What does depression look like for teenagers

Depressed or not in the mood?

The puberty is a time of change. Mental illness like depression occur more frequently. On which first signs should parents pay attention to?

Text: Constanze Löffler
Image: Alain Laboile - the photographer is the father of six children in southwest France, the picture comes from a series in which he photographed his own children and serves as a symbolic image.

Empty and Sadness 16-year-old Jakob has known since he switched from primary to secondary school. To drive them away he starts smoking weed. Later, the boy appears repeatedly drunk to class. When a trust teacher asks him about it, Jakob first denies the drunkenness and then starts to cry.

His life is completely screwed up and hopeless. He doesn't know what to do after school. And yes, he's thinking about killing himself. The teacher immediately calls Alain Di Gallo. The director of the Clinic for Child and Adolescent Psychiatry Basel is alarmed. "I called Jakob and his mother to the clinic that evening," he recalls.

For the psychiatrist, everything points to depression.

There the boy says that his parents have been separated for five years. His mother explains that she suffered greatly from her husband's unexpected departure and had hardly been there for her son. Jakob is convinced that his friends would no longer like him either. He withdrew more and more and immersed in comic drawing. For the psychiatrist everything points to one depression down.

Around one child per school class suffers from depression that needs treatment.

There are many stories like Jakob's. In the Swiss SMASH study from 2002 gave 35 percent of the girls and tight 20 percent of the boys surveyed claim they are more common sad and depressed. “Only a fraction of them end up with depression that needs treatment,” says Di Gallo, reassuringly. Around three percent of children and five percent of young people, around one person per class, suffer from it. The fatal: Symptoms often go undetected - especially when they coincide with the onset of puberty. Parents then find it difficult to tell whether the offspring is locking the room door because - as in this age completely healthy - they are separating themselves from them or because they are seriously ill.

Is it just pubertal mood swings?

"Occasional zero-minded moods and fluctuating self-esteem during puberty are completely normal," says Di Gallo. At the same time, this phase of life is a time in which frequent mental disorders developed. "Negative thoughts about yourself," says Di Gallo, "can be a building block in the development of depression." A study by the University of Zurich has shown that Adolescents react particularly quickly to negative feedback. That could explain why teenagers take everything so much to heart.

During puberty, the brain resembles a large construction site.

Such negative sensations fall on particularly fertile ground during puberty. Now the brain resembles a major construction site: Unimportant nerve connections are cut, important ones expanded. Not all parts of the brain develop at the same speed. The limbic system and amygdala - both brain structures that encode reward and emotions - thrive faster than the frontal lobe. This in turn has a controlling function, so it reminds us of order and reminds us of rules.

The ultimate kick

This imbalance makes adolescents vulnerable to risky behavior. Youngsters race around on the moped, try drugs, get drunk and change their sexual partners - always looking for the ultimate kick. "The threshold at which a stimulus creates the feeling of reward is higher in adolescence than in adulthood", explains the 55-year-old expert. "Adolescence is like a car with a lot of horsepower that young people can start but not yet safely drive."

What are the symptoms

For Boys developments like Jakob's are typical. you break the rules in school and in public, risk more in sports or in traffic. Girls, on the other hand, are more likely to injure themselves and tend to eating disorder. Psychiatrists and psychologists have clearly outlined the criteria for depression. "If adolescents withdraw for at least two weeks at a stretch from friends, school, family, neglect their leisure activities and are unusually depressed, one must assume a depressive phase", says expert Di Gallo. Unlike their peers, they would then no longer get out of bed, refuse school and break off contact with friends.

Depression is primarily diagnosed based on symptoms.

Nevertheless, the diagnosis is not always easy: "There are no clear laboratory values ​​or signs of the brain in the magnetic resonance", explains clinic director Di Gallo. Depression is primarily diagnosed based on symptoms. In addition to the severity of the symptoms, the decisive factor is the time factor: The feeling of emptiness just doesn't go away.

Who is particularly at risk?

Research shows that children who live in difficult social conditions growing up are at risk for mental illness. Also one genetic predisposition plays a role. If one parent is depressed, the child's risk of falling ill increases to 20 percent; if both parents are affected, it increases to 50 percent. "The genetic predisposition is not solely responsible for the development of depression," explains Di Gallo. In addition to the internal factors, external factors must be added. One of the most common reasons is parental separation. At a time when emotions are on a roller coaster stable relationships just particularly important. Jakob would also have needed his father - to deal with him as an adolescent and to identify with him as a man.

