Adolescence

The adolescent years are a critical time for brain development, with the brain reaching its biggest size in early adolescence, undergoing significant changes and remodelling during this crucial time. The adolescent brain works differently to that of an adult when making decisions and solving problems. Adolescent actions are guided more by emotions and the reactive amygdala, and less by the thoughtful, logical frontal cortex, which does not fully develop until a person is approximately twenty-five years of age (Casey et al., 2008). The neurotransmitters in the adolescent brain such as serotonin, acetylcholine and norepinephrine are central to the study of the biochemistry of depression, and it was found that low neurotransmitter levels respond effectively to antidepressant medications. Antidepressants work by increasing levels of neurotransmitters in the brain, which help to raise and regulate the mood and emotion in the teenager. However, side effects can be quite debilitating and may include agitation, dizziness, headaches, and stomach aches (Wicks-Nelson & Israel, 2015).

During the adolescent years young people begin to develop their sense of self and develop their identity. The complex interplay of the internal and the external factors that impact on identity development involve all aspects of social, psychological, and environmental factors, which impact on how an adolescent will feel, think, and interact with others around them (Wicks-Nelson & Israel, 2015). It is a developmental period which is often characterised by poor decision making that give rise to violence, alcohol and drug abuse, early sexual relations, teenage pregnancy, self-harm, and suicidality (Wright & Kutcher, 2016). Teenagers around the world are currently experiencing high levels of mental ill-health, and suicide is now the leading cause of death of teenagers. Data suggests that although adolescents as a group are considered high risk takers, some teenagers will be more prone than others to engage in risky behaviours, depending on the ecological and biological factors (Black Dog Institute, 2020). Recent data indicate suicidality, eating disorders, self-harm, anxiety, and depression are at an all-time high, and depression has now become the third leading cause of death among teenagers. Mental illness during the vulnerable adolescent stage has an adverse effect on adolescent brain development as well as mental health and wellbeing (Cavioni et al., 2020).

Depression

Depression, is labelled in the Diagnostic and Statistical Manual of Mental Disorders, (APA, 2013b) as clinical depression or major depressive disorder and described as being a serious mood disorder. Adolescents who suffer from depression experience ongoing feelings of hopelessness, sadness and have lost an interest in life itself. Teenagers can also present with physical symptoms such as digestive issues and chronic pain when depression is present. In order to be diagnosed with depression, a person must, for the duration of a two-week period experience five of the following eight symptoms. Read the list of signs and symptoms of depression at Beyond Blue’s website.

In order to be diagnosed with depression, at least five of symptoms must cause the young person significant distress or impairment in school, social, occupational, or other important areas of functioning. The symptoms must not be a result of substance abuse or any other medical condition (APA, 2013b).

Evidence of Symptoms 

Depression is characterised by an obvious decline and impairment of mood in the adolescent’s mental health and wellness. The early stages of depression may not initially cause any concern to those closest to them, as depression can often be misinterpreted as the stereotypical view that the teenager is in the storm and stress period of their life (Astalis, 2005). This misrepresentation may lead many adults to minimise the serious nature of depression and assume it is just the teenage phase they are going through (Geldard et al., 2019). It can be difficult to distinguish depressive illness from adolescent turmoil, especially when the teenager is attempting to forge new roles within the family, is struggling with independence and at the crucial stage of having to make vocational and career decisions (Berk, 2010).

There are a number of symptoms a young person will display through their cognition, social skills, and their behaviour. Early-onset depression is associated with low self-esteem, an increased risk of suicidal behaviours, substance abuse, recurring depression as well as other significant emotional and mental health concerns that often carry on into adulthood (Hodes & Gau, 2016).

Teenagers with depression often struggle cognitively with their concentration and to remember even the most basic things, describing the feeling as having brain fog. Young people with depression report their sleep patterns are affected either with an inability to sleep, they may be sleeping excessively, or they are waking multiple times throughout the night. There are significant changes in their appetite and weight, either losing or gaining a substantial amount of weight in a short period of time. Young people suffering with depression often have a reduced pain tolerance for minor aches and pains and their sex drive will either reduce or disappear completely (Nolen-Hoeksema, 2013).

There is often an inability to control emotions such as guilt, anger, irritability, and anxiety and they may find they have a myriad of emotions throughout the day. They may feel worse first thing in the morning and begin to feel better as the day progresses. It is very common for young people with depression to have a reduced capacity to experience pleasure, an inability to enjoy the here and now, and they often do not look forward to any activities, hobbies, or upcoming events. Motivation to carry out even the most menial of tasks is difficult and they describe themselves as having very low energy levels (Black Dog Institute, 2020).

Impact on the Individual and Interactions

As depression begins to worsen, it often leads the adolescent to isolate from friends and family and they will almost always seem to appear gloomy, downcast, and alone. There is very little social interaction or communication from the teenager with their family, spending large amounts of time in their room, which is usually darkened by closed blinds or curtains. They very often lose contact with their closest friends and will make no effort to return calls or initiate contact with them (Berk, 2010). Depression will impact significantly on school performance, which will create a downward spiral effect on later study or career options. It is well documented that an adolescent with depression will achieve much lower academic attainment than their non depressed peers due to a number of factors, which may include working memory, sleep deprivation, school absenteeism, which may lead to an increased risk of school dropout, further exacerbating their already low self-esteem (Quiroga et al., 2013). They have very little regard for their life, therefore will engage in risk taking behaviours such as inappropriate sexual involvements, reckless driving, drug and alcohol abuse, vandalism, shoplifting, self-harm, join gangs, and engage in serious criminal activities (Geldard et al., 2020).

Suggested Interventions

School staff are gatekeepers for depressed and suicidal teenagers, therefore ensuring all staff are trained to recognise depression in an adolescent is key to early identification and intervention (Mo et al., 2018). Cognitive Behaviour Therapy to support the behavioural, social, and emotional needs of teenagers to prevent, as well as treat depression is an excellent strategy to redirect a student’s negative thought pattern (Forman & Barakat, 2011). Cognitive Behaviour Therapy is designed to firstly confront, then modify an adolescent’s maladaptive cognition. The adolescent is taught self-control, challenge their self-destructive belief systems such as replacing the following statement: ‘I never succeed in anything’, with, ‘sometimes I succeed and sometimes I fail. I’m human and I’m ok’. Instigating a strong focus on future goals such as improved social, communication, and coping skills as well as a focus on a student’s academic, future career and vocational pathways are strategies that can be implemented by the school guidance counsellor (Wicks-Nelson & Israel, 2015). The school guidance counsellor is in a position to provide ongoing Cognitive Behaviour Therapy and support to individual students as well as implement group therapy for students struggling with depression (Education Queensland, 2019).