1. What You’ll Learn
1. Discuss emotional responses used to cope with life crises.
2. Differentiate between kinds of depression, possible causes, symptoms, and treatments for depression.
3. Explain why being depressed puts teens at risk.
4. Identify strategies for coping with depression.
5. Identify warning signs for suicide and discuss suicide prevention strategies.
6. Discuss eight steps teens might take to be resilient.

2. Key Terms life crisis minor depression major depression
cognitive behavior therapy
antidepressant
suicide
parasuicide
cluster suicides
suicide prevention strategies
resiliency

3. Life Crisis
A life crisis is an experience, such as a death in the family, a natural disaster, an accident, or a disappointment that causes a high level of stress.

4. How to Cope with a Life Crisis
Most people respond to life crises by working through a series of five emotional responses.
A person has worked through a life crisis when he or she accepts what is happening, adjusts, and bounces back.

5. How to Cope with a Life Crisis
Source: These five stages have been adapted from Dr. Elisabeth Kubler-Ross’ work on death and dying.
Five Emotional Responses Used to Cope with Life Crises
People respond to life crises by working through the following emotional responses:
Denying or refusing to believe what is happening
Being angry about what is happening
Bargaining, or making promises, hoping to change what is happening
Being depressed when recognizing the outcome is unlikely to change
Accepting what is happening, adjusting, and bouncing back

6. Depression
It is a normal reaction to feel angry or depressed while trying to adjust to a life crisis.

7. What to Know About Depression
Minor depression is a mood disorder accompanied by feelings of hopelessness, sadness, or helplessness.
Dysthymic disorder is a long-lasting form of depression.
Major depression is a mood disorder accompanied by long-lasting feelings of hopelessness, sadness, or helplessness.
Some teens experience double depression, which is having dysthymic disorder with periodic bouts of major depression.

8. What to Know About Depression
Symptoms Used to Diagnose Depression
The American Psychiatric Association uses these symptoms to diagnose depression:
deep sadness
apathy
fatigue
agitation
sleep disturbances
weight or appetite changes
lack of concentration
feelings of worthlessness
morbid thoughts

9. What to Know About Depression
What Causes Depression
Inability to cope with a life crisis 
Some teens are unable to get through life crises that most teens can cope with.
When teens can not cope with a life crisis, they may develop a form of depression.
Some teens develop post-traumatic stress disorder (PTSD) after experiencing a life crisis.
Teens with PTSD are often depressed.

10. What to Know About Depression
What Causes Depression
Changes in brain structure
A “pruning” or clearing of unused brain cell connections from the gray matter (interconnected nerve cells) takes place between the ages of 14 and 17.
There is a significant increase in mental disorders, including depression, when this clearing-out process takes place.

11. What to Know About Depression
What Causes Depression
Genetic predisposition
Genetic predisposition is the inheritance of genes that increase the likelihood of developing a condition.
Some teens may be genetically predisposed to having depression.

12. What to Know About Depression
What Causes Depression
Low serotonin levels
Serotonin is a chemical that is involved in controlling states of consciousness and mood.
Teens who have lowered serotonin levels are more at risk for depression.

13. What to Know About Depression
What Causes Depression
Traumatic family events
Teens who have experienced traumatic family events are at increased risk for depression.
Physical illness and disorders
Teens who have certain physical disorders and are ill might experience depression.
Some nutritional deficiencies, such as vitamin B, also might increase the risk of depression.

14. What to Know About Depression
What Causes Depression
Alcohol and other drug use
Teens who drink alcohol and abuse other drugs have much higher rates of depression.
Alcohol and other depressant drugs can compound depression.

15. Why Being Depressed Puts Teens at Risk
School performance Teens who are depressed might be tired, have difficulty concentrating, and be apathetic.
Social isolation Teens who are depressed often withdraw from friends and stop participating in enjoyable activities.

16. Why Being Depressed Puts Teens at Risk
Drug addiction  Teens who are depressed might use alcohol and other drugs to try to escape from problems or change their mood, which can lead to addiction.
Other addictions Teens might depend on certain behaviors, taken to extremes, to change their mood.
Physical illnesses  When a teen is depressed, his or her body’s immune system is suppressed and he or she is more susceptible to colds and flu.

