Depression in Teens

I got a lot of flak for a recent article in which I stated that teens need to just pick themselves up and do something – not be selfish while their parents work away. I am humbled by all of your replies and I get that if you could just lift yourself up, you would!  Surely I missed the boat on that one by oversimplifying the problem and being insensitive to all those who have tried their hardest for years.

Several teens in my practice now are going through exactly this.

Their parents are exasperated and doing all the wrong things. They often say, this is a crisis, how soon can you see her. And then don’t show up. I ask for a family meeting, and everyone is too busy. What is going on here? It turns out that families get burnt out along with the patient. Family therapy 101. I remember taking a class regarding Salvador Minuchin at the Bronx Psychiatric Center in the early 1980’s. He was one of the fathers of Family Systems Therapy. Of course the family is effected. Again and again after a brief probe of history we come to find out that this hurry up and wait style is emblematic of how the family copes.

In the literature it says what I have long suspected, that (Journal of Child and Adolescent Mental Health):

  • For all patients in the study, sleep disturbance was a predictor of depression and interpersonal functioning for depressed adolescents. Sleep disturbance predicted more depression and interpersonal stress across treatments and led to a slower improvement in depression and interpersonal functioning. These data suggest that sleep disturbance should be a target for future treatment development research among depressed adolescents.

It turns out that sleeping all the time, or not sleeping or a whacked-out sleep schedule is seriously correlated with mood disorders in adolescents.  No big surprise there.  So how can we make them just “snap” out of it and motivate if their circadian rhythms are, by definition, completely disturbed/dysregulated or disordered to the point where they’re catatonic?  As I recently re-learned from your feedback, there is no willing it if your body won’t respond.  The shut-down is real, absolute and frightening.  It may not get fixed easily, could take months or years to regulate, even with medication.  Of course the DSM-V acknowledges this when it lists the symptoms of Major Depression and/or Dysthymia.

So what do I do when a teen says she can’t get out of bed, and her medication is not working, and her parents are pissed?  I try my usual song and dance routine of exploring and urging them to find a passion.  But if that doesn’t work, and the family is too fried, and the meds are simply not helping, what then??  This is a tough road.

Around here, the hospital experience is mixed.  You go in and they tweak your meds, do some DBT classes that are all the rage, and kids complain works only minimally, and then get sent back to the same environment.  Do you go to the wilderness?  (Sorry folks, most people don’t have $35,000 lying around for this rainy day).

But what about the utter shame, and debilitation that the whole family endures?  When a teen misses her milestones, even graduating from HS or College with her peers, how does that set her up for the next phase?  It doesn’t.  We as a society need to find more ways and alternatives to stimulate kids.  HS cannot be a one size fits all experience.  In this political climate of cynicism, denial, fear and greed, how can we design a better road map for service, caring and compassion in our communities?  The questions are asked, but not answered.