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How not to miss the signs of teen depression

Paris Jackson's suicide attempt has put the spotlight on the fragility of teenagers and the importance of being aware of the difference between regular moodiness and depression. Here, an iVillage reader reveals how she fought teen depression and self-harm and won. Plus, an expert answers parents most pressing questions.

"From childhood, I had always been a very quiet and unhappy person with a very low self-esteem and general lack of confidence. I didn't know any better, so I just thought that was the way I was. So, I never told anyone – I just bottled it all up.

I've never had any reason to be depressed because my life has been relatively trouble-free and straightforward – often, I felt depressed for no reason. But at the age of 14, I came to a point where I could no longer cope. To make matters worse, my hormones were all over the place and I was a complete mess inside. It got so bad that I started to self-harm. I was so ashamed of myself for doing this and I was actually frightened of myself because I didn't know how far I'd go each time. I couldn't wear anything that would show the marks on my arms, so I always wore long sleeves, even in the summer.

I continued to self-harm for two years and managed to keep it a secret. I got more and more depressed to the point where I wouldn't even leave the house. I had no will to live anymore – I used to lie in bed in my black hole, crying all the time. I just felt so empty and lonely and wanted to put myself out of my misery by killing myself. The only reason I didn't was because I didn't want to upset my family and friends.

At first I just pretended to feel unwell and ended up missing loads of school, including my exams. Then I did become physically ill – my body was really weak, I was hardly eating and I suffered from insomnia.

My mum could see that I wasn't right, so she forced me to tell her what was wrong. It was so hard to tell her, but I'm so glad now that I did. I showed her my arms, which were a complete mess by then. She was so upset by it, so were the rest of my family, and I felt so guilty for upsetting and worrying them, but I was so relieved that I'd let it off my chest.

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She sent me to the doctors, who then referred me to a psychiatrist as an emergency case. He told me I had a quite severe case of clinical depression and that I'd had it since a very early age. It wasn't triggered by anything at all. I was put on antidepressants and sleeping tablets, and given scar treatment for my arms.

The fact that I knew I wasn't on my own anymore helped me start my recovery, and then the antidepressants kicked in. I saw the psychiatrist for about six months and, in that time, I reduced the amount of times I was harming myself and I started to take control. I forced myself not to self-harm again, and I made myself think positively, as it was the only way to beat my depression. I got so much better, I stopped seeing my psychiatrist. I did really well in my exams, which gave me a real sense of achievement. I started to enjoy life, to do what other teenagers did – I went out with my friends, got a new boyfriend and felt much more outgoing and confident.

It's been about a year now since I was diagnosed with depression and I have completely recovered. I still have the scars on my arms from then to remind me, but I'm not ashamed of them anymore. It feels like I've started afresh and I don't have to struggle through life anymore. I still have my 'off days' and the occasional spell of low self-esteem, and but I don't actually get depressed anymore. I know it could come back at any time, but now that I know how to deal with it, I don't think it would affect me as much. I think having had depression and beating it has made me a stronger person.

If I had any advice for people suffering from depression, it's to tell someone straight away; no matter how insignificant you think it is. Don't suffer alone like I did, because it will get you nowhere. There's no need to be ashamed of being depressed.

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It's more common than people think. I would say the key to beating depression is positive thinking – find something to look forward to. And don't turn down help, at least give medication a try. I hope my story has inspired some of you and has shown you that there is light at the end of the tunnel."

Depression in teens – your 8 top questions answered

If you think your child may be depressed, don't let it go untreated. Get answers to your most pressing questions about recognising and treating this condition from Dr Francis Mark Mondimore, author of Adolescent Depression: A Guide for Parents

1. How can I tell if my teen is depressed?
Everyone gets down now and again. When being down becomes an everyday affair day after day, week after week then something is seriously wrong. This is clinical depression. Loss of interest in school, friends, sports, anything and everything is another sign of serious depression. Low energy and loss of appetite are common. Other possible signs are dropping grades in school and alcohol or drug use. Thoughts of death and suicide are always serious danger signals.

2. Are there different types of clinical depression?
In discussing serious depression, psychiatrists talk about mood disorders. The most common and one of the most serious mood disorders is major depressive disorder. Teens with this problem have frequently incapacitating symptoms of depression that often last up to a year without treatment. Low, depressed mood, loss of interest in and the ability to enjoy things, sleep and appetite disturbance, low energy and feelings of failure and worthlessness are common.

Dysthymic disorder is a less severe but longer lasting depressive illness. Teens with dysthymic disorder have many of the same symptoms as those with major depressive disorder, but fewer of them, and their symptoms are not quite as severe. They may suffer from chronically poor sleep and energy level problems; they often feel bad about themselves and hopeless about the future. Dysthymic individuals often suffer with their symptoms for many years at a time.

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3. How common are these illnesses?
Serious depression is very common. Some experts have estimated that as many as one in five people will have symptoms of major depression during their lifetime.

4. How is teen depression treated?
Adolescents with milder depressions can sometimes be treated with psychotherapy (talk therapy), but research shows that "just talking" to a trusted friend or adult isn't enough. A special kind of psychotherapy called cognitive therapy helps identify and change depressed thinking patterns and has been shown to be as effective as medication for some patients. Severely depressed adolescents and adolescents with bipolar disorder, however, should always be evaluated for medication. Several decades of clinical research have shown that antidepressant medications are safe and effective treatments for serious depression in adults, adolescents and even children.

5. How long will my teen need to be treated for depression?
We know that major depressions last about a year without treatment, so staying in treatment for at least that long is clearly necessary. We also know that people who have had a bout of major depression have a 90 percent likelihood of having another one at some point in their lives. There is evidence that serious depression that starts early in life is even more likely to recur, so it's important to take the long view when making decisions about treatment.

6. What causes serious depression?
Genetics is a big piece of the picture, but life events, trauma and bad experiences probably make important contributions. Everyone seems to inherit a greater or lesser tendency to develop depression, and this tendency interacts with life events to set off the illness in some. Some researchers believe that the genetic factors are probably more important in people with early-onset depression.

7. Can drug or alcohol abuse cause depression?
Mood disorders and substance abuse problems seem to go hand in hand in many individuals, but it's not clear at all how the two types of problems are related to each other. Sometimes one seems to have caused the other, but it's often impossible to say which came first. It's the toughest "chicken or egg" question we have in psychiatry. One thing is certain, however: Depression is much harder some would say impossible to treat in a person who's abusing drugs or alcohol.

8. Where can I get help for my teen?
Family doctors and pediatricians are more and more aware of how common depression is in their patients and are very capable of diagnosing serious depression. Some will be comfortable treating milder depressions, but many will want an expert to take over the treatment and will refer their patients to a psychologist first or to a psychiatrist to be evaluated for medication.

If you or someone you know needs support, call Lifeline on 13 11 14. There's someone there to listen 24/7.
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