While everyone feels sad from time to time, depression, otherwise known as major depressive disorder is a state in which one feels low in mood, loses interest in things that one usually enjoys (anhedonia) and experiences specific cognitive and physical symptoms for more than two weeks. Like anxiety disorders, depression affects around one in 10 young people and may be classified as mild, moderate or severe, based on the number of symptoms present and level of functional impairment (the extent to which it gets in the way of important day-to-day activities). While adults often experience sustained low mood and difficulty sleeping, young people may experience fluctuating low mood (often better around peers, worse when alone) and excessive sleeping. Validated questionnaires such as the Child Depression Inventory version 2 (CDI-2) and Kessler 10 scale can also be used to confirm symptoms. We now know that even mild depression during adolescence can predict symptoms continuing to adulthood and recurrent episodes of mood disorder during adulthood; therefore, it should be identified and treated. Depression often co-occurs with anxiety, but fortunately, the treatments for both are similar.
Recommendations for the treatment of depression are influenced by its level of severity, which in turn hinges on the number of depressive symptoms (five connotating mild depression, six to eight moderate and over eight indicating the severe end of the spectrum) and the degree of resultant functional impairment.
First-line treatment of depression (of any level of severity) may include supportive counselling, stress management, physical activation and brief psychological interventions. These are more likely to work if a therapist has a good relationship with the young person. In addition, addressing life events or adversities that may be precipitating or prolonging the symptoms can also be helpful. If available, structured psychological interventions such as CBT, interpersonal therapy (IPT) and acceptance and commitment therapy (ACT) are all potentially excellent interventions. These may be delivered in person, online or as e-therapies (eg, SPARX).
It is also important to consider when to (or not to) prescribe a psychotropic medication. Prescribing such a medicine is not inherently wrong by any means; in fact, for many this can be lifesaving when undertaken in a considered manner. Whilst antidepressant medication does not work for mild depression, for depression that is more severe, antidepressant medication can be significantly beneficial if provided for the right people at the right times. When talking or e-therapies are ineffective, or if depressive symptoms are so severe that a young person cannot gain full benefit from them, antidepressant medication (usually an SSRI such as fluoxetine) may be indicated. Data recently released by He Ako Hiringa reveals that approximately one in eight young people (aged 12–25 years) had at least one psychotropic medication dispensed in the last 12 months. Between 2019 and 2022, commonly used antidepressants in young people increased from 1 per cent to 4 per cent in those aged 14 to 17, and 7 per cent and 10 per cent in those aged 18 to 25.3 On the other hand, use of benzodiazepines or antipsychotic medication in this age group should be an exceedingly rare occurrence (and certainly only after discussion with a child and adolescent psychiatrist).
Regardless of how effective medication is, recurrence of depression is common (between 30–40 per cent within 1–2 years). Therefore, it is useful to educate young people about depression, help them develop a better understanding of what affects their mood, learn new skills for managing stressful situations in the future and how to identify early warning signs of a recurrence. Whānau involvement can also increase the effectiveness of these strategies.