Why does exam stress or a poor report card drive a handful of children to suicide and not thousands of others in identical situations? Blaming mind-breaking syllabi and over-ambitious parents is oversimplifying the issue, say experts, pointing out that many adolescents who take the extreme step of ending their lives have undiagnosed or underlying depression.
“The suicides reported are really the tip of the iceberg; for each successful suicide, there are 10 attempted but failed ones. It’s a well documented fact that those who succeed in committing suicide have indicated their intentions. But in most cases, the cry for help has gone unheeded,” says Dr Rajesh Sagar, associate professor of psychology at the All India Institute of Medical Sciences.
In India, as many as 12.8 per cent adolescents suffer from a psychiatric disorder, says the Indian Council Of Medical Research. Of these, about 3-4 per cent have clinical depression. During adolescence, girls are twice as likely as boys to develop depression as they undergo far more hormonal changes at that age.
Stress alone doesn’t cause depression. Among the multifactorial causes are hereditary, personality and environmental factors, particularly in adolescence. “Teenagers are almost constantly stressed: first it’s the fear of Board exams, then results, followed by college admission, finding a job and relationship issues. Any of these may cause a susceptible person to break down and slide into depression. What’s important is that when identified, depression is treatable like any other illness,” says Dr Sagar.
The reason why depression in children is often missed is because it does not always manifest itself as sadness, dejection and anhedonia, the medical word used to describe an inability to enjoy experiences that give others pleasure. “In adolescents, depression usually throws up behavioural symptoms, with irritability, stubbornness or defiance being the more common ones. The problem is that these symptoms may often be dismissed as mood swings typical of puberty,” says Dr Amit
Sen, child psychiatrist, Sitaram Bhartia Research Institute.
In still younger children like infants, the signs of depression are often screaming, restlessness, and weeping attacks for no clear reason. Pre-school children may behave irritably and aggressively, while schoolchildren may be listless and apathetic.
Yet, parents need not fear that the child’s occasional scuffle indicates clinical depression, substance abuse or violence. “Some conduct problems are normal. But if the child’s behaviour makes a parent question, “what happened to her?’, then depression may be the underlying cause,” says Dr Sen.
Depression in young people often coexists with other mental disorders such as anxiety and disruptive behaviour, or illnesses such as diabetes, reports the American Journal of Psychiatry. “Depressive adolescents may exhibit other psychological abnormalities, such as anxiety disorders and disorders in social behaviour occur widely, followed by aggression and bullying and substance abuse,” says Dr Sagar.
Counselling accompanied with anti-depressant medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) is very effective in treating severe and persistent depression in young people. Available studies, however, do not support the efficacy of tricyclic antidepressants (TCAs) for treating depression in youth.
But more than that, listening to and supporting an adolescent through the turbulent teens can help you identify early signs of depression and get it treated in time. “Parents and the immediate family should recognize the symptoms and offer support instead of being judgmental. If communication channels are left open, the child will turn to you in a crisis,” says Dr Sagar.