ADOLESCENTS are those aged 13-17 years old, and there are 5.5 million of them in Malaysia. More than half of them are in school.

Adolescents are valuable assets to the country as they are future leaders who will continue to drive and sustain the development of the nation.

They are perceived as the healthiest group, but they do have their own set of unique problems and healthcare needs.

According to the Malaysian Health and Morbidity Survey 2017, one in five teenagers in the country are depressed, two in five suffer from anxiety and one in 10 are stressed.

The 2017 National Mental Health Survey previously proved that at least one in 10 young people or 10% of 5.5 million youth in the country ever thought of committing suicide.

Transition years

The teenage years can be challenging. Between physical changes in the body, intense peer pressure and an increased sense of social anxiety, teenagers often have difficulty finding their place, particularly in society.

Many want to fit in while others want to stand out, and that can cause them to rebel.

Teen depression is also becoming an alarmingly frequent trait of those transition years.

Recent research has found that the rate of depression is increasing and that there are distinct gender differences in teen depression.

The teen years are a natural transition from being a child to an adult.

While women of all ages tend to be more aware of their appearance than men, particularly in terms of how others see them, most young people start to develop a heightened sense of socialisation as they enter their teenage years.

As children, their clothing choices and hairstyles were not as important to them. As teenagers, their entire social life may depend on those factors, at least in their own eyes.

What is teen depression?

The mental and emotional disorder known as teen depression is no different medically from adult depression. However, the brains of adolescents are structurally different than that of adults.

Teens with depression can also have hormone differences and different levels of neurotransmitters. Neurotransmitters are key chemicals in the brain that affect how brain cells communicate with one another. They play an important role in regulating moods and behaviour.

The neurotransmitters that are important to our understanding of depression are serotonin, dopamine and norepinephrine. Low levels of these neurotransmitters may contribute to depression.

Depression can be associated with high levels of stress, anxiety, and – in the most serious scenarios – suicide.

However, symptoms in teens may manifest themselves in different ways than in adults. This may be because teens face different social and developmental challenges, such as peer pressure, changing hormone levels and developing bodies.

As teenagers, depression can also affect the aspects of their personal life (which refers to how an individual feels, thinks or behaves when they are alone and away from others), school, work, social and family life and can lead to social isolation and other problems.

Is teen depression different among men and women?

Yes, teen depression is gender relative.

Females are around three times as likely as males to report a depressive episode. The difference in depression rates could be attributed to the differences in the rate of physical changes between boys and girls.

Puberty typically starts earlier and hormonal changes tend to be more evident in young girls. Teenage girls are also inclined to be more concerned with how others perceive them.

While these differences in gender explain the overall differences in depression rates, other factors may be involved in the recent increase for female teenagers. Because women of all ages tend to be more aware of their appearance than men, particularly in terms of how others see them, most young people start to develop a heightened sense of socialisation as they enter their teenage years.

Teenagers and social media repercussions

The rise in depression rates among teenagers also coincides with the rise in popularity of the smartphone.

Today’s teenagers have not known a world of social interaction that doesn’t include social media. Both young men and women spend a significant amount of time on their smartphones now.

According to the National Health and Morbidity Survey 2017, six in seven secondary school children were active internet users in Malaysia and out of those, two in seven were addicted, with Form 5 students showing the highest rate of internet addiction at 38%, compared with Form 1 students at 18%.

In another study by the United Nations Children’s Fund, it is reported that Malaysia ranks second in Asia in 2020 for cyberbullying among youth, proving that cyberbullying is becoming an increasingly prominent problem in the country.

The use of smartphones and social media appears to correlate with the increase in depression rates among teenagers. However, it seems to have impacted teenage girls more than boys.

One reason for this may be that girls spend more time socialising on their smartphones, including texting and interacting on social media.

Boys also text and use social media somewhat, but tend to use their smartphones more for playing games.

Since teen girls are more focused on what others think of them than boys, the increased use of social media can increase that level of anxiety and, subsequently, the rates of depression.

An association has been found between moderate or heavy digital media use and the increased rate of mental health issues and worsened psychological well-being for teenage girls.

