Depressed or not in the mood?
Emptiness and sadness have been familiar to 16-year-old Jakob ever since he moved from primary to secondary school. To get rid of it, he starts smoking pot. Later, the boy repeatedly turns up to class drunk. When a guidance counsellor confronts him, Jakob first denies being drunk and then starts crying.
His life was completely messed up and hopeless. He had no idea what to do after school. And yes, he was thinking about taking his own life. The teacher immediately calls Alain Di Gallo. The Director of the Clinic for Child and Adolescent Psychiatry in Basel is alarmed. «I summoned Jakob and his mother to the clinic that very evening,» he recalls.
For the psychiatrist, everything points to depression.
There, the boy explains that his parents have been separated for five years. His mother explains that she has suffered greatly from the unexpected departure of her husband and has hardly been there for her son. Jakob is convinced that his friends no longer like him either. He has withdrawn more and more and immersed himself in drawing comics. For the psychiatrist, everything points to depression.
Approximately one child in every school class suffers from depression that requires treatment.
There are many stories like Jakob's. In the Swiss SMASH study from 2002, 35 per cent of girls and almost 20 per cent of boys surveyed stated that they were sad and depressed more often. «Only a fraction of them end up with depression that requires treatment,» reassures expert Di Gallo. Around three per cent of children and five per cent of adolescents, i.e. around one person per class, suffer from it. The fatal thing is that the symptoms often go unrecognised - especially when they coincide with the onset of puberty. Parents then find it difficult to recognise whether their offspring is locking their bedroom door because they are distancing themselves from them - as is perfectly healthy at this age - or because they are seriously ill.
Are they just adolescent mood swings?
«Occasional low moods and fluctuating self-esteem during puberty are completely normal,» says Di Gallo, adding that this phase of life is also a time when mental disorders develop more frequently. «Negative thoughts about oneself,» says Di Gallo, «can be a building block for the development of depression.» A study by the University of Zurich has shown that adolescents react particularly quickly to negative feedback. This could explain why adolescents take everything so much to heart.
During puberty, the brain resembles a large construction site.
During puberty, such negative feelings fall on particularly fertile ground. Now the brain resembles a large construction site: unimportant nerve connections are cut, important ones are expanded. Not all parts of the brain develop at the same rate. The limbic system and the amygdala - both brain structures that encode reward and emotions - develop faster than the forebrain. This in turn has a controlling function, i.e. it reminds us of order and rules.
The ultimate kick
This imbalance makes adolescents susceptible to risky behaviour. Young people race around on mopeds, try drugs, get drunk and change sexual partners - always in search of the ultimate thrill. «The threshold at which a stimulus provides a feeling of reward is higher in adolescence than in adulthood,» explains the 55-year-old expert. «Adolescence is like a car with a lot of horsepower that young people can start but not yet steer safely.»
What are the symptoms?
Developments like Jakob's are typical for boys. They break rules at school and in public, take more risks in sport or road traffic. Girls, on the other hand, are more likely to self-harm and are prone to eating disorders. Psychiatrists and psychologists have clearly outlined the criteria for depression. «If adolescents withdraw from friends, school and family for at least two weeks at a time, neglect their leisure activities and are unusually depressed, we have to assume that they are in a depressive phase,» says expert Di Gallo. Unlike their peers, they then no longer get out of bed, refuse to go to school and break off contact with friends.
Depression is primarily diagnosed on the basis of symptoms.
Nevertheless, the diagnosis is not always easy: «There are no clear laboratory values or signs of the brain on MRI,» explains clinic director Di Gallo. Depression is primarily diagnosed on the basis of the symptoms. In addition to the severity of the symptoms, the decisive factor is the time factor: the feeling of emptiness simply won't go away.
Who is particularly at risk?
Studies show that children who grow up in difficult social conditions are more at risk of mental illness. Genetic predisposition also plays a role. If one parent is depressed, the child's risk of becoming ill increases to 20 per cent; if both parents are affected, the risk increases to 50 per cent. «However, genetic predisposition is not solely responsible for the development of depression,» emphasises Di Gallo. External factors must be added to the internal factors. One of the most common reasons is parental separation. At a time when emotions are on a rollercoaster, stable relationships are particularly important. Jacob also needed his father - to deal with him as an adolescent and to identify with him as a man.
Foetuses are already under the influence of stress hormones during pregnancy.
