What does it look like?

• persistent low mood for at least two weeks
• plus some of the following: lack of energy, being very irritable, loss of pleasure in life, difficulties with sleeping, day-night sleep reversal, loss of appetite, loss of interest in sex, feelings of hopelessness.

In general, young people are likely to be very poor at recognising their experience as being depression.

This may be because: -

1. depression is a combination of feelings and experience
2. others problems may be more obvious to others such as crime or not going to school
3. being depressed is not cool and may be linked to feelings of shame and weakness.

Need to check out

• Current or previous use of drugs and alcohol. Depression may be direct result of change in substance use.
• Any important recent life events such as family changes, death of grandparent, rejection by sexual partner

If these are also happening, depressed mood may be appropriate and temporary response to an important life situation.

How long will it last?

• Depression has a tendency to be cyclical - that means that it comes and goes and people talk about having a period of feeling depressed. Its hard to predict how long this will last but average for severe depression may be around 6 months. The aim of 'treatment' is often to reduce the length of the depression.

WHAT CAUSES IT?

These are often referred to as risk factors:

• Loss of a relationship. This could be with a parent/carer or a friendship, or gang or sexual partner.
• Being powerless in highly adverse circumstances such as violence between adults at home, exclusion from school.
• Changes in life circumstances such as being evicted from accommodation or having to leave school and go to college
• Absence of a future life plan. No direction in life and assumption that desired aims are not achievable
• Any recent changes in regular use of drugs or alcohol.
• Dislike of self particularly around body image and weight.

HOW COMMON IS IT?

• Depression occurs in around 5% of young people at any one time. However, up to 40% of young people may experience depression at some point as part of their transition to adulthood.
• Young people attending AMBIT teams are likely to have much higher risk of depression as they will be exposed to many of the above risk factors. It would be reasonable to assume that rates of depression will be much higher than for general population.

WHAT TO DO?

You can access the NICE Guidelines here.

First things

• Adopt a non-judgemental approach to the young person's difficulties e.g. difficulties in slleeping and getting out of bed etc.
• Clarify whether depressed mood also tips into Self Injurious Behaviour or suicidal thinking or behaviour, and see whole section on Managing Risk. If these are present, discuss with other members of your team.
• Young person may need some time to get used to idea of thinking of themselves as depressed. This is common and important to give young person time to make sense of your understanding of his difficulties as being depressed (see Slow engagement.)

Developing help

• Depression is often maintained by a severe loss of routine and basic activity (like eating meals) and also by severely negative critical thinking directed towards the self. These two features of depression are the focus of CBT work with depression. As well as direct work, a CBT apporach would also include PsychoEducation so that the nature of depression and the rationale for the methods used would be explained to him/her. The basic approach is to try to re-establish increased activity (known as Behavioural activation) and secondly to try to illicit communication about negative thinking and to begin to gently challenge whether some of this thinking is accurate or helpful. See Cognitive Behavioural
• Another approach to depression is to focus on helping the young person to maintain and look at his friendship relationships and to work in restoring any exisitng ruptures in such relationships. This broad approach is known as IPT.
• For severe depression consideration need to be given to discuss with the young person the possibility of arranging to see his/her GP about the possibility of medical help (Pharmacological) for depression. This would need to be balanced against the young person's own wishes with respect to medical help and also the potential risk of misusing medication if this was prescribed.