17. Why Being Depressed Puts Teens at Risk
Mental disorders  Teens who are depressed are at increased risk for having major depression in adulthood. They also are at increased risk for developing other mental disorders.
Suicide attempts  Teens who are depressed have a sense of hopelessness and helplessness that, when coupled with other risk factors, increases their risk of making a suicide attempt.

18. Treatment for Depression
Physical examination  A physical examination is needed to evaluate health status.
Poor health status, such as illness, might precede depression.
Therapy Teens who are depressed may benefit from therapy, including individual counseling.
Cognitive behavior therapy is a form of psychotherapy that involves behavior therapy and cognitive therapy.

19. Treatment for Depression
Medication  A physician will determine if a teen will benefit from taking prescription drugs for depression.
An antidepressant is a drug used to relieve depression.
Antidepressant drugs require medical supervision to check for side effects.
The long-term effects of antidepressants on teens are still being studied.

20. Treatment for Depression
Coping with Depression
The following are strategies for coping with depression:
Talk with a parent, guardian, mentor, or other trusted adult.
Stay connected with friends.
Practice healthful behaviors, such as eating nutritious meals and exercising.
Use anger-management skills.
Practice stress-management skills.

21. Treatment for Depression
Coping with Depression
The following are strategies for coping with depression:
Avoid the use of alcohol and other drugs.
Take steps to develop resiliency.
Seek treatment if these strategies do not relieve depression.

22. Treatment for Depression
What are healthful ways that you deal with depression?

23. Treatment for Depression
Why is drinking alcohol or taking drugs never a healthful way to deal with depression?

25. Suicide
Teens who do not have things to do, people to love, and something to hope for can be at risk for making a suicide attempt.

26. What to Know About Suicide and Suicide Attempts
Suicide Suicide is the intentional taking of one’s own life.
Suicide is the ultimate mistake and can not be undone.
Suicide is never the best choice.

27. What to Know About Suicide and Suicide Attempts
Parasuicide Parasuicide is a suicide attempt in which a person does not intend to die.
Parasuicide is a cry for help.
Some teens who make a suicide attempt and do not intend to die are not found in time, and their attempts end in death.
Without help, teens who have attempted suicide once might attempt suicide again.

28. What to Know About Suicide and Suicide Attempts
A suicide attempt or talk of a suicide attempt always must be taken seriously.
Talk to a trusted adult if you have suicidal thoughts.
If you are depressed and have thoughts about suicide, seek help by calling a suicide hotline or find a mental-health professional in your area.
Never make a suicide attempt, even as a way to get attention.

29. What to Know About Suicide and Suicide Attempts
Cluster suicides Cluster suicides are a series of suicides occurring within a short period of time and involving people who are connected in some way.
If you know someone who has committed suicide, talk to your parents, a guardian, a school counselor, or another trusted adult.
Do not copy this person’s mistake.

30. What to Know About Suicidal Tendencies
Abuse of alcohol and other drugs People who abuse alcohol and other substances often have other risk factors for suicide, such as social problems.
Death of a parent, parental separation, or parental divorce  These events can cause extreme stress in teens due to a false feeling of responsibility. Teens also may feel like the mental pain they are feeling will never go away.

31. What to Know About Suicidal Tendencies
Feelings of alienation and rejection  Teens who do not have a supportive social-emotional environment and teens who feel that they have no one to talk to are at greater risk for attempting suicide.
Difficulty coping with body changes and sexuality  Teens might be uncomfortable or unhappy with the changes that occur during puberty and might feel uncomfortable with their sexuality.

32. What to Know About Suicidal Tendencies
Depression  Feelings of hopelessness or worthlessness that accompany depression also are risk factors for suicide.
Impulsive and/or aggressive behavior  Teens who are impulsive or aggressive do things without thinking through the potential consequences of their actions.
Mental disorders  A majority of people who have committed suicide either had a mental disorder or abused substances before they committed suicide.

