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The teenage years are a time of emotional highs and lows. So how do you distinguish normal teenage mood swings and rebellion from actual depression? The September 2008 issue of the Harvard Mental Health Letter highlights some ways to tell.

Although depression can occur at any age, it affects teens more than younger children. Depressive symptoms may start appearing around age 13, and often peaks between 16 and 24. Yet depression can be difficult to diagnose in young people, because symptoms seldom involve mood alone. One study concluded that fewer than half of teen patients suffered mainly from depressive symptoms. More often, they developed a mix of mood and behavioral problems, for example, agitation, anxiety, attention difficulties, or defiant behaviors.

Many schools have implemented screening programs to identify teens at risk as well as programs to prevent depression. These programs generally educate staff and students about depression and suicide, provide advice and practice in challenging negative thinking, and seek to build resilience and problem-solving skills. The most effective programs are those that are implemented consistently and on an ongoing basis.

Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter, says experts have identified the following ways to distinguish mood swings from depression in adolescents:

- Severity: The more pronounced the symptoms (changes in mood, behaviors, feelings, thoughts), the more likely that the problem is depression and not a passing mood.

- Duration: Any deterioration in behavior or mood that lasts two weeks or longer, without a break, may indicate depression.

- Domains: Problems noticed in several areas of a teen's functioning-at home, in school, and in interactions with friends-may indicate depression.

Also in this issue:

- Helping psychiatric patients stop smoking
- Losing an adult sibling
- Bright lights and dementia
- Happiness from giving money away
- Social networks and memory

The Harvard Mental Health Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $24 per year. Subscribe at http://www.health.harvard.edu/mental or by calling 877-649-9457 (toll-free).

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