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Thursday, March 25, 2010

Adolescent Depression Among 18 Year Olds: Child or Adult?

Adolescent Depression Among 18 Year Olds: Child or Adult?

Adolescent Depression Among 18 Year Olds:  Child or Adult?
Over the years, I've seen a number of parents who come to psychotherapy to deal with their own fear, frustration, and anxiety related to an 18 year old daughter or son who refuses to get help for depression. With regard to mental health decisions, in New York State, we consider an 18 year old to be an adult who can make his or her own decisions about getting mental health treatment. A concerned parent, who is worried about the welfare of his or her child, cannot force an 18 year old to get help if the teen doesn't want it. This raises a lot of complicated issues:

  • Even though the law considers an 18 year old to be an adult with regard to participating in mental health treatment, does an 18 year old always have the psychological maturity and judgment needed to make this decision?
  • Given all the hormonal and psychological changes that go on during adolescence, does an 18 year old always know what's in his or her best interests regarding psychological health?
  • How does teenage rebellion against parents and authority figures factor into this issue?
  • How does the depression itself affect an 18 year old's ability to make sound decisions for him or herself in this situation?
What is Adolescent Depression?

What is Adolescent Depression?
Adolescent depression is a psychological disorder that occurs during teenage years with symptoms of persistent sadness, loss of interest in his or her usual activities, loss of self worth, and discouragement. In many cases, teens will start to isolate themselves from family and friends. In some cases, teens might turn to alcohol or drugs to self medicate their depression. In more severe cases, teens might make impulsive attempts or gestures to commit suicide. There might be other symptoms from other psychological disorders such as anxiety, anorexia, bulimia, compulsive overeating, self mutilating, hair pulling, and other similar symptoms. See below (What Are the Symptoms of Adolescent Depression?)

What Causes of Adolescent Depression?

What Causes Adolescent Depression?
Depression during adolescence is not unusual. Some of the causes of depression in teens might be:
  • hormonal changes that occur during adolescence
  • stress associated with the normal process of maturing and developmental change
  • a reaction to a disturbing event: the death of a friend or loved one, the breakup of a relationship, problems at school, and other similar issues

Teens who are Most Vulnerable to Depression:

Teens Who Are Most Vulnerable to Depression
  • have low self esteem
  • are highly critical of themselves
  • have little sense of control over stressful events that occur to them
  • have been sexually, physically or emotionally abused or emotionally neglected
  • often come from a family with a history of depression
  • often have poor social skills
  • often feel that they don't "fit in" with their peer group
  • have an unstable home life
  • often have parents who are divorced
  • experience the loss of a parent

What are the Symptoms of Adolescent Depression?

What Are the Symptoms of Adolescent Depression?
  • acting out behavior (misbehaving in school, acting defiant with parents)
  • changes in appetite (either increase or decrease)
  • criminal behavior (shoplifting, alcohol or drug abuse, selling drugs, etc)
  • persistent sadness
  • irritable mood
  • difficulty concentrating
  • difficulty making decisions
  • problems with memory
  • sleep problems (either problems with insomnia, excessive sleeping or day time sleepiness)
  • excessively irresponsible behavior
  • excessive guilt
  • problems in school, including failing grades, fighting with teachers or other students, cutting classes, etc.
  • thoughts about suicide, making plans to commit suicide or actual suicide attempts
  • substance abuse or other forms of addictive behavior (gambling, acting out sexually)
  • excessive worry or preoccupation about death
  • significant weight change (either gaining or losing)
Is it Depression or Something Else?
Depression is difficult to diagnose in teens due to hormonal and other developmental changes that go on during this phase of life. Some of the above symptoms are just a normal part of being a teen and do not necessarily mean that your teen is depressed. A psychotherapist or psychiatrist, who specializes in working with teens, should be consulted to make a differential diagnosis. Also, it's a good idea to consult with your medical doctor to rule out any medical causes. A doctor who is knowledgeable about substance abuse can also rule out alcohol or drug abuse.

Depression Before and After Age 18:
Prior to the age of 18, as a parent, you can make the decision as to whether or not your child gets help. It's always better to include teens in on the decision making process, if you can, rather than trying to force them to get help. Also, when teens become involved in criminal activity, the court can mandate that they attend treatment and will often monitor their compliance in treatment.

But when teens turn 18, getting them into treatment for depression can be a thorny issue, if they are either afraid to get into treatment, they feel stigmatized, or they refuse to participate in treatment as part of their rebellion towards you.

What to Do If Your 18 Year Old Refuses to Get Help:
Recognize that, ultimately, as scary as this might be, in most cases, the decision is up to your 18 year old. But there are some steps that you can take to help your 18 year old to get help:

Normalize What Your Child is Feeling
As previously mentioned, it's not unusual for teens to be depressed. Your 18 year old might feel that he or she is the only one who is going through depression. This can be especially painful because teens often have a strong need to "fit in" with their peer group. If they think that what they're going through is "weird" or "crazy," it would be helpful for them to know that they're not alone.

Provide Your Child with Psychoeducational Material about Depression
Organizations like NAMI ( have websites that provide psychoeducational information about depression. So, even if your 18 year old won't listen to you, he or she might be more receptive to information that is online.

Elicit the Help of Someone Close to Your 18 Year Old
During the adolescent phase of growing up, teens are striving to have some degree of autonomy and control. This often translates into alternating behavior of over dependence and rebellion towards parents and authority figures. An 18 year old's decision not to participate in mental health treatment for depression can be adversely affected by his or her need to feel autonomous and independent from parents. So, even though you might be the one who is most familiar with what's going on with your teen, you might not be the one that he or she will listen to about this. In many cases, it's helpful to find someone who has some influence with your teenager--that might be an older sibling, an aunt or uncle, your child's medical doctor, or a coach. They might be more persuasive than you.

Try Not to Get into a Power Struggle with Your 18 Year Old
If your 18 year old refuses to get help for depression, your inclination might be to feel angry and frustrated. You might see all the signs and symptoms of depression and know that you have better judgment with regard to your teen getting help. However, aside from emergency situations, if you try to force, rather than persuade, your teen to get help, your teen might dig in his or her heels about this, making it less likely that he or she will get help.

What About Suicidal Thoughts, Intention, Plan or Attempt?
If your teen is talking about suicide, you need to consult with a psychiatrist who specializes in working with teens immediately. Teens can be impulsive and events that might seem insignificant to you can often be emotionally overwhelming for a teen. When teens are impulsive, often, there is no forethought about suicide--they make the attempt.

If your teen has actually made an attempt, of course, you need to call 911 immediately. If your 18 year old is taken to the emergency room for a psychiatric evaluation following a suicidal attempt or gesture, the psychiatrists can hold him or her for up to 72 hours or more if they feel that your child will be a risk to him or herself or others.

Hopefully, as a parent of a teen, you will never be faced with adolescent depression in your child. But if you are, aside from getting your teen help, the family might need family counseling and you might need your own psychotherapy to cope with this ordeal.

I am a NYC licensed psychotherapist, hypnotherapist and EMDR therapist who works with individual adults as well as couples.

To find out more about more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 or email me