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Lately Lindsay hasn't felt like herself. Her friends have noticed it, too. Kia was surprised when Lindsay turned down her invitation to go shopping last Saturday (she always loves to shop). There was really no reason not to go, but Lindsay just didn't feel like it. Instead, she spent most of Saturday sleeping.

But staying in more than usual isn't the only change in Lindsay. She's always been a really good student, but over the past couple of months her grades have fallen pretty dramatically, and she has trouble concentrating. She's even failed a couple of tests, and she hasn't yet turned in a paper that was due last week.

When she gets home from practice, she's not hungry for dinner. Though she usually manages to eat a little something with her family, she just doesn't have much of an appetite - and nothing seems to taste as good as it used to. After dinner, Lindsay goes to her room, does a bit of homework, and goes to bed. She's not even in the mood to talk on the phone with her friends.

When her mother asks her what's wrong, Lindsay feels like crying but doesn't know why. Everything seems wrong, yet nothing particularly bad has happened. Lindsay just feels sad all the time and can't shake it. Lindsay may not realize it yet, but she is depressed.

Depression is very common and affects as many as one in eight people in their teen years. Depression affects people of every color, race, economic status, or age; however, it does seem to affect more females than males during adolescence and adulthood.

How Do People Respond to Someone Who's Depressed?

Sometimes friends or family members can recognize that a person is depressed. They may respond with love, kindness, or support, hoping that the sadness will soon pass. They may offer to listen if the person wants to talk - although depressed people often don't feel much like talking or can't find the words to describe what's wrong. If the depressed feeling doesn't pass with a little time, friends or loved ones may encourage the person to get help from a doctor or mental health professional.

But not everyone recognizes depression when it happens to someone they know. And some people have incorrect ideas about what it means to be depressed. People who don't understand may react to the depressed person's low energy with criticism, scolding them for acting lazy or not trying. Some people mistakenly believe that depression is simply an attitude a person can change or a mood they can shake. It's not that easy.

Many people just don't realize that depression can cause so many problems or so much pain. Sometimes even people who are depressed don't take their condition seriously enough. Some people have the mistaken belief that depression comes from weakness or is a character flaw. This myth causes some people to hide their depression. Feeling embarrassed, they may avoid getting help.

Occasionally, when depression causes physical symptoms, a person may see their doctor and be relieved to have a normal physical exam. Once in a while, even a well-meaning doctor may minimize or even overlook a person's depression by concluding that there's nothing wrong when medical tests come back normal.

Why Do People Get Depressed?

There is no single cause for depression. Many factors play a role including genetics, environment, medical conditions, life events, and certain thinking patterns that affect a person's reaction to events.

Research has revealed that depression runs in families and suggests that some people inherit genes that make it more likely for them to get depressed. But not everyone who has the genetic makeup for depression actually gets depression. And many people who have no family history of depression have the condition. So, although genes are one factor, they aren't the single cause of depression.

Life events - for example, the death of a close family member or friend - can go beyond normal grief and can sometimes lead to depression.

Family and social environment also play a role. For some teens, a negative, stressful, or unhappy family atmosphere can affect their self-esteem and lead to depression.

Social conditions like poverty, homelessness, and community violence can make it more likely for people to become depressed.

For some teens, undiagnosed learning disabilities may block school success, hormonal changes may affect mood, or physical illness may present challenges or setbacks. With or without the genetics for depression, any of these can set the stage for depression.

Substance abuse can cause chemical changes in the brain that affect mood - alcohol and some drugs are known to have depressant effects. The negative social and personal consequences of substance abuse can also lead to severe unhappiness and depression.

Certain medical conditions can affect hormone balance and therefore have an effect on mood. Some conditions, such as hypothyroidism, are known to cause a depressed mood in some people. When these medical conditions are diagnosed and treated by a doctor, the depression usually disappears.

What Happens in the Brain When Someone Is Depressed?

Depression involves the brain's delicate chemistry - specifically, it involves chemicals called neurotransmitters. These chemicals assist in transmitting messages between nerve cells in the brain.

Certain neurotransmitters regulate mood. When they are not available in sufficient quantities, the result can be depression.

The brain's response to stressful events, such as any of those described above, may alter the balance of neurotransmitters and result in depression.

Sometimes, a person may experience depression without any particular sad or stressful event that they can point to. People who have a genetic predisposition to depression may be more prone to the imbalance of neurotransmitter activity that is part of depression.

Medications that are used to treat depression work by helping to restore the proper balance of neurotransmitters.

Types of Depression

For some people, depression can be intense and occur in bouts that last for weeks at a time. For others, depression can be less severe but can linger at a low level for years.

Doctors who treat depression distinguish between these two forms, diagnosing the more severe, short-lasting form as major depression, and the longer-lasting but less severe form as dysthymia.

A third form of depression that may be diagnosed is called adjustment disorder with depressed mood. It refers to a depressive reaction to a specific life event (such as a death, divorce, or other loss) when the adjustment to the loss takes longer than the normally expected time frame or is more severe than expected and interferes with the person's daily activities.

Bipolar disorder (also sometimes called manic depressive illness) is another depressive condition that involves periods of major depression mixed with periods of mania. Mania is the term for abnormally high mood and extreme bursts of unusual activity or energy.

What Are the Symptoms of Depression?