Even during pregnancy, fetuses are under the influence of stress hormones.

Researchers now understand better and better that experiences in infancy and early childhood can trigger depressive crises in adolescence. "Traumatic breakups or neglect in early childhood can have lasting effects on development", confirms Di Gallo.

Sometimes the triggers go back even further. Even during pregnancy, fetuses are under the influence of the placenta maternal stress hormones like cortisol. Prenatal stress permanently increases the stress hormone level in the unborn child and accelerates brain maturation, found out neurologists at Jena University Hospital. Stress during pregnancy is therefore a risk factor for later depression.

Are young people more often more depressed than they were ten years ago?

Expert Di Gallo is skeptical. Today depression is more in the spotlight more socially acceptable become and would therefore diagnosed more oftensays the child psychiatrist. "Times are no worse than they used to be, but the challenges facing young people have changed." Most children and adolescents are willing to perform. However, some struggle to live up to their own standards and feel stressed by it.

What role do smartphones and co. Play?

The new media are also partly to blame. example Cyberbullying: It used to be whispered behind closed doors. Today, insults and rumors spread anonymously and at breakneck speed on the Internet. Around five percent of all Swiss minors experience being severely bullied - a common risk factor for depression.

The use of electronic media changes the entire day and night rhythm.

Constantly playing on the mobile phone also changes social behavior. Instead of playing football with three or four real friends on the sports field or meeting up to go shopping, young people have contact with a few hundred friends - behind a closed door. The constant typing on the smartphone or screen changes their day and night rhythm. "The excessive use of electronic media at night is a risk factor for sleep disorders and depression", explains Susanne Walitza, Director of the Clinic for Child and Adolescent Psychiatry at the University of Zurich. Sleep disorders themselves can be a symptom of depression, but they can also promote the development of depression.

"Early diagnosis and continuous intervention are important"

Susanne Walitza, Director of Child and Adolescent Psychiatry at the University of Zurich

However, the expert believes that these risk factors can be positively influenced. "Parental care, clear boundaries and a structured daily routine in childhood and adolescence prevent this." They cannot always prevent mental illness. In order to recognize at an early stage whether a young person is slipping into depression, you need the attention and help of everyone in your environment: friends, parents and teachers. Because, unlike previously thought, depression and other mental illnesses do not simply grow out. "Early diagnosis and continuous intervention are important," explains Walitza. "Otherwise the long-term prognosis can deteriorate significantly." Studies show what happens if the therapeutic opportunity is wasted during puberty: Four out of five mentally ill adults were mentally unstable as adolescents.

"It is typical for depressed people that they often see everything as black and evaluate it negatively"

Susanne Walitza

The therapy of adolescent depression hardly differs from that of depressed adults, explains Walitza, since the symptoms were also very similar. "In the first step, we inform the young people about the disease." Help with minor disturbances Conversation and behavior therapy, in more severe cases supported by Medication. “It is typical for depressed people that they often see everything as black and evaluate it negatively,” explains the child and adolescent psychiatrist. "In therapy we bring events and sensations into a realistic context." If someone has a two in math, they are not a failure at school. If the girlfriend leaves him, it doesn't mean that the boy will never have a partner again.

Learn to trust yourself

The therapists also help To create triggers from the world. Take bullying, for example: "We contact the school and consider how we should deal with the situation," says Walitza, herself a mother of a teenager. Sometimes there would be talks with perpetrators and victims, sometimes whole classes including the parents would be trained. And occasionally a change of school is recommended. "The central goal of therapy is always to strengthen the child and to guide them to trust their skills and abilities", emphasizes the expert.

Also a inpatient stay can be helpful. Just get out of the depressing environment, away from the sad thoughts and ruminations. The 47-year-old attaches great importance to not simply dismissing the children after the therapy. "It must be clear how things will continue at home and at school and where the therapy can be continued on an outpatient basis."

And Jacob?

