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Teens who withdraw socially, eat or sleep too much may be depressed: doctors

TORONTO (CP) - Teens who sleep weekends until noon or beyond, pick at their food - or alternately can't keep away from the fridge - and seem to loathe conversing with parents except at the most basic level may just be acting like typical adolescents.

But for some teens, poor sleeping and eating habits coupled with social withdrawal may be signs of serious depression, say new North American guidelines released Wednesday for treating the disorder.

"These youngsters really stop functioning," said Toronto psychiatrist Diane Sacks. "They stop concentrating, they stop wanting to eat properly . . . they can sleep until 3 or 4 in the afternoon, get up, still feel fatigued - it's not a restful sleep - and they really don't want to communicate with anybody.

"They're very isolated."

Symptoms of depression, which seems to run in families and is linked to brain chemical anomalies, include a persistent feeling of sadness or irritability, loss of enjoyment in previously enjoyed activities, lack of energy and feelings of worthlessness.

About 10 per cent of Canadian teenagers are believed to have experienced depression, said Dr. Amy Cheung, a child psychiatrist at Sunnybrook and Women's Health Sciences Centre in Toronto.

"So if you can imagine going into a high school classroom, you would find about three or four adolescents who have suffered or are suffering from depressive disorder," Cheung said in an interview following presentation of the guidelines to health care providers at the Hospital for Sick Children.

Mental health experts aren't sure if teen depression is on the rise because its existence in adolescents wasn't really recognized until 10 to 15 years ago, she said.

"A lot of the symptoms have been attributed in the past to just moodiness and adolescent angst and other things. And only in recent years have we started to recognize it and treat it effectively with medications and psychotherapy."

Because teen depression is so common, mental health specialists came up with new guidelines to help family doctors, pediatricians and other front-line health professionals diagnose and treat the disorder.

The Guidelines for Adolescent Depression in Primary Care (GLAD-PC) are the first to be published for North American health-care providers, giving them a framework for identifying and recommending therapies for young people aged 10 to 21.

While adolescent depression is of growing concern, the number of mental health providers has been shrinking. Only an estimated one in six Canadian teens who needs professional help is receiving it, says the Canadian Psychiatric Association.

"Utilizing the guidelines will not only ease the burden on scarce specialist services, but most importantly, it will result in better outcomes for teens affected by depression," said Sick Kids Hospital pediatrician Dr. Miriam Kaufman, a member of the Canadian-U.S. committee that developed the benchmarks.

Dealing with a teen who may be naturally uncommunicative around adults - as well as being depressed - can be a challenge for doctors and therapists, admitted Sacks. But she's found that once they get referred for treatment, young people are often easier to help than adults, whose thinking patterns may be more deeply ingrained.

"They want help," Sacks said. "They want to be back functioning the way they were. They want to function like their friends.

"If they don't come with baggage that mental illness is something to be ashamed of and you approach them and explain to them and educate them about mental illness, or depressive disorder, they will come to you and they will work with you."

Some of her adolescent patients even bring friends they are worried about to see her, she said. "They don't want their friends killing themselves."

Suicide, of course, is one tragic result of depression, said Cheung, noting that of the 250 to 300 teens who kill themselves each year in Canada, half had been diagnosed with depression.

At least 10 per cent of all Canadian teens have suicidal thoughts each year, she said. More boys complete suicide than girls, although young females have a higher rate of attempted suicide than their male counterparts.

Treatment with antidepressants and various forms of psychotherapy are the two main tools in treating depression. The most commonly prescribed antidepressants are known as selective serotonin re-uptake inhibitors, or SSRIs.

While there has been controversy over SSRIs because of an increased incidence of suicidal thoughts in adolescents taking the drugs, doctors say their benefits outweigh their risks. (An analysis of clinical trials showed no suicides among 4,400 adolescents on the medications.)

Cheung said she outlines both the advantages and adverse effects of SSRIs for parents worried about putting their children on the medications, which include such brand names as Prozak and Paxil.

"The benefit is that your child will feel better," she said. "We also try to explain to them what harm can be done to your child if they're not treated.

"So imagine losing a year of your life as a teenager - you don't participate in school, you don't go out with your friends and you're really psychologically suffering."