One study found that the rate of depression also aligns with the amount of time spent on social media.

In that study, girls who spent six hours or more on social media were significantly unhappy than those who spent only 30 minutes a day on social media. The differences for boys were less noticeable.

How can you spot depression in a teen?

The symptoms of depression can often be difficult for parents to spot. Depression is sometimes confused with the typical feelings of puberty and teenage adjustment.

Symptoms

Teen depression signs and symptoms include a change from the teenager’s previous attitude and behaviour that can cause significant distress and problems at school or home, in social activities or in other areas of life. Depression symptoms can vary in severity, but changes in your teen’s emotions and behaviour may include the examples below.

Emotional changes

• Feelings of sadness, which can include crying spells for no apparent reason

• Frustration or feelings of anger, even over small matters

• Feeling hopeless or empty

• Irritable or annoyed mood

• Loss of interest or pleasure in usual activities

• Loss of interest in or conflict with, family and friends

• Low self-esteem

• Feelings of worthlessness

• Feelings of unrealistic guilt

• Fixation on past failures or exaggerated self-blame or self-criticism

• Extreme sensitivity to rejection or failure, and the need for excessive reassurance

• Trouble thinking, concentrating, making decisions and remembering things

• Ongoing sense that life and the future are grim and bleak

• Frequent thoughts of death, dying or suicide

• Appearing sad, irritable or tearful

• Changes in appetite or weight

• A decreased interest in activities once seen as pleasurable

• Regular complaints of boredom

• A decrease in energy

• Difficulty concentrating

• Feelings of helplessness

• Alcohol or drug misuse

• Major changes in sleeping habits

• Talking about or thinking of suicide

Behavioural changes

• Withdrawal from friends or after-school activities worsening school performance

• Changes in appetite – decreased appetite and weight loss or increased cravings for food and weight gain

• Use of alcohol or drugs

• Tiredness and loss of energy

• Insomnia or sleeping too much

• Agitation or restlessness – for example, pacing, hand-wringing or an inability to sit still

• Slowed thinking, speaking or body movements

• Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse

• Social isolation

• Poor school performance or frequent absences from school

• Less attention to personal hygiene or appearance

• Angry outbursts, disruptive or risky behaviour, or other acting-out behaviours

• Self-harm – for example, cutting or burning

• Making a suicide plan or a suicide attempt.

Some of these symptoms may not always be indicators of depression. Appetite changes are often normal, namely in times of growth spurts and particularly if the teen plays sports. Still, looking out for changing behaviours in the teen can allow you to help them when they are in need.

Self-injurious behaviour

Self-injurious behaviours such as cutting or burning are also a warning sign. These behaviours may be rare in adults but are more common in teens.

The intention of these behaviours is not usually to end one’s life, but they must be taken very seriously. They are typically transient and usually end as the teen develops better impulse control and other coping skills.

Causes

It is not known exactly what causes depression, but a variety of issues may be involved. These include:

• Brain chemistry – Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When these chemicals are abnormal or impaired, the function of nerve receptors and nerve systems changes, leading to depression.

• Hormones – Changes in the body’s balance of hormones may be involved in causing or triggering depression.

• Inherited traits – Depression is more common in people whose blood relatives, such as a parent or grandparent, also have the condition.

• Early childhood trauma – Traumatic events during childhood, such as physical or emotional abuse, or loss of a parent, may cause changes in the brain that increase the risk of depression.

• Learned patterns of negative thinking – Teen depression may be linked to learning to feel helpless rather than learning to feel capable of finding solutions for life’s challenges.

Risk factors

What are the risk factors for teen depression?

