Transcript of interview with David Brent, MD, a professor of psychiatry, pediatrics and epidemiology at the University of Pittsburgh School of Medicine
Interview conducted by Natalie McGill, reporter for The Nation’s Health newspaper.
Listen to this interview as a recording on our podcast page.
Depression can affect people of all ages, but when it comes to how it affects teens, what are some risk factors this age group may face?
Well, I think in a way you’re asking, “Why does depression start in adolescence?” The reasons, I think, are biological and social. With puberty there’s a rewiring that takes place in the brain and what happens is that the areas that are related to emotion and reward develop first. Whereas the areas related to cognitive control and inhibition develop later. And so you have an intrinsic imbalance between emotion and sensation seeking and the ability to modulate that.
And in addition, you have kids experimenting with alcohol and drugs, which can precipitate depression. And there are social issues that the salience of peer relationships becomes much higher and so the sense of disappointment with an interpersonal loss or discourse is also a lot bigger. And so kids at this age then become much more vulnerable to those types of disappointments.
What are some of the signs and symptoms of depression, particularly in teens?
I would say before I talk about the symptoms, the way that you would differentiate between adolescent moodiness, or ups and downs of adolescence, and depression is that for depression, there should be evidence of sustained impairment. Meaning that they have a sad or bored or irritable mood associated with some other symptoms like problems with sleep — either too much or too little. Eating too much or too little. Difficulty with concentration, motivation, feeling guilty, feeling worthless and having suicidal thoughts.
Those things are associated with functional impairment. Either they’re not doing as well in school. They’re withdrawing from their friends. They’re fighting more with their parents. That doesn’t mean that everybody who has those problems is depressed. But if you have somebody with a mood problem and you see a change in their function, those are the people you suspect have difficulty with clinical depression.
What are the risks to dismissing these signs of depression in this age group? Or what are the risks to dismissing the symptoms as just general moodiness?
The risks of not diagnosing depression are that the longer it goes untreated, the harder it is to treat. Chronic depression is much more difficult to treat, and takes a comparably longer time for a recovery to take place. Adolescence isn’t a static period of time. So you’re supposed to be acquiring knowledge, social skills, increasing your repertoire of competencies. And if you’re depressed, you’re not doing that. And you may never catch up.
If a parent or a friend of a teen notices these signs, what is the first thing they should do?
If it’s a parent, they should talk with their child and ask them how they’re doing. Go and make an appointment with either a mental health specialist or their primary care physician to get a clearer picture about whether or not there’s a problem. There are online screens. The PHQ9 is a very commonly used screen for depression. And a score above 10 — 10 or higher — is consistent with moderate depression.
With a friend, you have to gauge what your relationship is like. You can encourage your friend to get help. But it might also be a good idea for that teen to talk with his or her parent about what to do or a guidance counselor at school.
What types of treatment are available for teens to treat depression?
So there are two basic categories for the treatment of depression. One is psychotherapy. And for milder depression, we prefer to start with that. And the two types of therapy that have been shown to work are cognitive behavior therapy and interpersonal therapy.
Cognitive behavior therapy looks at the relationship between people’s thoughts, their feelings and behaviors, and identifies the common distortions and the way depressed people process information, where they tend to focus on the negative, which then reinforces their depressed mood. The treatment helps them to take a more accurate view of the world, which then can result in relieving their sense of depression.
Interpersonal therapy focuses on the interpersonal relationships of that individual and works on trying to reduce discord and improve the quality of those relationships as a way of helping that person have more rewarding relationships, experience more support and, in that regard, relieve depression.
And then there’s anti-depressant medications. Most notably Prozac or fluoxetine is one that’s been the best studied. And it’s the only agent that’s been shown to be effective in both children and adolescents. And in adolescents, there is some evidence for the effectiveness of escitalopram or Lexapro, and sertraline or Zoloft. But it’s not as strong as the data on fluoxetine. There’s evidence that these different treatments work and I think that people sometimes feel that once they’re depressed, there’s no hope. And I think to the contrary. I think there’s evidence that these treatments are effective for many people. And even if one treatment doesn’t work, a different one or a combination of treatments can help the majority of people.