These are some symptoms that people have when they're depressed:

  • depressed mood or sadness most of the time (for what may seem like no reason)
  • lack of energy and feeling tired all the time
  • inability to enjoy things that used to bring pleasure
  • withdrawal from friends and family
  • irritability, anger, or anxiety
  • inability to concentrate
  • significant weight loss or gain
  • significant change in sleep patterns (inability to fall asleep, stay asleep, or get up in the morning)
  • feelings of guilt or worthlessness
  • aches and pains (even though nothing is physically wrong)
  • pessimism and indifference (not caring about anything in the present or future)
  • thoughts of death or suicide

When someone has five or more of these symptoms most of the time for 2 weeks or longer, that person is probably depressed. Sometimes people go through bouts where these symptoms are really intense; other times these same feelings could be present at a lower level all the time for years. Some people have just one episode of depression, or they may go on to have more than one after being better for a while. When a person has had more than one bout with major depression, a doctor will diagnose the person as having major depressive disorder.

Teens who are depressed may also show other warning signs or symptoms. They may have increased problems at school because of skipped classes, lack of interest or motivation, or poor concentration and low mental energy caused by depression. Some teens drop out altogether, expecting to fail because of their problems.

For depressed teens who are already feeling self-critical and experiencing low self-esteem, a failure experience at school may simply be more than they can bear. They may not realize that depression is causing concentration problems, and their negative thoughts are probably causing them to mistakenly conclude that they are stupid. They also may express feelings of anger or indifference by drinking or doing drugs.

Some teens with depression have other problems, too, that can intensify their feelings of worthlessness or inner pain. Teens who cut themselves, those who have extreme feelings of ugliness, and teens who have eating disorders may have unrecognized depression that needs attention.

Everyone has some ups and downs, and occasional sadness is a normal emotion. The normal stresses of life can cause teens to feel sad every once in a while. Things like an argument with a friend, a breakup, doing poorly on a test, not being chosen for a sport, a best friend moving out of town, or the death of a loved one can lead to feelings of sadness, hurt, disappointment, or grief. These reactions are usually brief and go away with a little time and care.

Depression is more than feeling blue, sad, or down in the dumps once in a while, though. Depression is a strong mood involving sadness, discouragement, despair, or hopelessness that lasts for weeks, months, or even longer, and interferes with a person's ability to participate in their normal activities.

Depression affects a person's thoughts, outlook, and behavior as well as their mood. In addition to a depressed mood, a person with depression may also experience other symptoms like tiredness, irritability, and appetite changes.

When a person has depression, the world looks bleak, and the person's thoughts reflect the hopelessness and helplessness they feel. People with depression tend to have negative and self-critical thoughts. Sometimes, despite their true value, people with depression can feel worthless and unlovable.

Depression can cloud everything, making even small problems seem overwhelming. People who are depressed can't see a bright future ahead and feel powerless to change things for the better. They may feel like giving up. They may cry at small things or cry for no apparent reason at all.

Because of their deep feelings of sadness and their low energy, people with depression sometimes pull away from people around them or from activities they once enjoyed. This only causes them to feel more lonely and isolated, making the depression worse.

Depression can be mild or severe. At its worst, depression can create such feelings of despair that a person thinks about suicide.

Depression can cause physical symptoms, too. Some people have an upset stomach, loss of appetite, weight gain or loss, headaches, and sleeping problems when they're depressed.

Getting Help

Depression is one of the most common emotional problems. The good news is that it's also one of the most treatable conditions. There are professionals who can help. In fact, about 80% of people who get help for their depression have a better quality of life - they function better and enjoy themselves in a way that they weren't able to before.

Treatment for depression can include talk therapy, medication, or a combination of both.

Talk therapy with a mental health professional is very effective in treating depression. Therapy sessions help people understand depression and what they can do about it.

Sometimes medicine may be prescribed for a person who has depression. When a doctor prescribes medicine, he or she will carefully monitor the person to make sure he or she gets the right dose. The doctor will adjust the dose as necessary. Medicines can take a few weeks before the person feels the medicine working. Because every person's brain is different, what works well for one person might not be good for another.

People who are depressed shouldn't wait and hope it will go away on its own because depression can be effectively treated. Friends or others need to step in if someone seems severely depressed and isn't getting help. Many teens find that opening up to parents or to other adults they trust can help. Simply saying, "I've been feeling really down lately and I think I'm depressed," can be a good way to open the discussion. Ask your parent to arrange an appointment with a therapist.

People who are extremely depressed and who may be thinking about hurting themselves or about suicide need help as soon as possible. When depression is this severe, it is a very real medical emergency, and an adult must be notified. Most communities have suicide hotlines where people can get guidance and support in an emergency.

Although it's important to be supportive, trying to cheer up a friend or reasoning with him or her probably won't work to help depression or suicidal feelings go away. Depression can be so strong that it outweighs a person's ability to respond to reason. Even if your friend has asked you to promise not to tell, this is a situation where telling can save a life. The most important thing a depressed person can do is to get the right treatment.

Depression - and the suffering that goes with depression - is real. Depression doesn't make a person "crazy." Just as things can go wrong in all other organs of the body, things can go wrong in the most important organ of all: the brain. Luckily, most teens who get help for their depression go on to have fulfilling, happy teen and adult years - and most importantly, to enjoy life and feel better about themselves.

Reviewed by: D'Arcy Lyness, PhD
Date reviewed: September 2005

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