Depression or normal adolescence?

By Dr. Batya Ludman · Published November 2, 2012

I recently saw an email of a four panel cartoon. Panel one showed a teenager with a cigarette in her mouth, the second panel depicted a child with multiple piercings taking drugs, the third a pregnant teenager, and the fourth was a picture of a teen in pajamas sleeping on the couch. The caption read: "See Mom, aren't you glad I'm just me." So while you may be frustrated by your child's one word answers, their crazy hours, their fingers glued to a cell phone, some self centered behavior, and their seeming disregard for the world, I do find teenagers to be amazing. When I chat with them one on one I never cease to be surprised by their sensitivity and caring, strength and value system. Teenagers are wonderful. They are so open and honest. It can be hard when they wear their feelings on the outside, especially when their moods change constantly. They can be in tears and in so much pain one minute and laughing the next, leaving us adults upset and bewildered by their sudden mood changes. How do you differentiate between a teenager who is just acting like an adolescent from one who seriously needs help? How does one define a mood disorder or depression in adolescents? After all, aren't teens wired to behave like that? Have you known a teenager who is never sullen, moody, down or depressed? The short-tempered, eye-rolling, disgruntled, argumentative child who sits glued to their technological devices is a frequent fixture in my waiting room (and once they are inside my office, well, they are often a delight). Most kids get down from time to time whether they are having a bad day, did poorly on a test, had a fight with a girlfriend, or just for no apparent reason feel angry or sad. At the end of the day, I often tell a parent that their child's "devastating" behavior is "just" normal. But what if he or she is having problems? What should you, as a parent, look for and how do you know when they need help? Figuring out what goes on in the mind of an adolescent is not easy and it is always best to err on the side of safety.

Here are some questions for you to answer for yourself to help you decide if your child needs some help. Is your child overly judgmental or critical of his own behavior; does he blame himself for anything that seems to go wrong and have a hard time seeing the positives in life? While teenagers are often known for their erratic sleep and eating behaviors, have these patterns changed? Does your child sleep more or less than usual, wake at strange hours, have great difficulty getting to and staying asleep, or seem exhausted all day long in spite of having a full night's sleep? Have they dramatically cut back on, or seem unable to stop, eating? Is there a marked weight gain or loss? Are there dramatic mood swings with or without anger, irritability, or sadness that seem to last longer than they should, are frightening or intense? Is there behavior that is simply unexplainable? Is your child unmotivated? Is he socializing less or lacking energy? Has he lost interest in activities that he previously seemed to enjoy? Is she indecisive or having a harder time making decisions, focusing or concentrating? Does he act dejected, have little or no hope, seem sad, feel worthless or inadequate or seem unable to see that things can improve with time? Does he engage in self-destructive and risk taking behavior? Does he drink or use drugs to excess? Is she sexually promiscuous, dealing with an eating disorder, cutting or other forms of self-mutilation? Does he isolate himself, withdraw from or talk of not having friends- both in reality and within his social media network? Does he allow you a glimpse into this world and do you like what you see or does he relate to technology in an unhealthy way? Does he think or talk about hurting himself, wish that he were no longer here or suggest that others would be better off without him?

Being a teenager is tough. Not quite adult and no longer a child, they feel pulled by peer pressure, challenged by having to make decisions for which they may not feel ready, all while dealing with the normal physiological, physical and emotional challenges and changes of adolescence. The world has changed and it may be through text messaging and Facebook that we actually gain a greater insight into the emotional world of our children than we did by frontal contact in the old days. Symptoms of depression involve changes in mood, behavior, thoughts and feelings. When your child's sadness seems to last longer than it should (a few weeks or more), involves several areas of functioning, (home, school, with friends or family), seems worse, more frequent, intense or severe and doesn't go away or improve with time, you should question whether something else is going on. Trust your gut and if you're concerned, seek professional help. Depression is treatable.

A version of this article appeared in The Jerusalem Post.