33. What to Know About Suicidal Tendencies
How to Recognize Signs of Suicide
Signs that a teen might be considering a suicide attempt include:
making a direct statement about suicide, such as “I wish I was never born,”
making an indirect statement about suicide, such as “I wonder where I can get a gun,”
having a change in personality,
withdrawing from contact with family and friends,
losing interest in personal appearance,
being preoccupied with death and dying, and
using alcohol and other drugs.

34. What to Know About Suicidal Tendencies
How to Recognize Signs of Suicide
Signs that a teen might be considering a suicide attempt include:
losing interest in schoolwork,
running away from home, and
having a close friend or relative who has committed suicide.
giving away possessions,
talking about getting even with others,
failing to recover from a disappointment or a loss,

35. Getting Help
Suicide prevention strategies are techniques that can be used to help prevent a person from thinking about, attempting, and completing suicide.
Contact a suicide hotline for more information about ways to help a person who is thinking about suicide.

36. What to Know About Getting Help
Listen.  If friends share their thoughts of suicide with you, listen to them using active listening skills and encourage them to talk to you.
Encourage them to seek help.  Tell your friends that there are ways that depression can be treated and refer them to a suicide hotline.

37. What to Know About Getting Help
Tell a trusted adult.  Do not promise your friends that you will keep their suicidal thoughts a secret and remind them that you care and want them to continue to be a part of your life.

38. What to Know About Getting Help
Suicide Prevention Strategies
If you are concerned about a teen:
look for warning signs when a teen is depressed,
listen without giving advice,
take a suicide threat seriously,
ask if the teen has a specific plan and means to follow through,
do not be sworn to secrecy,
call a parent, a guardian, or other responsible adult immediately, and
stay with the teen until professional help arrives.

39. Resiliency
Resiliency is the ability to adjust, recover, bounce back, and learn from difficult times.
Being resilient is a powerful protective factor, which is something that increases the likelihood of a positive outcome.

40. How to Be Resilient
Work on your relationships with members of your family. 
Feeling connected to family members gives you added strength during tough times.
Develop a close relationship with a mentor. 
A mentor is a responsible person who guides another person.
When you need someone to talk to, or are looking for advice, a mentor can help you get through difficult times.

41. How to Be Resilient
Choose friends who are supportive and who have responsible behavior.   
Friends who choose responsible behavior will encourage you to make wise choices during difficult times.
Do not put off dealing with your feelings when a difficult situation arises. 
Face up to what is happening and work through your feelings to gain acceptance and take responsible actions.

42. How to Be Resilient
Avoid choosing harmful behaviors as a way of coping with tough times.     
Harmful behaviors interfere with your ability to cope and make the situation worse.
Ask for support when you need it. 
People who ask for support show that they are in control and are strong enough to know when to seek support or assistance.
Willingness to ask for help is a key ingredient in developing resiliency.

43. How to Be Resilient
Discuss available support groups with a parent, guardian, mentor, or other responsible adult.
A support group is a group of people who help one another recover from an addiction, a particular disease, or a difficult situation.
People who attend support groups agree to keep what is said at meetings confidential.

44. How to Be Resilient Be involved in school activities.
Being a member of a school team or participating in an activity gives teens a sense of belonging and helps them feel connected to other people.
Practice healthful behaviors.
Your thoughts and emotions can trigger certain body responses.

45. How to Be Resilient Volunteer to help others.
Acts of giving stimulate the brain to release endorphins, which are substances produced in the brain that create feelings of well-being.
Helping others who are less fortunate can help you put your own troubles in perspective.

46. How to Be Resilient
What healthful things do you do to increase your resiliency?

48. Study Guide 1. Match the following terms and definitions.
___ antidepressant
___ parasuicide
___ resiliency
___ serotonin D C A B
A. the ability to adjust, recover, bounce back, and learn from difficult times
B. a chemical that is involved in controlling states of consciousness and mood
C. a suicide attempt in which a person does not intend to die
D. a drug that is prescribed by a physician to relieve depression

49. Study Guide 2. What is cognitive behavior therapy?
Cognitive behavior therapy is a form of psychotherapy that involves behavior therapy and cognitive therapy.

50. Study Guide 3. What are cluster suicides?
Cluster suicides are a series of suicides occurring within a short period of time and involving people who are connected in some way.

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