James Donaldson on Mental Health – Parents Guide to Co-occurring Substance Use and Mental Health Disorders (Pt.3)

The next few sections introduce adolescent mental health disorders, their symptoms and treatment, and substance issues that commonly co-occur with these disorders.

Depression is tough enough on its own, but the combination of substance use and depression in teens elevates the risk of self-harm and sometimes suicide. Teens and young adults who are depressed have chronic feelings of worthlessness and lose interest in things they previously enjoyed. While adults with depression may be sad and lethargic, depressed teens tend to be more irritable, restless and negative. The most common kind of depression is called major depressive disorder. This disorder is made of up severe episodes that last at least two weeks. Persistent depressive disorder has milder symptoms, but it may last for years.

Major Depressive Disorder

If your child has been in a consistent depressed or irritable mood or has lost pleasure in daily activities (or both) for at least two weeks, it’s possible he or she could have a major depressive disorder. These symptoms must be very different from previous moods or behavior in order to receive a diagnosis. Other signs of a major depressive disorder include:

• Marked weight loss or gain
• Sleeping too much or too little
• Restlessness, lethargy or fatigue
• Feelings of worthlessness or excessive or inappropriate guilt
• Cloudy or indecisive thinking
• A preoccupation with death, plans of suicide or an actual suicide attempt

Persistent Depressive Disorder

Persistent depressive disorder can be diagnosed when a young person is in a depressed mood or very irritable for most of the day for at least a full year. When a person has a persistent depressive disorder, the severity of the symptoms may vary, and sometimes can include episodes severe enough to meet the criteria for major depressive disorder.

When a teen or young person has depression, the thing parents tend to notice first is withdrawal, or when the teenager stops doing things he or she usually likes to do. Of course, teens often make radical changes that are completely normal — the key for parents is to notice when the change lasts for more than two weeks. That can be the main difference between normal teen angst and depression.

Treatment for Depression

Depression is sometimes treatable with therapy or medication alone, but experts agree that a combination including therapy and medication is usually the best approach.

Depression in young people is often treated with cognitive behavioral therapy (CBT) and other specialized evidence-based approaches. Interpersonal therapy (IPT) focuses on changing relationships in the child’s life, behavioral activation (BA) focuses on engaging in activities in order to improve one’s mood, and dialectical behavior therapy (DBT) focuses on helping to regulate emotions. As a parent or family member, you could be involved too. Family therapy is used to engage the family in helping to manage difficult symptoms.

Medications may include selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Parents should closely monitor their children when they’ve just begun taking medication, or when their dose has recently been changed. Antidepressants need to be taken daily as prescribed for at least 2-4 weeks to start being effective, and the dosage will likely need to be adjusted by a clinician.

Depression & Interaction With Substance Use

Adolescents with depression often use alcohol or drugs to dull their painful feelings and to cope with constant negative thoughts. It may work at first, but over time substance use makes depression worse.

Depressed teenagers know there’s something wrong with them, and they often turn first to the remedy peers may be offering: alcohol or drugs. But these substances, by affecting the reward centers of the brain — the same areas that are associated with depression — in turn, make them more depressed when they’re not using. Because of this, they’re quickly at risk for problematic substance use or addiction. Addressing only one issue will likely result in treatment failure; integrated care treats these co-occurring disorders as intertwined.

Alcohol use is especially damaging to depressed teenagers because it affects adolescents differently than it does adults. Rather than getting sedated with alcohol, as adults tend to be, adolescents get more energetic and are prone to engage in more risky behavior, including trying to harm themselves.