The boy turned down the professor's offer to stay in the clinic. "He got in touch three weeks later because the inner tension had increased," says Alain Di Gallo. Then Jakob was ready for one outpatient therapy. During that time he realized how much his father had hurt him by leaving and breaking off contact - and that he wanted to meet him.

The reunion gave him the opportunity to hurl all his anger at his father. At the same time it was that Beginning to build a new relationship. Today Jakob is studying communication design. And the depression is a bygone episode in his life.

About the author:

"Ms. Walitza, what should I do if my child has a crisis?"

If that child in puberty in withdraws, allowed to Parents don't let up.

Interview: Constanze Löffler

Ms. Walitza, what are the signs of a psychological crisis in adolescents?

Parents should listen carefully to new symptoms. Perhaps your child is more often in a bad mood and irritable or unusually serious and sad. Maybe it stops meeting with colleagues in the afternoon or on the weekend. Or it sags in school, gets bad grades or refuses school altogether.

How should parents react?

Such symptoms also occur in the course of normal pubertal development. Parents know their children best. If you feel that something is wrong, you should investigate it and talk to the offspring. A Open Talk quickly clarifies whether they can rest assured or need to intervene.

What if it's a crisis?

There is no such thing as puberty without crises! Some crises are smaller, others bigger: lovesickness, skipping school, experiences with illegal substances up to minor traffic offenses. Most crises pass. If parents can no longer get anywhere on their own, there is help: with Parents advice from Pro Juventute, at cantonal family and parenting advice or that Emergency service of the child and adolescent psychiatric clinics.

Who are the right people to talk to in the event of a possible depression?

Above all, it is important that parents, teachers and friends act quickly. If parents suspect that their son or daughter is depressed, they should first contact the Pediatrician turn. If the offspring doesn't feel better soon, make an appointment with one of them Child and adolescent psychiatrist or with a psychologist who specializes in this age group. If the children speak of suicide, they and their child should immediately consult a specialist. Adolescents who are not doing well, Incidentally, they often confide in their peers and ask them to keep what has been told to themselves. That throws the confidante into conflict. Here, too, the advisors from anonymous helplines can help. Depression is to be taken very seriously and must not be trivialized.

How do parents prevent crises?

Parents should keep in touch with their children, by looking for a topic with which the child identifies. And even if the offspring reacts negatively and thinks that you don't understand anything about it, parents are allowed to do not let go. Studies show that parents underestimate their role during their children's puberty. They have a bigger impact than they think they are. Parents should always show that they are there and interested in their child. For example, when parents don't know where their teenagers spend the night, I find it alarming.

How can parents empower their children?

By making adolescents one Interest or passion have to deal with when they are not doing well. You need one Replacement, when the first lovesickness breaks out or there are problems with schoolmates. For example, if a child feels bullied and marginalized, they will likely withdraw gradually. However, if the child is integrated into a sports team and is valued by the comrades there, it becomes the Rejection by classmates as less significant feel. Other children ride, play an instrument or draw mangas - The main thing is that they are passionate about what they do.

To person:

What if life doesn't make sense anymore?

In 2014, according to the Federal Statistical Office 31 young people between 10 and 19 years of age The life. “This number has to give us food for thought,” says child and youth psychiatrist Alain Di Gallo. After accidents are Suicide is the most common cause of death among young people in this country.Experts estimate the number of suicide attempts 100 times higher. depressions are the strongest risk factor for suicide: Affected boys and girls often have suicidal thoughts. The reasons they give are feelings like lonliness and not feeling loved, anger, anger and disappointment. “Suicidality must be openly addressed with depressed young people. If necessary, be specific Auxiliary measures binding ”, says Di Gallo. This includes a visit to a specialist and also making weapons and medicines inaccessible at home.

Continue reading:

  • When teenagers think about suicides. Call two to three teenagers who are suicidal Every day at the Pro Juventute emergency number 147. What drives adolescents to kill themselves? And how can suicides be prevented?
  • Back to life through the clinic. If a child suffers from mental disorders, often only treatment in a protected setting will help. The Clienia Littenheid is a private clinic for psychiatry and psychotherapy. She is taking care of Young people who have lost their emotional balance to have.

The article comes from our 2017 health supplement “That makes children strong”. The booklet is included in the March issue and can be downloaded from us ordered become.