Interview with Will & Megan

As Will D. entered his teens, something inside him began to change. The once-easygoing student from Washington, D.C., became more anxious. His tension "was the kind that just sits in your stomach, as if you're really nervous about something," he recalls. "It was like that all the time." Back then, Will had nothing to be nervous about. But his anxiety continued to deepen, eventually morphing into a depression that struck him at the age of 15.

Will's anxiety was mixed with intense feelings of being down and an inability to control those feelings. "I was constantly tired; I had no motivation to leave my bed or my room. I felt like I was constantly worried but didn't know what about," he now says. Will began to avoid school because it was stressful. Months went by, and still he couldn't snap out of his mood. Will's mother noticed the change and the signs of depression, because she has it too. "She recommended that I go to a doctor," says Will.

"Although every teen sometimes feels down, clinical depression is different. Unlike a short-term funk after getting a low test score (you got over it, right?) or being cut from the team, full-fledged clinical depression comes with overwhelming feelings of being down for weeks or months. There is no break. An upsetting life event can trigger it, but for many, depression is an uninvited and persistent companion.

Diagnosis: Misery

One in every eight teens suffers from clinical depression, according to the Center for Mental Health Services. Affecting about 2.5 million people under age 18 in the United States alone, depression cannot--and should not--be ignored. Untreated, it can lead to more severe consequences, including suicide. In fact, suicide is the third leading cause of death in people between the ages of 15 and 24.

How do you know if you're clinically depressed? If you feel so low that nothing interests you; if you feel like your mood has flat-lined; if you're always tired; if unreasonably dark feelings last for more than a few weeks, think depression, says Dr. David Fassler, an adolescent psychiatrist at the University of Vermont College of Medicine. But he adds that depression in teens can surface in different ways, usually with no single, obvious symptom.

That wasn't the case with Megan M., now 20, of Washington, D.C. Megan says that she'd been living for years with uncontrollably sad feelings and anxiety. Still, her depression wasn't diagnosed until she was 14 and her parents noticed self-inflicted cuts on her arm. "I was in a deep, dark place," she now says. Megan explains that she couldn't control the feelings, but she could control the amount of pain she inflicted on herself. In her mind, the cutting was like a bizarre self-therapy to deal with a problem she didn't understand.

Because teen depression takes such different forms, it can easily be missed. However, self-destructive behaviors, such as "cutting," can sometimes spring from an underlying depression. So can drug or alcohol addiction or eating disorders. Teens driven by unshakable depression may do desperate things to try to escape their dark moods, explains Fassler, who is also the author of Help Me, I'm Sad: Recognizing, Treating, and Preventing Childhood and Adolescent Depression.

Depression has a strong genetic component. (In Will's case, relatives on both sides of his family have been depressed.) This component leads to differences in how the brain works and responds to stress, making a person susceptible to feeling down and out--and getting stuck in that mode. In addition, levels of certain brain chemicals are out of kilter in someone with clinical depression. "Medications are designed to help restore the balance," adds Fassler. But depression is not anyone's fault. Instead, says Fassler, it is a medical condition, and it is treatable. In fact, "70 to 80 percent of teens respond to therapy," he says.

Personal experience also plays a role. Violence, sexual abuse, the recent death of someone close, neglect, bullying--all of those factors increase the risk of developing depression, says the National Institute of Mental Health.

Getting Well

There are two main types of treatment for depression: medication and talk therapy. Several types of antidepressants are available, but it's impossible to say which will work best for a person. "Not everyone responds to the same medication," says Fassler. Working carefully with a doctor you see regularly, you may have to try different treatments until you find the right one. But the process takes time.

That's what Will discovered as he tried different drugs that didn't work for him. At 17, he felt so down that he overdosed on his antidepressant in an attempted suicide. Eventually, Will got on the right medication, and within a few weeks he experienced a huge improvement in his mood. Will is now 21 and his depression is under much better control. He advises teens with depression to be persistent. When you start on the path to recovery, "you have to be prepared for the pills not to work," he says.

In talk therapy, a person with depression meets one-on-one with a trained therapist, like a psychologist, psychiatrist, or psychiatric nurse, or in group sessions moderated by a therapist. Talk therapy helps depressed teens learn new ways to think through problems and literally exercises parts of the brain to improve mood. The coping strategies can be slow to sink in, and sometimes teens need to try different therapists for the right fit. According to Fassler, many teens get the most help from a combination of medications and talk therapy, though some do well with either approach alone.

Getting Help

Depression is a chronic disease; it's long lasting or frequently recurring. Megan's friends found it hard to understand that aspect--that she couldn't just snap out of it. Will suggests a person with depressed friends "be supportive and try not to get frustrated with them .... Getting upset is an easy way to make them feel more isolated and unmotivated to try to get better."

If you have anxiety or depression that won't go away, seek help. "The good news is that treatment does work," Fassler says. Talk to family members or a guidance counselor, school nurse, or teacher. You can also speak with your family doctor or someone at a local teen clinic. Make sure the person understands that your problem isn't a passing phase. "Don't be shy about getting help," urges Will. "It's an illness like any other, not to be ashamed of."