Depression During Puberty

Puberty can be a difficult time for you and your child. While your child is developing physically, they are also experiencing rapid growth of psychosocial maturity. Put simply, during this time, children begin to naturally pull away from their families and connect with their peers to establish independence and individuality.

While social withdrawal, moodiness, and other behavioral changes are commonly attributed to this normal developmental stage, researchers are realizing that in some cases, these changes could indicate that puberty is actually contributing to depression.

The Frequency of Depression During Puberty

It is estimated that 2% of children under age 10 experience depression, according to the American Academy of Pediatrics. However, between the ages of 10 and 14, the average age range of puberty onset, depression rates increase from 5% to 8% for children overall.

Signs of Depression

Puberty is a unique time when changes in appearance and behavior are naturally occurring. As such, parents, teachers, and caregivers need to be especially aware of signs of depression, which may be hard to differentiate from normal behavioral changes.

Moodiness, separation from parents, and identification with peers are behaviors common during puberty.

Symptoms that may indicate depression, however, include:

• Thoughts of self-harm
• Avoidance of school
• Academic decline
• Risk-taking behaviors
• Persistent vague physical complaints
• Excessive guilt
• Unexplained crying
• Feeling misunderstood
• Losing interest in things of former interest
• Clinging to a parent or worrying that a parent may die
• Sleeping difficulties
• Weight changes
• Unexplained fatigue
• Difficulty concentrating and focusing

Take signs of depression seriously. Never be dismissive, particularly if your child is expressing thoughts of self-harm or suicide.

Why Does Depression Increase During Puberty?

Several theories for the striking increase in depression during puberty exist. However, there is little agreement among researchers and clinicians.

Hormones

Estrogen, a female sex hormone, has consistently been linked to depression. Estrogen levels dramatically increase in girls during puberty, which may contribute to the increase in depression rates among them. Conversely, testosterone, a male sex hormone that increases in boys during puberty, has not been linked to depression.

One study looking at gender and sex differences in depression proposed that a diathesis-stress model could account for why girls are more prone to depression. This theory proposes that predisposed hormonal vulnerabilities interact with environmental stresses to contribute to the onset of depression.

Stage of Physical Development

The research published in The Journal of Affective Diseases reported that physical development during mid-puberty predicted the increase in depression rates more than other any factor that was studied.

Timing at Puberty Onset

The timing of puberty onset may have an impact on depression rates: Children are "early" or "late developers" may exhibit more depressive symptoms than those who felt they were developing at the same time as their peers.

Stressful Life Events

During puberty, academic work and social relationships become more complex and demanding, which can be stressful. Some children are more prone to depression as a result of stressful life events.

Where to Get Help

More research is needed to determine the cause of the increase in depression during puberty. Regardless of the causes, depression during childhood can have a profound impact on a child's functioning including school performance and relationships. It is also associated with lasting effects on later relationships, social functioning, parenting, school performance, substance use, and the onset of other mental disorders.

Steps you should take:

• Don't ignore behavioral and mood changes in your child, as there is clear evidence that rates of depression increase during puberty.
• Listen to your child about how they are feeling and take their concerns seriously; let them know that you are there to offer support and help.
• Talk to your child's doctor. Always be concerned about any new or unexplained behaviors in your child and bring them to the attention of your child's physician. A physician can rule out other medical problems, and help decide if the behavioral changes are a normal part of puberty or a sign of depression.

Your child's doctor will ask questions about the types of symptoms your child is experiencing as well as the duration and severity of these symptoms. Your doctor may recommend treatment options or may refer you to a mental health professional such as a psychiatrist, psychologist, or counselor.

Treatment

Research suggests that children with mild depression can often be successfully treated with support and symptom monitoring. For moderate to severe cases of depression occurring during puberty, treatment options may include the use of antidepressants and psychotherapy, often in combination.

Two types of psychotherapy that may be effective in treating major depressive disorder in adolescents and children are:

• Cognitive-behavioral therapy (CBT): This approach focuses on identifying and changing the cognitive and behavioral patterns that are associated with cycles of depression.
• Interpersonal therapy (IPT): This type of therapy focuses on identifying relationship problems and addressing those conflicts. Poor relationships or the termination of important relationships (such as a breakup or a parental divorce) can contribute to symptoms of depression.

Caution and careful monitoring are necessary when children and adolescents take antidepressants, as these medications can increase the risk of suicide. Education is important for helping teens and loved ones understand the potential risks and how to spot signs of suicidal thinking.