Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal
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Ask the expert
Children and youth

How do I know if my teenager is depressed or just going through a bad time?

During the teenage years, you do not progress at the same rate all the time. Some months you are more active and other months you are not very active. You can be sad or go through difficult periods, but this does not necessarily constitute depression. The condition needs to be examined very carefully to see if it is transitional or more sustained.
- Johanne Renaud, MD, Mini-Psych School 2010

Are teens aged 12 to 17 who take narcotics, ecstasy, or hashish at a higher risk for depression?

Studies have demonstrated that children and adolescents who take drugs before the age of 16 have an increased risk of psychosis. To my knowledge, no study has evaluated the impact of drugs on depression. However, I see a large number of young people at the clinic who present both problems. The biggest problem among 12 to 25 year olds is the coexistence of major depression and addiction. I have also seen cases involving young people who were thought to be bipolar, but this diagnosis was actually the effect of drugs on the person's brain. If you visit the Web site of the National Institute on Drug Abuse (NIDA), you will see brain scans of young people who have taken drugs: even after 7 years, the brain tissue still contains small holes. These are images that young people understand.
- Johanne Renaud, MD, Mini-Psych School 2010

Does depression in children depend on their temperament?

Children experience depression in different ways. Some children are more shy and anxious, whereas others are extremely reactive and have a higher risk of suicide. We therefore treat these two types of depression in different ways. For more anxious children, we work on social anxiety and teach them to face their fears. Some will need medication to calm their anxiety and relieve their depressive symptoms. For children with stronger reactions, we are currently trying to develop a model called the dialectic behavioural approach, which teaches them how to withstand emotional upheavals as they happen. We show them how to think about something else or distract themselves in order to withstand difficulties instead of trying to hurt themselves or commit suicide.
- Johanne Renaud, MD, Mini-Psych School 2010

Why are school-aged children and teens still treated 6 to 12 months after remission of depression?

This protocol is based on relapse studies. If you stop too soon, the risk of a relapse is higher. Generally after one episode, we see the person for 6 to 12 months. Unfortunately, major depression can now be considered as a chronic illness, as a lot of adult patients need more than one trial of medication and psychotherapy. However, the same treatment is not necessarily appropriate for a teenager because they need to have some hope. I tell them that the condition needs to be taken very seriously and that they need to undergo psychotherapy to get different ways to cope with their stressors.
- Johanne Renaud, MD, Mini-Psych School 2010

Can young adults who are not treated for depression recover on their own without psychological assistance or medication?

Absolutely. But this takes more time, and there will be an impact on how they socialize and function in the world. Certain youths are not at all suicidal, only depressed; they do not have a lot of energy, but they can still function. But these children risk not living up to their full potential. I have seen young people who have realized in retrospect that they had not really been well for two years, but they never thought they suffered from depression.
- Johanne Renaud, MD, Mini-Psych School 2010

Are people who take Acutane more susceptible to depressive episodes?

Although this hasn’t been proven, people who receive this acne treatment may have depressive symptoms. The medication is not necessarily the cause of the symptoms. It could be that someone with a very intense acne problem is at a higher risk of a depressive episode. This condition can be embarrassing, and you don’t feel very self-confident. I would still recommend the Acutane treatment, as the product is improving, but anyone who takes this medication needs to be followed and supported by a doctor.
-Johanne Renaud, MD, Mini-Psych School 2012

A teenager who has a depressive episode with suicidal thoughts claims to be feeling better a few weeks later. Should this person still go for psychotherapy?

You have to be very careful because when somebody suddenly gets better and you haven’t seen a gradual improvement, this may be a sign that they have decided to kill themselves. Generally with depression, the person undergoes at least 6 to 12 months of treatment. At the end of the first year of treatment, the intensity is decreased to see if the person is stable or experiencing previous symptoms. Although sometimes expensive, other types of support, such as seeing a psychologist, are necessary and can be covered under insurance up to a certain number of times per year.
-Johanne Renaud, MD, Mini-Psych School 2012

How can you adjust medication dosages for teens whose brains are still developing?

We have a few options that we need to follow. At some point we may have more information, because now we have different Magnetic Resonance Imaging studies on the brains of teenagers with depression. If you look at MRIs of people with depression, there are certain types of abnormalities. Treating these people with psychotherapy or medication improves the way that the medication is used in their brains. In the future, we may conduct MRI or computed tomography  scans on a regular basis as a baseline intervention before treating the depression.
-Johanne Renaud, MD, Mini-Psych School 2012

How can a youth under 18 get help when his parents don’t want to help?

This question comes up again and again. Psychotherapy is an option, although this may not be easy for teenagers if they have to pay for these sessions. In terms of medication, since you have to involve the pharmacist, it’s not that easy. We can always do something, but just giving medication is not ideal, because the teenager still needs supervision and support.

Children reach the age of consent for medical care starting at 14, so they can seek help on their own at this point, although it is still hard to do this when your parents don’t support your actions. Teenagers can also go see their school counsellors; although again, this is not always the ideal option.

In all cases, we need to sit down together to look at all options that are in the best interest of the child. Sometimes youth protection may need to be called. Teenagers may also not want their parents to know about their problem, but we usually need to ask the parents for more information about the young person’s biological background, and then all other information is kept confidential.
-Johanne Renaud, MD, Mini-Psych School 2012

What advice would you give a teenager who’s going through depression?

Teens can find it hard to get help, as they don’t know where to turn, and they may try to alleviate their suffering in other ways. I would tell someone with depression that if you look for resources, if you call the help lines, if you get a therapist and if you get help, it does get better. You have to be supportive of any teen who is depressed, because they really need support at this time in their lives.
- Johanne Renaud, MD, Mini-Psych School 2012

Does the risk of depression for teens with ADHD decrease if they are on medication?

If ADHD is the major problem, the person needs to get the best treatment for that condition first. Practitioners have to be careful, as some teenagers with ADHD who receive treatment may become more depressed because of the side effects of the medication for their first problem. The response to treatment needs to be closely monitored to ensure that the depression is not a side effect. Some medication may increase anxiety or depressiveness or even cause rebound reactions (a lower concentration when the effect of the molecule decreases). Again, comprehensive work has to be done with the school staff and the treating team, as well as with the teenager and the parents, to determine the best treatment.
-Johanne Renaud, MD, Mini-Psych School 2012

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