Katie Hutchinson, LMFT #50843
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Your Health Connection Article 2010

Depression and Anxiety in Adolescence

No one ever said that parenting a teen was a piece of cake…

The teenage years can be filled with challenges, struggles, and hopefully some joy as kids experience the transition into young adulthood. It is a time of rapid physical and cognitive growth that can lead to teenagers talking back, staying out too late, listening to cacophonous music, engaging in risky behavior, and piercing an unusual body-part. 

At some point, these teenagers may experience some psychological concerns that are not just a phase of “normal” development. This article describes some of the common mental conditions that teenagers might encounter including: depression, anxiety, substance abuse, and attention deficit disorder. We also provide some tips for parents to help kids with these conditions.  

This article is not treatment or therapy, and it is not a substitute for treatment or therapy. Rather it is intended as a resource for people to help themselves. While people can do a lot for themselves, professional help can sometimes be extremely valuable. Consulting with a professional can help refine the ideas and strategies contained herein, and provide additional guidance and help.

There are many reasons why teenagers become depressed. Stressful environments can lead to depression. Teens can develop a sense of worthlessness and inadequacy over school performance, social relationships, or family life. If activities that the teen usually enjoys fail to improve his or her sadness or sense of isolation, there’s a good chance that he or she is depressed. Depression also tends to be more common in those who have a history of depression in their families. Statistics suggest that 1 in 8 adolescents are depressed. Teens can exhibit depression in the following ways: sadness or a feeling of worthlessness, anger or irritability, overeating or under-eating and correlated weight change, difficulty falling asleep or sleeping most of the day, fatigue and decreased energy, difficulty concentrating and making decisions, withdrawal from friends and family, rebellious behavior such as a sudden drop in grade point average or cutting school, somatic symptoms that might include headaches, low back pain or fatigue, use of alcohol or drugs, a preoccupation with death or harming oneself.

There are several forms of depressive disorders. The most common are major depressive disorder and dysthymic disorder. Major depressive disorder is characterized by a combination of symptoms that last at least two weeks and interfere with a person’s ability to function normally. Dysthymic disorder, is a long–term (at least one year) less severe type of depression. Dysthymic disorder may not disable a person, but can prevent one from functioning normally or feeling well a lot of the time.

If your teenager has depression, they may feel exhausted, helpless and hopeless. It may be extremely difficult for them to take any action to help themselves. But it is important to realize that these feelings are part of the depression and do not accurately reflect actual circumstances. 

Anxiety disorders are very common, affecting 1 in 8 teenagers. If left untreated, teens with anxiety disorders are at a higher risk to perform poorly in school, miss out on meaningful social experiences and engage in substance abuse as a means of self medicating. 

Many people think that anxiety can be willed away but they are incorrect, anxiety is a chemical imbalance that can be treated with a variety of different methods. Most often, anxiety begins in childhood, but can start in adolescence or early adulthood. 

What causes anxiety? There are many factors that cause anxiety. Scientists believe that genetics is a contributing factor as anxiety tends to run in families. In addition, anxiety can be modeled by a child witnessing his anxious parent and then taking on his parents affect. Mostly likely, it is a combination of genetics and modeling. 

Teens can exhibit anxiety in the following ways: anger for no apparent reason, sadness and depression, fatigue, mood swings, substance abuse, changes in sleeping and eating patterns, compulsive or obsessive behavior such as hand washing or checking doors, constant worrying, trembling and muscle tension, feeling tense, difficulty concentrating, feeling irritable, feeling nauseous, and an exaggerated startle response. 

There are various types of anxiety that can affect teens. Generalized Anxiety Disorder is characterized by excessive worrying about a variety of things such as grades, friends, and family issues. Teens with Generalized Anxiety Disorder tend to be very hard on themselves and tend to be perfectionists. Obsessive Compulsive Disorder is characterized by unwanted and intrusive thoughts (obsessions) and feeling the need to perform rituals (compulsions) to combat the anxiety. An example of Obsessive Compulsive Disorder might be a teen who is worried that his parents will die so he washes his hands twenty times in a row in order to protect his parents from dying. Children with OCD are usually diagnosed by age 10. Panic Disorder is another type of anxiety disorder. Panic Disorder is diagnosed if a teen has two or more anxiety attacks, followed by at least one month of concern over having another panic attack. Panic Attacks can be extremely debilitating and can cause the teenager to become agoraphobic (afraid to go out in public). Social Anxiety Disorder is an intense fear of social and performance situations like answering a question in class. Specific Phobia is an intense, irrational fear of a specific object like a spider or a specific situation like riding in an elevator. School Refusal describes the disorder of a teen who will not go to school on a regular basis or has a problem staying in school the entire day. Generally the teen complains of physical symptoms right before school is to commend and if the child stays home the physical symptoms disappear. 

Anxiety can be a debilitating mood disorder but with the proper medication (if needed) and psychotherapy the disease can be managed and the teen can have a happy and healthy future!

Substance Abuse
Many teenagers use, abuse, and become dependent on substances. According to the National Institute on Drug Abuse, by 12th grade, 47% of teens have tried illicit drugs, and 72% have tried alcohol. One study found nearly 1 in 10 high school seniors reported nonmedical use of Vicodin; 1 in 20 reported abuse of OxyContin. Abuse of over-the-counter cough and cold medicines is another widespread and serious issue. The biggest problem is with medicines that contain dextromethorphan (DXM). This is common in brands like Coricidin, Dimetapp DM, Nyquil, and Robitussin. When heavily consumed (10 to 50 times the suggested amount) DXM can cause hallucinatory effects similar to those of PCP.
With substance abuse it is important to have your child enroll in a ten-step program such as Alcoholics Anonymous or Narcotics Anonymous as well as have he or she visit a therapist in order to become aware of the underlying feelings associated with the drug use. 

Advice for Parents
Parenting teenagers can be very challenging. The following suggestions are some tips for parents to increase communication and to aid teenagers during a time of distress. 

1. When disciplining your teen, replace shame and punishment with positive reinforcement for good behavior. Shame and punishment can make an adolescent feel worthless and inadequate.
2. Expect your teenager to make mistakes. Overprotection or making decisions for teens can be perceived as a lack of faith in their abilities, making the teen feel insecure. 
3. Give your teen breathing room. They must follow their own path and this may diverge sharply from yours. 
5. Listen, teenagers don’t want to talk to an overly critical parent, they want to be heard.
6. Do not offer advice or solutions unless you are asked to do so, this way you can keep the lines of communication open.
7. Don’t judge, teens need to feel safe to vent their frustrations and to feel accepted by their parent or caregiver.
8. Find activities for your teen to help alleviate some of the restlessness like a sport or a relaxing hobby.
9. Support your teen during this scary and stressful time. 
10. Stay calm when your child becomes anxious about a situation. 
11. Praise small accomplishments. 
12. Be flexible and try to maintain a normal routine. 
13. Talk to your teen’s teachers at school to open the lines of communication and request any appropriate accommodations that might help your child become more comfortable. 
14. Obtain a comprehensive evaluation from a competent mental health professional.