Amrita Kachroo, 17, was a quintessential teenager - fond of partying, fashionable clothes and of eating out. But the pressure of the looming class XII CBSE board exams, coupled with her parents' separation, turned the vivacious teenager into a wreck. She stopped eating, barely slept or communicated and stopped attending school. Her condition - diagnosed as clinical depression - became so bad that it took weeks of intensive psychotherapy, strong anti-depressants and bed rest to normalise.
Amrita's case is typical of multitudes of hapless Indian teenagers who are increasingly battling the demons of depression. According to the Indian Council of Medical Research (ICMR), in 2001, 12.8 per cent of school-going children in India were victims of acute depression and behaviour-related problems. The current number, though unrecorded, has ratcheted up dramatically since then. Discloses Gurgaon-based psychiatrist Dr Sanjay Chahel, "There's been a huge upswing in the number of pre-pubescent and young adults coming to me with depression and depression-related disorders. I personally diagnose about 15 to 20 such kids - three to four of them very severe cases - each month."
The largest contributors of depression amongst youngsters these days are interpersonal relationships and academic pressure. Manju Shah, a volunteer at Saath, an NGO that works for the prevention of suicides, explains, "The 16-29 age group witnesses the highest rate of suicide deaths. Apart from relationship and academic pressures, many young people also plunge into depression because of family problems and unrealistic parental expectations. These days, frustration among adolescents is pretty high while the threshold of tolerance is low. This creates a schism between perceived and fulfilled expectations."
But what really is adolescent depression and how does one distinguish it from other common growing-up symptoms such as sulkiness, irritability, antisocial behaviour, negativity and social withdrawal? According to psychiatrists, depressed children believe that happiness is achieved through "the acquisition of fame, money and beauty, while happier children subscribe to the view that feeling good comes from healthy attitudes and pursuing worthwhile goals." Generally, depression is considered acute if it starts interfering with a child's daily routine of eating, sleeping and communicating.
While a couple of decades ago children's depression was almost unknown, today, it is rampant. Dr Veena Rai, a sociologist at Delhi University, elaborates, "We're witnessing a changing social topography where a youth's basic needs, relationships, healthy goals and responsibilities are not being automatically met. They are fed a constant diet of images about how they are meant to look, sound and be. Meaning is attached to what they have or look like, rather than what they do or achieve. This triggers a feeling of inadequacy which then manifests itself as depression."
So, what's the best way to tackle the problem? Recognising the warning signals and timely treatment. A 2002 study conducted by Brown University (USA) revealed that many parents simply do not recognise the symptoms of depression in their adolescent children. Even parents who enjoy good communication with their children do not necessarily realise when their child is depressed. "Youngsters go through a riot of hormonal and psychological changes. They like to assert their individualism which leads to a lot of conflict," says Rai. Apparent symptoms such as being a loner, introverted, aggressive, violent, and addiction to alcohol or drugs are commonly seen among depressed youngsters.
Also, psychiatrists reiterate that during teenage years, pressure to conform to peers is extremely strong. If children feel different, inadequate or deprived in some way, then it leads to depression. A downward spiral in performance at school/college is also an indicator.
Besides, keep a lookout for a change in personal hygiene and appearance, destructive and/or defiant behaviour, belief in hallucinations, sudden change in appetite or weight, restlessness, agitation (pacing, wringing hands and biting nails), constant fatigue, and complaints of feeling guilty or worthless.
The consequences of untreated depression can be dangerous. It could lead to increased incidence of depression in adulthood and, in some cases, even suicide. According to the American Psychological Association (APA), suicide is the third leading cause of death among young people aged 15 to 24 years. Even more shocking, it is the sixth leading cause of death among children aged 5-14 years. The disquieting fact is that these struggling teens often receive no counselling, therapy, or medical intervention, even though various studies have established that treatments of depression in children and adolescents can be effective.
Adolescence can be really stressful. It is a time of physical and social transformation with hormones producing rapid mood swings from sadness to elation. Lack of life experience results in impulsive behaviour or imprudent decisions. For a teen suffering from chronic depression, feelings of worthlessness and hopelessness are common. The ratio of 'sad' to 'happy' moments also becomes lopsided.
Imbalances of important bio-chemicals called neurotransmitters, in the brain can result in depression. "Neurotransmitters allow the brain's cells to communicate with one another," says neurologist Dr Sanjay Motiani of Kailash Hospital, NOIDA (Uttar Pradesh). "Two neurotransmitters that tend to be out of balance in depressive people are serotonin and norepinephrine. An imbalance in serotonin may cause sleep disorders, irritability and anxiety (characteristic of depression) while an imbalance of norepinephrine (which regulates alertness/arousal), leads to fatigue and depressed moods." A cortisol imbalance, another natural biochemical the body produces in response to extreme cold, anger or fear,
is also prevalent among depressed people.
Studies indicate that depression is three times more common in children whose biological parents suffer from it even if the children have been adopted into a family whose members do not have the illness. But, as experts exhort, this doesn't mean that children coping with these situations are the only ones susceptible to depression. Even youngsters from stable environments develop the problem.
Sociological theories suggest that depression-linked conduct disorders result from a child's attempt to cope with a hostile environment or to gain social status among friends. "Because conduct disorders do not go away without intervention, appropriate treatment is essential. Behaviour therapy and psychotherapy, in either individual or group sessions, is effective in such cases," says Dr Chahel.
Though the problem of depression is gigantic, the good news is that it is a treatable disease that, with proper intervention, can bring youngsters back from the brink of disaster to lead a confident and productive life. Rai, though, has a word of caution for parents and guardians, "Be alert to the warning signals. If ignored, these signs can be life-threatening. But if addressed on time, the same signs can save a young life from falling into an abyss," she says.