Your brooding teen: Just moody or mentally ill?

Irritable and angry
One one reason parents may not recognize depression in their teenagers is because depression expresses itself so differently in teens, experts say. Changes in sleeping and eating habits are a red flag, as with adults. But while depressed adults are sad and melancholy, depressed teens are angry and irritable. Adults may say they don’t enjoy things anymore; teens may still enjoy activities but not look forward to them. They often say they’re bored, and can be indecisive, giving a lot of “I don’t know” answers.

Sharon Fawcett, a mother of two teenagers in New Brunswick, Canada, had struggled with depression herself for almost a decade, so she was always on the lookout for signs of the illness in her daughters. But, she said, she completely missed the disease in her younger daughter.

“Jenna started telling me she was depressed when she was 14, but to me, she was just laying around and being lazy, and using this as an excuse,” Fawcett said. “I thought: she’s not depressed, she’s angry and she’s moody. I just thought it was the stereotypical adolescent moodiness and negativity.

“The thing that confused me about my kids — and I’ve heard other parents say this — is how they can be so happy when they’re out with their friends, and as soon as they come home they’re depressed and angry and not speaking with us. I’ve learned since then that kids reserve their anger for the people they know they’re safe with.”

Guide Diagnosing depression Depression is a serious illness that comes in many forms with a variety of symptoms. Learn what they are. msnbc.com

For a while, Fawcett attributed her daughter’s dressing in black, listening to heavy metal music and hiding her face behind long bangs and a hooded sweatshirt to teen fashion and old-fashioned rebelliousness. But by the time Jenna was 16, she had developed acute social anxiety, had difficulty concentrating and was refusing to go to school. She missed 100 days of school one year and failed most of her courses.

The dramatic change in performance for the girl who had been an honor student finally convinced Fawcett her daughter needed help. She consulted the family pediatrician, who referred her to a psychiatrist for a combination of talk therapy and medications, which have been very effective.

“The school failure was the most obvious identifying symptom,” Fawcett said.

A clear red flag
Experts agree that irritability and moodiness that keep a teenager from functioning normally for more than two weeks should be clear red flags. Ditto for withdrawal from activities and social isolation from friends. Other warning signs parents should look for are substance abuse, which is often a form of self-medication, and cutting, or self-injury, which can be a precursor to suicide.

“Parents will often let this go at least two weeks or more because they’re convinced it’s just a phase, even though if their child had a rash, they wouldn’t ignore it,” said Koplewicz.

The good news, he said, is that teenagers respond to targeted treatment, such as psychotherapy either with or without medication.

“The nice part is that we see dramatic turnarounds with kids, often in four to eight weeks. We believe wholeheartedly that we can change the trajectory for these kids if we nip it early.”

Roni Caryn Rabin is a health writer who lives in New York City. She has written for The New York Times, The Washington Post, Newsday and Real Simple magazine, among other publications, and is author of the book, "Six Parts Love: A Family's Battle with Lou Gehrig's Disease." She teaches journalism at the Columbia University Graduate School of Journalism.

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