What is depression?

Depression is a psychological condition that affects your feelings, behaviors, and thoughts.

You may have:

• Feelings of sadness, frequent boredom, irritability, or aggravation
• Feelings of hopelessness or worthlessness, or unhappy thoughts about yourself or your life
• Trouble with sleep, school work, or with your friends

You might also have outbursts of anger, and/or an increased interested in drugs, alcohol, sex, or risky behavior. You may even feel that your life is not worth living, or think about hurting yourself.

Who gets depressed?

Depression affects children, teens, and adults of all ages. No one knows the exact number of teens affected by depression, but we do know that it affects a large number of teens, both male and female, from all ethnic and racial backgrounds. Sometimes it happens as a direct result of a stressful or upsetting situation, and sometimes it appears when you would least expect it. It’s important to try to understand the difference between feeling sad or “blue” and being what is called “clinically depressed.”

What are the symptoms of clinical depression?

You may:

• Feel sad or “empty” a lot of the time – these feelings may come and go, but last for at least two weeks.
• Not feel like doing things you used to enjoy, like playing sports, hanging out with friends, or studying. It is harder to have fun than it used to be.
• Feel irritated a lot of the time (things get on your nerves more easily), or you may get angry or lose your temper more easily.
• Feel tired, bored, or have less energy, or you may be restless and edgy.
• Notice changes in your eating habits. You may eat more or less than you did before you started feeling depressed.
• Have changes in your sleep, either sleeping a lot more or a lot less than you used to, and/or having trouble falling asleep or waking up. You make wake up during the night or wake up too early in the morning and may not be able to go back to sleep.
• Find it harder to concentrate and make decisions.
• Not feel good about yourself or about anything you do.
• Often feel guilty about things that you do or don’t do.
• Feel that things will never get better.
• Have thoughts about not wanting to live or about hurting yourself, or you may have tried to hurt yourself.
• Use drugs or alcohol, or engage in other risky behaviors.

How do I know whether I am depressed or just sad?

It is normal to feel down or sad sometimes. However, if you have some or all of the above symptoms most of the time for at least two weeks, you could have depression. If you are depressed, you may or may not notice changes in yourself, but usually people who are close to you will notice a change in you. Likewise, if you are close to someone who is truly depressed, you may notice a big change in that person’s behavior or mood. However, some people can act happy even when they feel depressed.

There are no laboratory tests that can be done to prove that you are depressed, like there are for illnesses such as strep throat or diabetes. But if you think you may be depressed, it is worth talking with someone about it. A professional who is trained to understand depression, such as your health care provider or a counselor, will be able to ask the right questions to help decide if you are going through a period of sadness or whether you have depression.

When is it normal to be sad?

• After a loss or disappointment
• Before or after a big life change, such as a move, or going to college
• After hearing bad news about yourself or someone close to you, such as a diagnosis of a serious illness

What are the effects of depression?

Depression has many different and powerful effects.

Depression can:

• Make it harder to work at a job or in school.
• Make it more difficult to make and keep friends. It can also become more difficult to get along with family members.
• Affect your physical health. For example, you may feel tired or run down all the time.
• Make you feel tempted to turn to drugs, alcohol, or sex as a way to escape from your feelings.
• Make you feel extremely irritable and cause you to act out in ways that can get you into trouble, such as yelling or fighting.
• Cause you to have trouble paying attention, which can lead to car accidents and other mistakes.
• Lead to serious injury and even suicide if not treated.

What causes depression?

No one knows for sure what causes depression. The most important thing to keep in mind is that it is not your fault if you become depressed. Most likely, depression is caused by a combination of things, some of which have to do with the chemicals in your brain and some that have to do with what’s happening in your life.

Some factors that may put you at risk for depression are:

• Genetics – If other people in your family have had a depressive illness, you may have similar genes and be more likely to get depressed.
• Family problems – A major loss in your family or conflict among members of your family may cause you to feel depressed.
• Feeling bad about yourself – If you are constantly being put down, abused, or neglected, or if you are having difficulty at school or other activities, you may be more likely to feel depressed.
• Feeling alone – Feeling that you are different from others or that your friends and family don’t understand you can make you feel depressed. Some examples of people who may feel alone or isolated from others are teens who are gay, lesbian, or bisexual, teens who have just broken up with a boyfriend or girlfriend, teens with medical problems, or teens who have a parents/family members going through a difficult time themselves.

These are just a few common examples, but there are many circumstances that can lead to feelings of depression. You may experience many of these things and yet not feel depressed. Or you may not have any of these problems but still feel depressed.

It’s important to talk with someone qualified to help you if you suspect that you are depressed. A trusted adult such as a parent/guardian, a teacher, guidance counselor, nurse, doctor, or clergy person can help you find the right counselor. If you ever think that you are going to hurt yourself, it is extremely important to tell someone right away and get help to keep safe: you can always go to an emergency room.

How to Get Help

What should I do if I’m depressed?

If you think you are depressed, it may help you to tell a friend, but it’s also very important to talk with a parent or an adult with whom you feel comfortable. Friends are great to talk to and often very helpful, but for objective advice about serious issues, it is important to also talk with an adult. If you don’t feel comfortable telling an adult that you are depressed on your own, you might ask a friend to be with you when you talk with someone, or help you find someone trustworthy.

