MOODY or DEPRESSED:
THE MASKS of TEENAGE DEPRESSION

by Gerald D. Oster, Ph.D. and Sarah S. Montgomery, LCSW-C

Mary seems so tired all the time, she doesn't get excited about anything...Tyrone's become so withdrawn; he shuts himself in his room and refuses to talk to anyone -- even his best friends. We found some poems in Michael's notebook that really scare us; they're all about darkness and death. Kim's been acting so impossible lately, I can't tell if she's going through a stage or if something is terribly wrong.

These are the bewildered voices of actual parents confronted with the moody, tense, or even hostile expressions and behaviors of their struggling teenagers. Emotionally, the teen years can be a roller coaster, sometimes a dangerously fast one. Teens throughout time have had to confront the onset of adolescence and the emotional, mental, and physical changes that go with puberty. On top of all these changes, today's teenagers have to worry about more than passing their driving tests and finding dates to the prom. Many also confront serious problems such as: surviving the trauma of broken homes, experimenting with drugs, escaping gang violence, and protecting themselves against AIDS and unwanted pregnancies.

Although most teenagers successfully navigate through these hurdles without too much wavering, there are some who find themselves overwhelmed and act out their distress. How do parents, or teens themselves, tell if they are just experiencing the natural ebb and flow of the "wonder years" or whether there is something more serious going on? And what happens to adolescents who become upset or depressed and due to their sad mood and catastrophic thinking can no longer deal with their daily lives?

The onset of depression during the teenage years can be gradual or sudden, brief or long-term; and it can be hidden or "masked" by other clinical conditions such as anxiety, eating disorders, hyperactivity, and substance abuse. Although the incidence of more severe depression is less than 10 percent in all teenagers, many of the symptoms (sadness, poor appetite, physical complaints) are seen more often. In fact, research has shown that up to a third of all teens experience some of these symptoms, even so-called "normal" teens.

The signs of clinical depression refer to marked changes in mood and associated behaviors that range from sadness, withdrawal, and decreased energy to intense feelings of hopelessness and suicidal thoughts. It is often described as an exaggeration of the duration and intensity of "normal" mood changes. A key indicator is drastic change in eating and sleeping patterns. Another vital observable feature is a significant loss of interest in previous activity levels and interests, a change that lingers. For example, a top high school or college student loses all interest in school and no longer has direction.

Many parents berate themselves for not picking up on signs of depression in their children. "How was I so blind?" "How could I have thought that this was just a stage all kids go through?" The fact isclinical depression can be difficult to discern. If parents feel that they are picking up on signs of depression, they should not rely soley on their teen's reassurances that everything is fine. Unlike adult depression, symptoms of youth depression are often "masked." Instead of expressing sadness, teenagers may express boredom and irritability, or may choose to engage in risky behaviors. Most youngsters do not say "Hey mom, hey dad, guess what, I'm depressed."

Even the mask of success can be misleading. Overachievers rarely express their genuine feelings, especially anger. They are driven to succeed and try fiercely to be independent. But many are actually very dependent on outside accomplishments to justify their existence. These teens can crash emotionally when they experience rejection or failure such as the break-up of a relationship or failing to be admitted to a "competitive" university. The most important message a parent can send to an overachieving teen is "I know you are human and struggling just like everyone."

For many teens, symptoms of depression are a reflection of troubles in the family. When parents are struggling over marital or career problems, or are ill themselves, teens may feel the tension and try to distract their parents. One powerful option that teens possess is to blatantly express severe depressive or suicidal feelings; they may do this so the parents can clearly see that they are still needed in heir primary role as parents. Teenagers may be trying to help their parents in the only way they know how.

Most parents, more than other adults, know their children best. But they can't diagnose a troubled teen alone. They need advice from neighbors, friends, teachers and others who know their son or daughter. Sometimes, it takes a more objective person, such as a mental health professional, to establish that the changes taking place justify treatment for depression. It often strengthens the entire family when they have the courage to intervene and get help to face the issue troubling their teenager.

If you suspect that your child is struggling with many of these signs of depression, there are positive ways to help. Some of these ways include:

	Encourage them to share their thoughts and feelings; listen to their concerns without being judgmental; acknowledge the pain and suffering.
	Share similar unpleasant experiences that ended positively to provide a basis of hope; but make sure not to minimize their concerns and worries.
	Seek professional help from someone experienced in normal adolescent developmental changes.
	The possibility of suicide is always there. References, threats and attempts at hurting oneself should always be taken seriously.

When adults seek treatment, they choose their own therapist and therapy. However, for the child or teenager someone else makes the choices. Usually an adult will say "my pain is horrible, I need relief," but with youths it is the parent, relative, or teacher who must recognize this suffering.

You can help stop the downward spiral of clinical depression by helping the teen receive the help they need; this can be emotionally draining and painful, but well worth the effort. Until recently, teen depression was largely ignored by health professionals, now the "mask" has been unveiled and there has been excellent progress in its diagnosis and treatment. With the aid of teachers, school counselors, mental health professionals, and other caring adults, the seriousness of a teen's depression can be accurately evaluated, and plans can be made to improve his or her well-being and ability to fully engage in life.

5/29/98

Gerald D. Oster, Ph.D. and Sarah S. Montgomery, LCSW-C, are the co-authors of
Helping Your Depressed Teenager: A guide for parents and caregivers (JohnWiley, 1995) and Clinical Uses of Drawings (Jason Aronson, 1996).

Dr. Oster is Clinical Associate Professor of Psychiatry at the University of Maryland Medical School and also has a private practice. He has co-authored five other books on child and adolescent assessment and therapy.

Ms. Montgomery, a graduate of Williams College and UM School of Social Work, is a clinical social worker providing therapeutic services to children and families in Baltimore City Public Schools. She is also a workshop leader of topics related to childhood depression, overcoming grief, and using drawings in clinical work.