Depression can be a transient response to many situations and stresses. In adolescents, depressed mood is common because of the normal maturation process, the stress associated with it, the influence of sex hormones, and independence conflicts with parents. It may also be a reaction to a disturbing event, such as the death of a friend or relative, a breakup with a boyfriend or girlfriend, or failure at school. Adolescents who have low self-esteem, are highly self-critical, and who feel little sense of control over negative events are particularly at risk to become depressed when they experience stressful events. True depression in teens is often difficult to diagnose because normal adolescent behavior is marked by both up and down moods, with alternating periods of feeling 'the world is a great place' and 'life sucks.' These moods may alternate over a period of hours or days. Persistent depressed mood, faltering school performance, failing relations with family and friends, substance abuse, and other negative behaviors may indicate a serious depressive episode. These symptoms may be easy to recognize, but depression in adolescents often manifests very differently than these classic symptoms. Excessive sleeping, change in eating habits, even criminal behavior (like shoplifting) may be signs of depression. Another common symptom of adolescent depression is an obsession with death, which may take the form either of suicidal thoughts or of fears about death and dying. Long-term depressive illness usually has its onset in the teen or young adult years -- about 15-20% of American teens have experienced a serious episode of depression, which is similar to the proportion of adults suffering from depression. Adolescent girls are twice as likely as boys to experience depression. Risk factors include stressful life events, particularly loss of a parent to death or divorce; child abuse - both physical and sexual; unstable caregiving, poor social skills; chronic illness; and family history of depression. Depression is also associated with eating disorders, particularly bulimia.
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