Adults with whom you might feel comfortable talking to about being depressed:

• Parent, guardian, or other adult relative
• School counselor
• Teacher or coach
• Healthcare provider
• Minister, priest, rabbi, or other clergy person

Any of these adults should be able to help you get treatment from someone who works with depressed teens. If you tell one of these people and they are not able to get you help, tell someone else. You know your feelings best! Sometimes even adults may have a hard time accepting that a teen is depressed, or they may not know what to do.

What if I am thinking about hurting myself?

Anyone who has thoughts or feelings about hurting themselves should be taken seriously and should get professional help right away. Suicide is the third leading cause of death in teens and young adults, but it can be prevented with proper intervention and treatment. It is important to realize how serious it is to have thoughts about suicide or hurting yourself. When someone is very depressed, they are not able to think clearly and can become confused or make quick decisions about what to do. You must remember that hurting yourself is never the right option, and that there are people who can help you.

What should I do if I think that one of my friends is depressed?

If you think your friend is depressed, you should try to get him or her to tell an adult, such as a parent, school counselor, or health care provider. If your friend will not get help, you should talk to a trusted adult. This is especially important if your friend has told you or another close friend that they don’t want to live anymore.

You might worry that your friend will be upset with you if you tell an adult. In fact, they may have asked you not to tell anyone. You must remember though, that it is better for your friend to be angry with you at first for telling someone than to possibly hurt him or herself.

You or your family can find a counselor by talking with your health care providers, school nurse, school counselors or clergy person. Your health insurance company keeps lists of mental health providers organized by specialty: you can ask for a counselor who works with teens.

Treatment Options

How is depression treated?

There are many different kinds of treatment for depression. Deciding on the right treatment for you depends upon how much difficulty you are having, what treatment options are available to you, and your personal feelings about how you want to deal with the depression.

Counseling or Therapy

Counseling or therapy (sometimes called psychotherapy) can help with depression. It includes talking about your thoughts, feelings, and behaviors in a confidential setting. This means that the counselor cannot tell anyone what the two of you talk about, unless you are a danger to yourself or others. Talking with a counselor can help you realize that someone else understands how you feel and that you are not alone.

When you have depression, it is not unusual to see your life in a distorted way. For example, you may think that you are not good enough, that others don’t like you, or that you are the cause of bad things that are happening. A counselor can help you learn to look at these situations differently. Meeting with a counselor can also help you find ways to cope with tough situations and be more effective in dealing with difficult feelings.

Counseling can be done in a few different ways. It can be done alone with a therapist, which is called “individual therapy,” with a teen and his family, which is called “family therapy,” or with a group of teens together, which is called “group therapy.” Sometimes a teen will participate in more than one kind of counseling at a time.

You or your family can find a counselor by talking with your health care provider, or school nurse. Your health insurance company keeps a lists of mental health providers organized by specialty: you can ask for a counselor who works with teens. All insurance policies, by law, have to pay for some counseling appointments. If you or your family has a hard time finding resources, you can look in the yellow pages under “mental health.”

Medication

If depression is causing problems in your life, or if you feel that counseling isn’t helping enough, your health care provider may suggest medication. Brain chemicals are responsible for some symptoms of depression. For many people with depression, taking medication helps by changing the levels of those chemicals.

Sometimes the person you see for counseling will be able to prescribe medication, such as a doctor, a psychiatrist or a nurse practitioner. Other counselors, such as a clinical social worker or psychologist cannot prescribe medication, but will refer you to a mental health provider who can. If this is the case you will continue counseling sessions with your counselor and see the provider who writes your prescriptions less frequently.

There are many different medications that treat depression. If you decide to go on medication, it does not mean you will be on it for the rest of your life. Once you have been feeling better for a while, your counselor and your health care provider can talk about lowering the dose or stopping the medication. Remember that even if you are feeling better, you should always talk with your health care provider before making ANY changes with your medicine.

You might be concerned about taking medicine for your depression, or you might worry what other people think about it. However, many people have found medication to be very helpful. It is very likely that you know and respect someone (such as a teacher, parent doctor or friend) who uses medication for depression, too. Taking medication for depression is just like taking medicine for a physical problem-it is just a way to help yourself get better.

Day Programs and Hospitals

If you become so depressed that you have trouble with your everyday life, or if you are having thoughts about hurting yourself, you may need more help than regular counseling sessions can give you. In this case, you may enter a day program or a hospital. In a day program, you arrive in the morning and spend the day in counseling, group discussions, and activities with mental health professionals and other patients. In a hospital you receive professional care all day and overnight. Both treatments can be very helpful for teens who are severely depressed. Sometimes these are options when you first feel depressed, or may be offered if you have been very depressed for a while and things have not gotten better.

A hospital is a place where you can get a lot of support and where mental health professionals can keep you safe. People don’t have to be “crazy” to be in a hospital. Hospital programs have scheduled activities to help you understand your emotions and figure out how to manage the problems in your life. Often, your family will be involved in your hospital stay and they will get the help they need as well.

How to Cope

Strategies that may help with depression:

Once you have been diagnosed with depression and you are beginning (or considering) some kind of treatment, it is important to have a variety of strategies to help you cope with everyday life.

What else do I need to know?

Depression is more common than you think and most people who receive treatment for depression get better. Unfortunately, many people who are depressed don’t seek help. Some people think that seeking treatment is a sign of weakness. Others are afraid to be seen as “crazy” for seeing a counselor or taking medication. Some people feel that their thoughts and feelings aren’t important enough to concern others, or are none of anyone else’s business. Don’t be one of these people. Depression is real and with help you can get better.

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