Teen Depression or “Mood Swings”?

One of the situations I found most challenging working in emergency rooms and urgent care settings was when a teen came in for “medical clearance”. This phrase is code for “a teen in an emotional crisis who may need be having a major psychiatric issue…or not.” My job was look into any possible medical issues of the mood changes and then to call the on-call psychiatric crisis team in for the remainder of the evaluation, if needed…which was the majority of the time.

I recall one 17 year old teenager who had threatened to commit suicide earlier that day.  I remember being struck by two observations: how sad she appeared and how “normal” her family was by all standards. They were basically like any of our neighbors.

Talking to this particular teenager, I learned she had great success in school, sports and music and appeared to have a very loving and supportive family. Yet, she never felt happy…ever. Her parents described her to me as a “serious” teenager and very busy, burning the candle at both ends and feeling enormous pressure about the college application process.

That particular day, she decided the world would be better off without her and it frightened her so much she told one of her high school teachers.  After the initial shock of the moment, her parents and teachers were able to look back and notice small clues that were missed by this teens outward success that lead to that day. Thankfully, they knew to bring her in for a crisis evaluation and the team on-call agreed she was clinically depressed and needed in-patient care. Finding that care was a different story with the usual bed crunch we have in the child psychiatry world but at least in this case we had a family on board with care and a teen wanting help. These situations don’t always occur this way.

What makes teen depression so challenging is teens are moody and can have off days. So, how do we decide if our teen is “clinically” depressed or just going through a short term rough patch, perhaps due to t a friendship issue or issue with a boyfriend or girl friend, or simply having a bad day?

Keep in mind that most teens, despite their reputation as a group, do listen to adults and follow the rules. Remember, a busy teen is a happy teen most of the time. What we have to look for is a flip-flopping of emotions where the teen’s mood shifts from being mostly cooperative and happy to mostly not so cooperative and unhappy. In other words, instead of the teen melodrama being the exception and fleeting, it becomes more persistent and prevailing and lasts at least 2 weeks, if not more. That’s the point we have to pause and get our teen evaluated.

www.aboutourkids.org has a list of screening questions that can help you decide whether you may need to seek professional help for your child. Keep in mind that a “screening” test picks up kids who MIGHT have a problem – kids you want to have someone else look at – but it may not mean that there is a HUGE problem.

1. Does your child feel sad, blue, or tearful?
2. Is your child often angry or picks fights at school or at home?
3. Does your child no longer care about favorite activities?
4. Has your child lost or gained a lot of weight?
5. Does your child have trouble sleeping or sleeps too much?
6. Does your child have trouble sitting still or appears very slowed down?
7. Does your child always look tired or is “too tired to play”?
8. Does your child feel hopeless or tell you, “I’m no good?”
9. Does your child have trouble concentrating or making small decisions?
10. Does your child talk about how life is not worth living, death, or suicide?
11. Have you noticed these symptoms have been present for almost every day for a 2 week period?
12. Do these problems get in the way of activities at home, in school, or with friends?

If your teen is clinically depressed, you will have a large peak to climb – but don’t let that deter you. There will be peaks and valleys as you help your teen battle this beast but keep the ultimate peak, the gold ring in mind to keep you focused: the smile on your child’s face that you’ve likely not seen in all too long a time.