• depression
  
  
• rapidly changing moods lasting a few hours to a few days
  
  
• increased physical and mental activity
  
  
• defiance of authority
  
  
• decreased need for sleep
  
  
• impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
  
  
• excessive involvement in pleasurable but risky activities
  
  
• grandiose delusions
  
  
• in severe cases, hallucinations

Major and bipolar depression may be considered familial when several members of one family are affected. Sometimes, depression is brought on by a "triggering event" in individuals genetically predisposed to the disorder. There is also a connection between alcohol/drug abuse and depression.

"If you suspect that your child is seriously depressed, seek outside help," recommends Currier. "An early and accurate diagnosis is the first step toward successful treatment and recovery. Unfortunately, bipolar disorder is often misdiagnosed in adolescents as borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), or schizophrenia. I highly recommend that you seek assistance from a board-certified clinical social worker, psychologist and/or psychiatrist."

Effective treatment for depression may include medication and counseling or psychotherapy for the teen and his or her family. Providing education about stress reduction, good nutrition, exercise and sleep habits can also be helpful.

Patricia Ladew is a writer for the May Institute. She can be reached at [email=pladew@mayinstitute.org.]pladew@mayinstitute.org.[/email] Stephen Currier is the vice president of May's Behavioral Health Services. He can be contacted at 508-678-0041.
For more information, call 1-800-778-7601, or visit www.mayinstitute.org.