Sunday, July 28, 2013

All depression is not created equal.

In the past few weeks, I have shared research findings on some light-hearted topics; puppies, email etiquette, sunscreen. This week, I’m going to hit you with something a bit heavier. Bear with me, it’s important.  

Depression is an illness defined by at least two week periods of either sad/low mood or loss of pleasure/interest in previously enjoyed activities. In addition, depression is characterized by at least 4 of the following symptoms: difficulty falling or staying asleep, sleeping way too much, tearfulness, low self-esteem, feeling excessive guilt, slowed down movement, feelings of worthlessness, difficulty concentrating, suicidal thoughts, feeling fatigued, and significant weight loss or gain.

Unfortunately, depression is ubiquitous in our society.  Previous research suggests that as many as 30% of all people will experience a depressive episode in their life.  So, chances are you will come face-to-face with depression; whether that is you or someone you care about. But depending on your age, depression may look different, come with different risks, and have different consequences for the rest of your life. Many people have looked at developmental differences in depression before. For example, we know that after puberty, depression is twice as common among females. We also know that the symptom of depressed mood among children who are experiencing depression is more likely to look like irritability than sadness. But in general, we don’t know how the lives of depressed children differ from the lives of depressed teenagers or young adults.

Early this year, Dr. Paul Rohde of the Oregon Research Institute and his colleagues published the long-awaited results of a prospective longitudinal study on depression across development. In this study, his research team was determined to understand whether depression has the same impact on a life if it hits at different stages of development. In other words, they wanted to know:

Is depression just depression, regardless of age?

To complete this study, the research team conducted very long and very thorough psychiatric assessments of 816 youth. The youth were assessed at the beginning of high school, and then re-assessed at the end of high school, at age 24, and at age 30.  They were interested in whether experiencing your first depressive episode at different stages of development was related to gender, length of illness, suicidal thoughts, rates of co-occurring disorders, and rates of recurring episodes. The stages of development they were interested in were childhood (ages 5-13), adolescence (ages 13-18), emerging adulthood (18-24), and adulthood (24-30). Here’s what they found.

Throughout the entire study, 64% of all participants experienced at least one depressive episode.  Five percent of all participants experienced their first depressive episode during childhood, 19% experienced their first depressive episode during adolescence, 24% experienced their first depressive episode during emerging adulthood, and 16% experienced their first episode during adulthood.

The important developmentally specific findings were that participants who experienced their first depressive episode during childhood were much more likely to have recurring depression throughout the rest of the study and were much more likely to have co-occurring disorders such as substance abuse problems and anxiety later in life. They also found that while depressive episodes during adolescence and adulthood lasted between 24-28 weeks, depressive episodes during childhood lasted for an average of 69 weeks. That’s more than an entire year!. In addition, they found that participants who experienced a depressive episode during adolescence were at least twice as likely to make a suicide attempt (19%), especially if they were female. Finally, emerging adulthood was the developmental period with the highest risk for developing depression.  

This research is important to all of us, but particularly for parents who are on the front lines of this fight with depressive illness. People used to think that it was impossible for children to have depression, but we’ve come a long way in the past 20 years. This study shows us that about 1/20 children do develop depression before they turn 13. That’s one child in every elementary school classroom. Furthermore, their depression lasts longer than it does in adults, and these children continue to experiencing depression and other problems for the rest of their lives. I can’t help but wonder whether these findings are just a consequence of not effectively addressing and treating these kids. Luckily, by looking for two week periods of irritability, tearfulness, low self-esteem and the other symptoms, we can take steps to put a stop to this life-long trajectory by getting the child involved in cognitive behavioral therapy.

This study also emphasizes that depression during adolescence comes with twice the risk of suicide as any other developmental stage. This occurs largely because thoughts of death and hopelessness are common in depression, while impulsivity is normative for adolescence. If you are a parent, consider protecting your child from their own impulsivity by making medicines hard to get to (Tylenol is one of the most dangerous medications you have in your cabinet), lock up your fire arms, and be cautious with the sharp objects you have around the house. Just as important, don’t reject or punish your teen for sharing thoughts about suicide or death. Listen, develop a safety plan, and help them find help. You won’t stop the thoughts, you will only stop your child from talking to you about them.

As for emerging adulthood, we now know that college-aged individuals are at the highest risk for developing depression.  In this study, 28% of participants experienced a depressive episode during these years. The stress of being between adolescence and adulthood can really be overwhelming; this age group experiments for the first time with alcohol and recreational drug use, has poor eating and sleep habits, and often is under a great deal of stress making decisions about their future. If you are a college student, watch out for the symptoms of depression, find ways to take better care of yourself (here’s one), make time to relax, and get help early at your campus mental health clinic. There’s hope.

Rohde, P., Lewinsohn, P. M., Klein, D. N., Seeley, J. R., & Gau, J. M. (2013). Key characteristics of major depressive disorder occurring in childhood, adolescence, emerging adulthood, and adulthood. Clinical Psychological Science, 1(1), 41-53.

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