Carla and Kelly are nonidentical twin sisters, age 15, coping with the recent divorce of their parents.
They are more tearful than usual. They spend more time in their rooms and seem more resentful when told by either parent what to do. But that is where the sisters' similarities end.
Carla's school grades have plummeted. She has all but stopped calling or joining friends on weekends. She is up most nights, and she is rarely smiling. All are stark behavioral changes, none of which have happened to Kelly.
Carla has developed depression. Kelly is sad, but OK.
Depression, when it occurs, is potentially lethal. Suicide is the third-leading cause of death in adolescents and is most often preceded by a major depressive episode.
Adolescents are particularly vulnerable to developing suicidal thinking in the context of depression, in part because adolescence is a time of identity formation during the human lifespan.
It is normal and typical for an adolescent to question his or her identity, to wonder what the meaning of his or her life is, to strive to define a useful role outside of the immediate family -- a way of fitting into the larger "whole" of the surrounding village, society, and universe.
It is particularly devastating then for an adolescent to be additionally bombarded with depressive symptoms, whether triggered by traumatic (or perceived traumatic) life events or not.
Warning signs of major depressive disorder in adolescents include:
Feelings of hopelessness and/or helplessness
Unexplained pangs of guilt
Blunting of facial expression
Isolating one's self from family and friends
Inability to derive pleasure from activities that are usually perceived as pleasurable
An increase in risk taking
New onset of drug or alcohol use
Deterioration in school work
Disruption of sleep and/or appetite
When any such warning signs arise, it is time to act quickly -- and compassionately -- to get help. Adolescents do not always welcome offers of help from parents, school counselors or even friends, and they may even see them as an intrusion.
It is important for all those involved with depressed adolescents to help them recognize the following:
That getting an evaluation is "only information." It does not mean they are sick, weak or crazy
That 10 to 20 percent of all teenagers experience major depressive symptoms and thoughts of death
That, left untreated, depression develops a biological "life of its own" in the brain -- one that is not controllable by willpower or personal strength
That part of the biological life of depression is suicidal thinking, which is always based on illogical assumptions (no matter how true they seem in the moment)
That depression is almost always curable or improved by treatment
That they must cooperate with the treatment process -- and that all privileges and freedoms need to be held contingent on cooperation with treatment
Parents need to be informed of all of these points and reassured that, in the vast majority of cases, they are not the cause of their child's depression.
Parents also need to be warned never to place themselves in the position of having to judge whether or not their own child is in danger of hurting him/herself. When in doubt, or when any signs are present, this judgment must be placed in the hands of a professional.