Teenage Depression
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Teenage Depression

By Adam Dalkilic

Although depression can occur during any age, symptoms of teenage depression can present differently than depression seen in adults. Symptoms of teenage depression fall into two major categories: behavioral and emotional1. Behavioral symptoms include fatigue, insomnia or oversleeping, weight loss or weight gain, alcohol and drug use, anxiety, decreased cognition (slower reactions and thinking), isolation, academic failure, spontaneous anger eruptions, self-injurious behavior, attempted suicide or planned suicide2. Even though treatments vary according to patients, the most commonly used treatments for teenage depression are psychotherapy and antidepressant medications. There are case reports about use of transcranial magnetic stimulation (TMS) therapy in treatment resistant depression in teenagers above 16 years of age.

Traditionally used before the discovery of serotonin reuptake inhibitors (SSRIs) and TMS, psychotherapy remains one of the most commonly administered treatments for teenagers with depression. Psychotherapy works by giving patients supportive environments, where patients discuss with a licensed therapist the symptoms and impact of their depression and try to find solutions3. The main types of psychotherapy for adolescents are cognitive behavioral therapy (CBT), supportive, interpersonal, psychodynamic, and mindfulness-based therapies. In CBT, the therapist focuses on educating the patient about thoughts, emotions, and behaviors and helping him/her manage feelings and develop healthy behaviors4. On the other hand, psychodynamic therapy focuses on using therapeutic relationship to help patients in identifying and modifying defense mechanisms to treat depression and harmful tendencies in a patients’ behaviors5. Fortunately, 75% of patients, regardless of age difference or type of psychotherapy, feel some benefit from this treatment type6. According to a research summary that examined the effectiveness of psychotherapy in a sample of 14,406 adolescents and children, data showed that psychotherapy had been effective in treating teenage depression7. Most large scale studies, such as the one previously mentioned, suggest that psychotherapy is a valid option for teenagers with depression.

However, psychotherapy might not work for every teenager suffering from depression, so medications serve as an alternative. Some of the commonly prescribed antidepressants for teenagers include fluoxetine, escitalopram, sertraline, and paroxetine. Most antidepressant medications, including the ones previously mentioned, are SSRIs. SSRIs work by preventing the depletion of serotonin, an important chemical messenger, in the brain8. Just as SSRIs work in adults, studies show that the same efficacy is present in children and adolescents9. If SSRIs or psychotherapy do not work for youth with depression, newer treatment options for treatment-resistant patients have been studied. Specifically, transcranial magnetic stimulation (TMS) has been tried in teenagers and showed some promise, but so far TMS is not approved by the FDA for use in ages younger than 18. TMS works by using an electromagnet to induce magnetic waves directed to a specific part of the left prefrontal cortex (PFC). The TMS machine rapidly turns the electromagnet on and off while targeting the dorsolateral PFC, which is the region of the brain shown to be less active in depressed patients and regulates the mood10. Because TMS treatment is applied locally and has no systemic side effects, it has been rapidly growing in popularity among the patients who have side effects from medications. Although the FDA has not yet approved the use of TMS in depression patients under 18, some studies have shown that TMS appears to be safe and effective for depressed adolescents11,12. More data on the success of TMS in adolescents is needed, data in adults treated with TMS show that approximately 60-70% of patients with depression that were resistant to medications and psychotherapy have shown significant improvement with TMS. When depressed adolescents do not benefit from psychotherapy or antidepressants, they should check with their health providers, whether TMS treatment might be an option for their depression or not.

1 (2018, November 16). Teen depression – Symptoms and causes – Mayo Clinic. Retrieved December 30, 2020, from https://www.mayoclinic.org/diseases-conditions/teen-depression/symptoms-causes/syc-20350985

2 See above

3 American Psychological Association. (2020, July 31). Understanding psychotherapy and how it works. http://www.apa.org/topics/understanding-psychotherapy

4 (2019, March 16). Cognitive behavioral therapy – Mayo Clinic. Retrieved December 30, 2020, from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610

5 Shedler, J. (2010). Psychodynamic psychotherapy brings lasting benefits through self-knowledge. Retrieved January 01, 2021, from https://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy

6 See Footnote 3

7 Merry, S.N., Hetrick, S.E., Cox, G.R., Brudevold‐Iversen, T., Bir, J.J. and McDowell, H. (2012), Cochrane Review: Psychological and educational interventions for preventing depression in children and adolescents. Evid.‐Based Child Health, 7: 1409-1685. https://doi.org/10.1002/ebch.1867

8 Mayo, Clinic. The most commonly prescribed type of antidepressant. (2019, September 17). Retrieved January 01, 2021, from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

9 Cheung, A. H., Emslie, G. J., & Mayes, T. L. (2006). The use of antidepressants to treat depression in children and adolescents. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 174(2), 193–200. https://doi.org/10.1503/cmaj.050855

10 (2018, February 23). Transcranial magnetic stimulation (TMS): Hope for stubborn …. Retrieved January 1, 2021, from https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335

11 Narang, P., Madigan, K., Sarai, S., & Lippmann, S. (2019). Is Transcranial Magnetic Stimulation Appropriate For Treating Adolescents with Depression?. Innovations in clinical neuroscience, 16(9-10), 33–35.

12 Croarkin, P. E., & MacMaster, F. P. (2019). Transcranial Magnetic Stimulation for Adolescent Depression. Child and adolescent psychiatric clinics of North America, 28(1), 33–43. https://doi.org/10.1016/j.chc.2018.07.003