Associate Medical Director; Senior Pediatric Psychopharmacologist
Child Mind Institute
Anxiety and depression occur in both genders, but by the teenage years, girls are much more at risk than boys. Before puberty, the prevalence of mood disorders is about the same in boys and girls—3 to 5 percent. But by mid-adolescence girls are more than twice as likely to be diagnosed with a mood disorder as boys, with the prevalence at adult levels, 14 to 20 percent.
Why such a big disparity in mood disorders? We know from looking at brain scans that there are differences in the way girls and boys process emotional stimuli. Girls mature, in terms of their emotional recognition, faster than boys—and that sensitivity could make them more vulnerable to depression and anxiety.
It's plausible that that these gender differences around the time of puberty can be traced to evolutionary advantages: Girls may be wired to tune in earlier to emotional stimuli because it was advantageous for nurturing babies; for young men, given their roles as hunters and tribe protectors, emotional responsiveness might have been an important attribute not to have.
The argument that the differences in emotional sensitivity are hard-wired is underscored by the fact that even as women's lives have clearly changed—with many more women living professional, competitive, Type-A lives—the rate of depression hasn't dropped. Even the participation of far more girls in sports and other intense physical activities hasn't reduced the rate of depression, though physical activity is important to emotional wellbeing, and one effective way to help jumpstart recovery in someone who's depressed.
Symptoms of depression in teenagers
In adolescent depression, the thing people tend to notice first is withdrawal, or when the teenager stops doing things she usually likes to do. There might be other changes in her mood, including sadness or irritability. Or in her behavior, including, appetite, energy level, sleep patterns and academic performance. If several of these symptoms are present, be vigilant about the possibility of depression.
This is especially important because by the time family members and other people around a teenager note her lack of interest in most things, or what we call anhedonia, she's usually been depressed for some time. Depression is an internalizing disorder, i.e. one that disturbs a patient's emotional life, rather than an externalizing one, which manifests in the form of disruptive or problematic behavior. As such, it takes a while not only for others to recognize it, but often for the patient herself to realize that her thinking, and emotional responses, are disturbed.
Note that there are actually two kinds of depression. In major depressive disorder—the most familiar form of depression—the cluster of symptoms that define depression occur in what may be severe episodes that tend to last from seven to nine months. But there is also another form of depression called dysthymic disorder, in which the symptoms are milder, but they last longer, measured in years. So while the experience of dysthymia may be less debilitating for the child at any given moment, the risk is that there is more accrued damage, more time in which the child is kept out of the healthy development process.
Symptoms of anxiety
Anxiety is a normal adaptive system that lets the body know when it's in danger. But anxiety becomes a problem when it's out of proportion to the situation, and interferes with a person's ability to function. An overly anxious teen might withdraw from activities because she's too scared or anxious, and her anxiety doesn't go away with reassurance.
A teenager who has been anxious since childhood may have a lifestyle built around her anxieties: the activities and environments she chooses and those she rules out, the friends she is comfortable with, the expectations and limitations she has trained her family, friends, and teachers to accept. That's why it's more challenging to treat anxiety the longer a child has lived with it, and developed unhealthy coping mechanisms to manage it.
Why early intervention is critical
When a child is depressed or anxious, her suffering isn't the only reason it's important to get help.
In addition to the disorders themselves, there are add-on effects that may cause lifelong issues. With depression comes low energy and poor concentration, two factors that are likely to have a significant impact on social and academic functioning. Anxiety, and the withdrawal that may accompany it, is likewise a detriment to social and academic progress.