The Relentless Rise of TEENAGE DEPRESSION; It Should Be a Time of Carefree Abandon, a Last Hurrah before the Onslaught of Adulthood. So Why Are So Many of Our Young People Being Treated for Depression and Self-Harm? Carol Midgley Reports

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Byline: Carol Midgley

IT WAS A relatively minor incident at school that finally pushed Emily* over the edge. She had lost some schoolwork, exasperating for any student, but Emily's reaction was extreme. She went home and took an overdose. She had been planning it for a while, saving up tablets and doing internet research, but the coursework crisis proved to be the last straw. This was the culmination of years of suffering from depression, something she endured for a long time, not understanding what was wrong, blaming herself and assuming she was simply a 'broken' person.

So at the age of 17 she was admitted to a mental health unit, where she spent her 18th birthday. One of the questions she is asked frequently but finds difficult to answer is, 'How old were you when it started?' For her there was no one moment; things are not always this clear cut. She knows that her mood was dropping from her early teens, when she would lie awake into the early hours, crying herself to sleep. At the age of 14 she self-harmed for the first time, cutting her arms.

There was no particular trigger, as is often the case with the onset of depression. Her parents were not divorced or neglectful; there had been no family bereavement; she was living a 'comfortable' life in a comfortable family home; she was an A-grade student. But she was also a perfectionist, driving herself to do better and better academically while being fastidious about her appearance. Everything - her hair, make-up, exam results - had to be perfect.

She knows now that the compliments she received were a substitute for self-esteem. 'I had used my work as a kind of distraction. If I got good grades it meant I was a worthy person,' she says. Initially her family assumed it was typical teenage moodiness. 'I think people found it hard to get their heads round why I'd be depressed; my parents are together and in many ways I come from quite a fortunate background. I didn't know what was wrong either.' According to the World Health Organization, depressive disorders were the third biggest global health problem in 2004; by 2030 they will be number one. Cases of child and adolescent depression have been growing, although this could be partly because we have become better at diagnosing. Irish teenagers have a one in five chance of experiencing a depressive episode by the time they turn 18 years of age. Although it is *SOME NAMES HAVE BEEN CHANGED. [c] THE TIMES/NEWS SYNDICATION 'relatively rare', depression does exist in childhood, according to Fiona McNicholas, a consultant child and adolescent psychiatrist at the Lucena Clinic in Dublin. After puberty, the prevalence of depression 'increases exponentially' with girls more affected than boys. Last year's My World survey found that 11 per cent of children aged between 12 and 19 years had seen a mental health professional, a figure that climbs to 30 per cent for young people aged between 19 and 25.

Various reasons are cited: the fragmentation of the family; increasing focus on academic achievement; earlier access to alcohol; social-networking sites; a materialistic society that values image above happiness; bleak employment prospects; economic pressures on the family; a sometimes dire reduction in circumstances since the end of the boom. Experts say that with so many factors in a state of flux we have yet to see the full effects of the most drastic changes in modern society.

Lucie Russell, of mental health charity YoungMinds, says that the pressures on young people today are unprecedented. 'Young people need to build a resilience to navigate the world they live in. There's this online world where someone might have 500 virtual friends but no real ones. There's cyber bullying, porn, sexting, violence. Many are not likely to get jobs and there are exams, exams, exams. Education policy is very much about academic achievement. It's not about wellbeing.' Then, Russell says, there is also the pressure to have the 'perfect body, perfect exam results, perfect number of friends. …