Depression and anxiety in adolescents: differences and causes

What is depression?

Depression, according to the Diagnostic and Statistical Manual of Mental Disorders, is a mental disorder characterized by a depressed mood accompanied by feelings of sadness, emptiness or irritability in younger people (children and/or adolescents), as well as loss of interest or pleasure in all or almost all activities most of the day or almost every day. Often, we observe that depressive symptoms are accompanied by problems of insomnia, weight loss or difficulty in gaining weight in children, as well as agitation, fatigue or loss of energy, feelings of worthlessness, difficulty in concentrating, thinking or making decisions.

In many cases it is accompanied by recurrent thoughts of death. Depression affects the way a person, whether adult, young adult, adolescent or child, thinks, feels and acts, causing emotional, functional and physical problems in the person, and causing clinically significant distress or impairment in social, occupational or other important areas of functioning.

What about anxiety?

According to the WHO, anxiety is a normal emotional reaction to threatening situations. In this sense, normal anxiety is that which helps us to function better in life, prepares us to act and/or respond to the demands of the environment or to situations where we have to respond in order to survive. It would be the one that allows us to act quickly if we see a car approaching us, so we would react by moving away. However, anxiety becomes pathological when it prevents us from acting adaptively or causes us significant discomfort.

Anxiety disorders are characterized by the feeling of excessive fear and worry, in the form of an anticipatory response to a future threat, as well as behavioral alterations that are associated with this threat, whether real or subjective. Anxiety disorders are differentiated according to the type of objects or situations that induce fear, anxiety or avoidance behaviors, and according to the thoughts associated with these situations.

People who develop a generalized anxiety disorder may have problems sleeping, muscle pain caused by constant anxiety. They may have problems or discomfort in the digestive system, such as dry mouth, heavy digestions, gas, diarrhea or constipation. In addition, you may notice tachycardia, choking sensation, weak legs and tremors, among other things.

How do they differ?

The difference between anxiety and depression lies not only in the symptoms, but also in the temporal moment, because while anxiety is characterized by excessive worry and is related to the person’s fear of the future, depression has more to do with a feeling of deep sadness in the present moment. Both conditions can be compatible, since a person can present more depressed symptoms and, at the same time, an anxious condition of worry and fear for the future.

How do they affect adolescents and are they able to manage it in the same way as an adult would?

As we know, the symptoms of depression are different in childhood than in adulthood, because while children usually present more physical discomfort, fear and agitation, adolescents tend to show emotions related to irritability and behavioral problems, aggressiveness and restlessness. They may also have intense feelings of sadness, hopelessness and frustration that make it difficult for them to lead a normal life. In addition, they may have trouble concentrating and lack of motivation. Therefore, emotional management is different in cases where irritability is evident and where the person has not yet reached maturity at the cerebral level, as it is still in the process of maturational development.

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Why is an early diagnosis of these disorders important?

Currently we find that mental disorders represent 16% of the problems in adolescents, with the onset of symptoms being around 14 years of age, or earlier. However, in most of these cases there is no intervention. In this regard, depression is one of the leading causes of disability among adolescents worldwide and suicide is the third leading cause of death in young people aged between 15 and 19 years, according to the Spanish Council for the Defense of People with Disabilities and/or Dependency in the Conference on mental health “Early detection of mental disorders in young people”. Therefore, when depression is suspected in adolescents it is mandatory to act immediately, since early detection of mental disorders is essential to prevent suicide in this group, as well as to promote quality of life and that young people can have a healthy adult life.

What are the main causes of depression and/or anxiety in young people?

Among the many factors that increase the risk of developing depression in adolescents are poor social adjustment with the peer group accompanied by poor social skills and poor self-concept, conflicts with peers, prolonged bullying or academic problems. We also find lack of parenting and parenting skills in fathers and mothers, lack of communication in the family environment or problems in family relationships.

In general terms, depression is caused by the interaction of certain biological factors (hormonal changes, alterations in brain neurotransmitters such as serotonin, noradrenaline and dopamine, genetic components, etc.), with psychosocial factors (stressful circumstances in affective, academic or relationship life) and personality factors (especially psychological defense mechanisms).

We have observed in recent years that parental academic expectations, “over-demands” and authoritarianism in the family environment or a more “laissez-faire” style, can cause many ups and downs in adolescents.

How can we realize that something is wrong? What treatments are recommended?

Excessive sleeping, much more than the usual tiredness, or spending too much time in bed may indicate depression or substance abuse; difficulty sleeping, insomnia and other sleep disorders. Loss of self-esteem; withdrawal or loss of interest in pleasurable activities. Low and unexpected change in academic performance.

Among the “Warning Signs” of mental health problems that parents should be on the lookout for are:

  • Excessive sleeping, difficulty sleeping, insomnia and other sleep disorders.
  • Loss of self-esteem.
  • Low and unexpected change in academic performance.
  • Loss of weight and appetite.
  • Binge eating (sign of possible anxiety).
  • Abrupt changes such as aggressiveness and excessive irritability.
  • Unexpected crying.
  • Abandonment or loss of interest in pleasurable activities (Anhedonia).
  • Apathy.
  • Expressions of hopelessness or worthlessness.
  • Isolation.
  • Signs of self-harm (Self-injury).
  • Obsessive preoccupation with physical image.
  • Abandonment of friends and social groups.
  • Outbursts.
  • Not feeling good about him/herself
  • Lack of confidence in him/herself or others.
  • Anxiety and/or nervousness.