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The wintertime blues hit many adults after the holidays. The skies are gray and the calendar deplete of special celebrations.

But adults aren't the only ones subject to depression. Children and teenagers are, too.

The percent of Tennessee adolescents and teenagers who have experienced sadness, depressive episodes or suicidal thoughts and attempts has gone down in the past several years, according to the 2013 Data Book published by the Tennessee Department of Mental Health and Substance Abuse Services.

That, in part, may be because community leaders have put a focus on early identification of children with interpersonal problems as a result of the high level of school violence throughout the country, said John Page, a licensed advance practice social worker and chief operating officer for specialty programs for Centerstone behavioral health care organization.

Still, the issue of teenage depression should not be overlooked. About 11 percent of adolescents have a depressive disorder by age 18, according to a survey cited by the National Institutes of Mental Health.

"We just have to be aware that the teenage world can be just as treacherous as the adult world," Page said.

Mislabled moodiness

Depression can be difficult to diagnose in teens because it may be seen as typical adolescent moodiness.

"Sometimes symptoms of depression in teenagers look different than symptoms in adults, and sometimes adults miss it," said Dr. Todd Peters, assistant chief of staff for Vanderbilt Behavioral Health. "Sometimes parents or teachers mislabel it as just getting anxiety and being a teenager."

It can be a struggle for adults to believe teenagers have issues heavy enough to cause depression.

"Adults think all kids have to do is go to football games and have slumber parties," said John Page with Centerstone behavioral health care organization. "They forget teenagers have the same kind of pressures we have, and we respond the same way. ... They feel the gravity that adults do; it's like, 'I am in a no-win situation. There is no way out of this for me. I feel the weight of the world on me.'

"Parents can be disconnected from the fact that their kids can feel just as down and depressed about their world as adults do."

Teens also may not understand or express their feelings very well, or may not be aware of the symptoms of depression and may not seek help.

Parents also can be "blindsided," Peters said, because teens hide their feelings.

"Oftentimes really great parents may miss it because a lot of kids do a great job keeping this under the radar," Peters said. "Kids are bright and wanting to do well, so they keep it under the radar until they can't take it anymore."

Recognize the signs

Teenage depression is a serious problem that calls for immediate medical treatment.

These symptoms may indicate depression, particularly when they last for more than two weeks:

Poor performance in school

Withdrawal from friends and activities

Sadness and hopelessness

Lack of enthusiasm, energy or motivation

Anger and rage

Overreaction to criticism

Feelings of being unable to satisfy ideals

Poor self-esteem or guilt

Indecision, lack of concentration or forgetfulness

Restlessness and agitation

Changes in eating or sleeping patterns

Substance abuse

Problems with authority

Suicidal thoughts or actions

Don't be afraid to ask

Many parents and caregivers believe that if they ask a child or teenager whether they are having thoughts of suicide, then the child is more likely to act on those thoughts.

That's not true, said Dr. Todd Peters, assistant chief of staff for Vanderbilt Behavioral Health.

"Not asking is not making it go away," Peters said. "It actually could add to higher likelihood."

Directly saying: "You're depressed," might not be the best approach, Peters said, because most likely they will vehemently deny it.

So, Peters said, encourage more thoughtful, open communication: "I am noticing these things are happening and I am wondering if you are struggling with things. Is there something you and I need to do together to make it better?"

Be responsive

Sometimes families get into trouble, said Dr. Todd Peters, when a child does approach a parent or caregiver asking for help because they feel low and the parent response is: "You'll be fine. Suck it up. It will get better."

"If they are coming to you saying they need help, start noticing," Peters said. "And if their life is spinning out of control, step in, even if the kid is not asking for help."

Girls show more depression than boys

Numbers show that a higher percentage of girls experience depression.

John Page, a licensed advance practice social worker, believes that may be in part due to social pressures girls feel during their development stage at ages 11, 12 and 13.

"Boys and others look at them differently," Page said. "They are very concerned about their body image, about interpersonal relationships and being accepted by others."

Boys don't go through that to the same extent, Page said. "Girls are two or three years ahead of boys in terms of pressures," he said.

In the early teen years, however, neither sex is prepared emotionally to deal with this.

"With so many pressures on them and so little skills about how to interact and solve (their) own problems they can become more isolated," Page said, "and when they become more isolated they become more stressed out and depressed about their situation."

Depressive episode

A person is considered to have experienced a major depressive episode if he or she has had at least five or more of the following symptoms nearly every day in the same two-week period where at least one of the symptoms is a depressed mood or loss of interest or pleasure in daily activities.

• Depressed mood most of the day

• Markedly diminished interest or pleasure in all or almost all daily activities

• Significant weight loss when not sick or dieting, or weight gain when not pregnant or growing; decrease or increase in appetite

• Insomnia or hypersomnia

• Psychomotor agitation or retardation

• Fatigue or loss of energy

• Feelings of worthlessness

• Diminished ability to think or concentrate, or indecisiveness

• Recurrent thoughts of death or suicide ideation

Source: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition

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