Distinguishing depression from normal adolescent mood swings

Parents often wonder how to distinguish normal teenage mood swings and rebellions from actual symptoms of depression. I asked Dr. Nadja N. Reilly, a member of the editorial board of the Harvard Mental Health Letter, for some advice on this topic.

Dr. Reilly has a particular interest in finding ways to identify and prevent youth depression. A practicing psychologist, she is also the director of the Swensrud Depression Prevention Initiative at Children’s Hospital Boston. This program, named for the family foundation that funds it, provides school-based training and an ongoing curriculum so that participants can incorporate what they’ve learned about depression into a system for monitoring and intervention.

Dr. Reilly recommends that parents and school officials pay attention to three key areas in order to distinguish normal teen angst from something more serious:

Severity. Symptoms of teen depression encompass changes in mood (anger, sadness, irritability), behaviors (sleeping or eating more or less than usual, taking drugs or alcohol, acting out; withdrawing from friends and family), feelings (loneliness, insecurity, apathy), thoughts (hopelessness, worthlessness, thoughts of suicide), and perceptual disturbances (pain, hallucinations). The more pronounced these symptoms, the more likely that the problem is depression and not a passing mood.

Duration. Any notable deterioration in behavior or mood that lasts two weeks or longer, without a break, may indicate major depression.  Children and adolescents can also suffer Dysthymic Disorder, or minor depression.  In this type of presentation, symptoms can appear for more days than not, for at least one year.

Domains. Problems noticed in several areas of a teen’s functioning — at home, in school, and in interactions with friends — may indicate a mood disorder rather than a bad mood related to a particular situation.

You can find more information about how to recognize and prevent depression in youths through the following organizations:

The Swensrud Depression Prevention Initiative at Children’s Hospital Boston;

Adolescent Wellness, Inc., a nonprofit organization, offers information about school curricula developed by clinicians at Children’s Hospital Boston and McLean Hospital; and

The School Psychiatry Program at Massachusetts General Hospital provides online links to a variety of screening tools and advice about various psychiatric problems.