Rhea is a 13 year old child studying in an IB school. When Rhea first came in for therapy she spoke about feeling empty and that nothing was making sense. She felt quite alone and didn’t feel like speaking to anyone. She would often spend her lunch break alone these days. While Riya was part of the school football team, she hadn’t been going for practise for nearly a month. There were times when Rhea’s mother would force her to go, but she was always feeling exhausted. There are times Rhea feels overwhelmed and cries, and just doesn’t want to talk to anyone. She experiences a lot of irritability and ends up snapping at those close to her. But then feels guilty. She believes it would just be better for everyone if she goes away.

Experiences similar to that of Rhea’s are on the rise in children and teenagers, but mental ill health is often misunderstood or ignored. Misconceptions are rampant about presence of mental health problems in this age group. Statements like ‘what do they have to feel sad about’ and ‘everything is great in their life’ are used as substitutes to gently exploring any need for help. What adds to the complexity of teenage mental health problems like Depression is that the teenage years are a turbulent time characterized by developmental changes in the brain influencing emotions and behaviour. Parents are often at loss about what can be considered developmentally appropriate changes and what could be Depression. So this leads us to the question of what does Depression
look like in teenagers?

Depression is not occasionally feeling sad or being irritable or angry. It is not a temporary and transient state. According to the Diagnostic and Statistical Manual (DSM V), it is perpetuating feeling of sadness or irritability, and/ or lack of interest or finding pleasure in activities that lasts for atleast 2 weeks. Teenagers experiencing Depression will also show a combination of some of the following:

•  Increase or decrease in weight / change in appetite
• Increase or decrease in sleep
• Feeling tired or lacking energy
• Difficulty concentrating or making decisions, slowing down of thought
• Feelings of worthlessness or guilt
• Thoughts of death or suicide, self-harm
• Unexplained physical symptoms like headaches, stomach aches etc.
• Frequent absenteeism from school
• Irritability and tantrums

What should be highlighted is these symptoms cause disruptions in the teenager’s functioning at school, home, in social settings or in any other areas of their life.

But why is Depression occurring in our teenagers? One aspect of it is biological understanding of Depression that there are lower levels of neurotransmitters like serotonin which are required to regulate mood. Adverse or stressful life circumstances also play a part where teenagers exposed to abuse, violence & conflict, bullying, social isolation, educational setbacks, stress at school/ home are more at risk of experiencing Depression. A growing trend of ‘perfection’ as the accepted norm is also harmful. Teenagers today are expected to meet all the checkboxes of being ‘the perfect child’ – whether this is getting good grades, participating in extracurricular activities, thriving in sports, being
popular or accepted amongst peers, topped with the expectation of getting into a great college.

With increased pressure related to being all-rounders, feelings of unworthiness and guilt can increase and teenagers are more at risk of developing mental health problems.

While there are varied social, economic, biological, and psychological factors that are linked to depression, the pressing need for providing access to psychological or psychiatric help for Depression cannot be denied. The National Mental Health Survey (NMHS 2015-16) provides data that the prevalence rate of Depression in 0.8% (CI 0.3 – 1.4) of teenagers between the ages of 13 – 17 years in India. Early identification and introduction of interventions can help in better prognosis
and treatment. It is time that this invisible illness is recognized and teenagers suffering from it are given the help they need.

- By Tejaswi Shetty, Psychologist, Narayana Health – SRCC Children’s Hospital.