Researchers now also understand better and better that experiences in infancy and early childhood can trigger depressive crises in adolescence. «Traumatic separations or neglect in early childhood can have lasting effects on development,» confirms Di Gallo.
Sometimes the triggers go back even further. Even during pregnancy, foetuses are under the influence of maternal stress hormones such as cortisol via the placenta. Prenatal stress permanently raises stress hormone levels in the unborn child and accelerates brain maturation, neurologists at Jena University Hospital have discovered. Stress during pregnancy is therefore considered a risk factor for later depression.
Are young people more depressed today than they were ten years ago?
Expert Di Gallo is sceptical. Today, depression is more in the spotlight, has become more socially acceptable and is therefore diagnosed more frequently, says the child psychiatrist. «Times are no worse than they used to be, but the challenges facing young people have changed.» Most children and adolescents are willing to achieve. However, some find it difficult to fulfil their own expectations and feel stressed as a result.
What role do smartphones and the like play?
The new media are also partly to blame. Take cyberbullying, for example : people used to whisper behind closed doors. Today, insults and rumours spread anonymously and rapidly online. Around five per cent of all Swiss minors experience severe bullying - a frequent risk factor for depression.
The use of electronic media changes the entire day and night rhythm.
Constantly playing on mobile phones also changes social behaviour. Instead of playing football with three or four real friends on the sports field or meeting up for a shopping trip, young people socialise with a few hundred friends - behind closed doors. Constantly tapping away on their smartphones or screens changes their day and night rhythms. «Excessive night-time use of electronic media is a risk factor for sleep disorders and depression,» explains Susanne Walitza, Director of the Department of Child and Adolescent Psychiatry at the University of Zurich. Sleep disorders themselves can be a symptom of depression, but can also favour the development of depression.
«Early diagnosis and consistent intervention are important»
Susanne Walitza, Director of Child and Adolescent Psychiatry at the University of Zurich
However, these risk factors can be positively influenced, says the expert. «Parental affection, clear boundaries and a structured daily routine in childhood and adolescence are preventative.» They cannot always prevent mental illness. Recognising at an early stage whether a young person is slipping into depression requires the attention and help of everyone around them: friends, parents and teachers. This is because, unlike previously thought, depression and other mental illnesses do not simply grow out of control. «Early diagnosis and consistent intervention are important,» explains Walitza. «Otherwise, the long-term prognosis can deteriorate significantly.» Studies show what happens if the therapeutic opportunity is missed during puberty: Four out of five mentally ill adults were already mentally unstable as adolescents.
«It's typical for depressives to often see everything in black and judge it negatively»
Susanne Walitza
The treatment of adolescent depression hardly differs from that of depressed adults, explains Walitza, as the symptoms are also very similar. «The first step is to educate the adolescents about the illness.» In the case of mild disorders, he says, talking and behavioural therapy helps, supported by medication in more severe cases. «It's typical for depressives to see everything in black and judge everything negatively,» explains the child and adolescent psychiatrist. «In therapy, we put events and feelings into a realistic context.» If someone has a B in maths, they are not a school failure. If his girlfriend leaves him, it doesn't mean that the boy will never have a partner again.
Learning to trust yourself
The therapists also help to eliminate triggers. Take bullying , for example : «We get in touch with the school and think together about how to deal with the situation,» says Walitza, herself the mother of a teenager. Sometimes talks are held with perpetrators and victims, sometimes entire classes, including parents, are trained. And sometimes a change of school is recommended. «The central aim of therapy is always to strengthen the child and guide them to trust in their abilities and skills,» emphasises the expert.
An inpatient stay can also be helpful. Simply getting away from the depressing environment, away from the sad thoughts and brooding. The 47-year-old attaches great importance to not simply releasing the children after therapy. «It has to be clear how things will continue at home and school and where therapy can be continued on an outpatient basis.»
And Jacob?
The boy turned down the professor's offer to stay in the clinic. «Three weeks later, he contacted us again because the inner tension had increased,» says Alain Di Gallo. Jakob was then ready for outpatient therapy. During this, he realised how much his father had hurt him by leaving and breaking off contact - and that he wanted to meet up with him.
The reunion gave him the opportunity to hurl all his anger at his father. At the same time, it was the beginning of a new relationship. Today, Jakob is studying communication design. And the depression is a past episode in his life.