Factors that may increase a teen’s risk for depression include:

Personal/personality issues

• Having a difficult time with their sexual orientation, in the case of teens who are LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual and more)

• Having trouble adjusting socially

• Having no social or emotional support

• Living in a violent household

• Being bullied

• Having a chronic illness

• Teens who have trouble adjusting socially or who lack a support

• Having issues that negatively impact self-esteem such as obesity, peer problems, long-term bullying and academic problems

• Having been the victim or witness of violence such as physical or sexual abuse

• Having other mental health conditions such as bipolar disorder, an anxiety disorder, a personality disorder, anorexia and bulimia

• Having a learning disability or attention-deficit/hyperactivity disorder

• Having ongoing pain or a chronic physical illness such as cancer, diabetes and asthma

• Having certain personality traits such as low self-esteem or being overly dependent, self-critical or pessimistic

• Abusing alcohol, nicotine or other drugs

• Being gay, lesbian, bisexual or transgender in an unsupportive environment

• Inherited traits – Some studies indicate that depression has a biological component. It can be passed down from parents to their children. Children who have one or more close relatives with depression, especially a parent, are more likely to have depression themselves.

Family issues

Traumatic early life events – Most children don’t have well-developed coping mechanisms. A traumatic event can leave a lasting impression, such as:

• Loss of a parent or physical, emotional or sexual abuse can have lasting effects on a child’s brain that could contribute to depression.

• Having a parent, grandparent or other blood relative with depression, bipolar disorder or alcohol use problems

• Having a family member who died by suicide

• Having a family with major communication and relationship problems

• Having experienced recent stressful life events such as parental divorce or the death of a loved one.

Complications

Untreated depression can result in emotional, behavioural and health problems that affect every area of the teenager’s life. Complications related to teen depression may include:

• Alcohol and drug misuse

• Academic problems

• Family conflicts and relationship difficulties

• Suicide attempts or suicide.

How is teen depression diagnosed?

For proper treatment, it is recommended that a psychologist or psychiatrist perform a psychological evaluation, asking the teen a series of questions about their moods, behaviours, and thoughts.

The evaluation should also take into account the teen’s family history, school performance and comfort in peer settings.

A physical examination may also be used to help rule out other causes of their feelings. Some medical conditions can also contribute to depression.

Medications are used to treat teen depression

Just as depression has no single cause, there is no single treatment to help everyone who has depression.

It can take time to determine which one works best.

Treatment for adolescents with depression is usually a combination of medication and psychotherapy.

Numerous classes of medications are designed to alleviate the symptoms of depression.

Psychotherapy for teen depression

Teens with depression should see a qualified mental health professional before or at the same time as starting medication therapy.

Psychotherapy has been found to be effective for treating depressed teens, those who have turned to substance abuse and those who are engaging in self-destructive behaviour.

Cognitive behavioural therapy or interpersonal therapy (IPT) during psychotherapy sessions can help by replacing negative thoughts and emotions with good ones.

In IPT, the aim is to strengthen personal relationships by improving communication and problem-solving skills.

Parents or caregivers will participate in select sessions.

What’s normal and what’s not

It can be difficult to tell the difference between ups and downs that are just part of being a teenager and teen depression. Talk with your teen. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming.

When to see a doctor

If depression signs and symptoms continue, begin to interfere in your teen’s life, or cause you to have concerns about suicide or your teen’s safety, talk to a doctor or a mental health professional trained to work with adolescents. Your teen’s family doctor or paediatrician is a good place to start.

Or your teen’s school may recommend someone.

Depression symptoms likely won’t get better on their own – and they may get worse or lead to other problems if untreated.

Depressed teenagers may be at risk of suicide, even if signs and symptoms don’t appear to be severe.

If you are a teen and you think you may be depressed – or you have a friend who may be depressed – don’t wait to get help.

Talk to a healthcare provider such as your doctor and school nurse. Share your concerns with a parent, a close friend, a spiritual leader, a teacher or someone else you trust.

When to get emergency help

Suicide is often associated with depression. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Prevention of teenage depression

There is no sure way to prevent depression. However, these strategies may help. Encourage your teenager to:

• Take steps to control stress, increase resilience and boost self-esteem to help handle issues when they arise

• Practice self-care, for example, by creating a healthy sleep routine and using electronics responsibly and in moderation

• Reach out for friendship and social support, especially in times of crisis

• Get treatment at the earliest sign of a problem to help prevent depression from worsening

• Maintain ongoing treatment, if recommended, even after symptoms let up, to help prevent a relapse of depression symptoms. – June 27, 2022.

* Dr Azhar Md Zain reads The Malaysian Insight.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.