Xavier Fàbregas, founder and medical director of the Mas Ferriol detoxification center, is aware that the signs of depression in adolescents are not easy to interpret and it is common for them to be confused with the changes typical of this vital stage. He clarifies that, perhaps a differentiating sign, would be «the persistence in the symptomatology in the same direction; that is to say that the symptoms are not changing and contradictory, but that they are maintained over time. Sadness, isolation and apathy that do not vary could be an indicator of a depressive episode, when the most common in adolescence is the “up and down”. But it should be noted that a special manifestation of depression in adolescents can be
irritability, which is sometimes not detected as a symptom of depression».
How to face a conversation with them to find out what is happening to them?
It must be said that the relationship with a teenager is never easy. Adolescence is a stage of conflict with oneself and with others, in the search for one’s own identity that initially requires the destruction of previous ties. In order to differentiate themselves, the closest relationships are questioned, in the confidence that they are the most solid relationships and that they will resist turbulence. We must send the signal that as adults we will be able to resist this period of conflict, which will normally be resolved in a few (which seems very long) years. And it is essential to use our experience of having gone through the same thing to pull on patience, affection and understanding in a necessary and unavoidable phenomenon to acquire maturity and personal autonomy.
When should we go to a professional?
Professionals are also here to be able to assess whether what is happening requires deep and systematic interventions or sometimes only a differential diagnosis. It is not necessary to wait for the situation to reach extreme situations because sometimes explaining to the adolescent and his family what happens as normal adolescence is already enough to redirect the situation a little. And if there are symptoms of something more serious, you can intervene in time. The only positive element of the increase in psychopathology derived from the pandemic is that people have understood that it is necessary to speak openly about mental health.
What would be the itinerary to follow in case you need help?
Sometimes the process is initiated by the school psychologist if there have been conflicts at school, or through the outpatient doctor or pediatrician. Other times it will be due to the adolescent’s own demand for not feeling well or because he knows the positive experience of a person in his circle of friends who has gone to see a psychologist and has felt helped. Even the experience that a reference character has on the networks can cause a feeling of identification and motivates this request for help.
If there is a minimal demand for help, you can take advantage of a first interview without commitment to continue to break the ice. Sometimes, in the consultation we do an interview to assess the situation and demand, and it is not strange that in many cases months go by from the first contact to establishing a collaboration agreement. But if that first contact has been able to dismantle some of the fears and reluctance that existed before coming, it can be a good start for a future effective therapy.
While you have an appointment to go to the doctor, what can we do as parents to help you on a day-to-day basis?
Coordination between parents is essential to avoid sending mixed messages. And they have to prioritize the quality over the quantity of the messages. Sometimes they can share some joint activity to maintain positive contact (such as practicing a common sport or hobby, a trip, watching a football match, a series…) although initially many reluctance is expressed and we feel rejected. It is important to avoid dramatic scenes, at least on our part, since we are supposed to be the adults, although without the pretense that we put up with everything. You have to be able to convey that some situations are unacceptable, such as violence against others or against oneself.
What should we never do in these cases?
Give up. Depression is a chronic illness, but in many cases it can be cured with proper treatment. And adolescence almost always heals over the years. Seek professional help if there is no significant progress. We have already spoken before about the need not to send contradictory messages and seek consensus to bring positions closer together. Nor should we stop asking for help when we feel overwhelmed.
What are the most common reasons for depression at these ages?
Teenagers are hypersensitive. And they are undergoing a stage of great changes on the way to being self-sufficient and responsible. The awakening of sex, the discomfort with one’s own body that is changing, acne, first love and first disappointment, fear of the future, educational changes towards models less externally directed as in the first years of Primary and more focused on self-management, the demand for greater responsibility because “you are no longer a child”….
There is a question I always ask when I give talks to parents of teenagers: what age would you want to go back to if you could? No one answers that at fourteen or sixteen. We would all like to go back to 25 because being a teenager is a drama. For hormonal reasons, the part of the brain that governs during this stage is the limbic system, which is the part where we manufacture emotions. These emotions have to be nuanced thanks to the influence of another part of the brain, the prefrontal cortex of the neocortex, in order to not only do what we feel like doing, but what is convenient for us. Today I would start playing with the video game console, but tomorrow I have an exam, so first I’ll start studying. Control the primary desire, the visceral for what is necessary and appropriate. That is what maturity is.
There is a tolerance for frustration that needs to be developed, a need to train the delay of immediate gratification that is the basis of emotional intelligence. And that works. And in vulnerable individuals there is the possibility of an episode of depression that further complicates this vital stage.
What medical methods are the most common to get out of this situation?
The essential is psychotherapy. In some cases it is also necessary to medicate this depression to facilitate recovery. It is also necessary to rule out other pathologies that mask or complicate the picture: obsessive disorders, drug use, eating disorders, personality disorders, psychoses, anxiety… Fortunately, adolescence has a good prognosis in most cases. because it is going to be one more vital crisis, perhaps the first or second in our lives and it catches us untrained and insecure. Others will come, but that is one of the powerful ones.
It is essential to make a good diagnosis between normal adolescence and adolescence plus depression. The high number of suicide attempts during this age has skyrocketed with the pandemic. That is the biggest challenge. The prevention of all the cases in which we can intervene gives a second chance to learn to cope with our anxieties.
Does having depression in adolescence mean that you will also suffer from it as an adult?
In cases where there is a clear first episode of depression, it is possible that it is a factor that predisposes to future episodes, although I cannot be exhaustive with this because I believe that we still do not have enough data to make this statement absolutely. The study of depression in adolescents has many methodological difficulties due to the large number of factors that concur. Physical changes, cultural and educational factors, family relationships, access to substances make it difficult to draw definitive conclusions. But, it is true that understanding the disease improves the prognosis.