Depression in adolescents is notoriously hard to spot. Sulkiness, moodiness, tantrums, antisocial behaviour, negativity, withdrawal - these are all a fairly typical part of growing up. Yet Young Minds estimates that as many as one in five teenagers is presenting symptoms of depression at any time. More alarmingly, Childline estimate that there are are 19,000 suicide attempts by adolescents every year. That's one every 30 minutes. The majority of those attempts are made by young women aged between 15 and 19, usually by overdose. Of all these attempts, a minimum two suicides by people under the age of 25 in the UK and Republic of Ireland are recorded every day.
While some attempts are reactions to age-specific circumstances - exams, eating problems, body image, relationship break-up, pregnancy, sexuality, bullying, problems at home, abuse - many are alarm bells signalling an underlying mental illness.
So how are parents to tell the difference between teenage angst and clinical depression? Symptoms to watch out for include unrelenting sadness, hopelessness, boredom, unexplained irritability or crying, loss of interest in usual activities, changes in eating or sleeping habits and alcohol or substance abuse. Other alarm bells include missed school or poor performance, unexplained cuts or burns indicating deliberate self-harm, threats or attempts to run away from home, persistent physical aches and pains, outbursts of shouting, complaining, reckless behaviour and thoughts about death or suicide.
I went overnight from being a shy, well-behaved, studious teenager to coming home drunk on school nights, talking incessantly about death and life's inherent pointlessness and listening to deafening nihilistic music. I began hiding in my room, blowing my Saturday job money on cigarettes, breaking down in tears over the slightest thing and bringing home report cards with ailing grades. Like most parents with a teenager in the house, mine figured it was just a rebellious phase, a hormonally induced nightmare that would eventually pass.
I now know that one of the earliest symptoms I presented - my obsession with death - is a common way for adolescent clinical depression to announce itself. But several more years of slamming doors, getting into trouble at school, binge-drinking and ranting at my mother about how we were all going to die of cancer, would follow before my parents insisted I see our GP, who diagnosed "anxiety with depression" and put me on antidepressants. I was 18.
In those days, you didn't turn the TV on to find Princess Diana talking about her struggles with depression. You couldn't buy memoirs like Elizabeth Wurtzel's Prozac Nation and Lauren Slater's Prozac Diary. There were no films like Thirteen or Girl, Interrupted. You didn't have Kurt Cobain singing about clinical depression and then blowing his brains out.
You didn't have movie stars like Angelina Jolie going on talkshows explaining why she used to cut herself. You didn't surf the web and find online support communities for every kind of psychological ailment imaginable. You didn't open the newspaper and read columns like this. And I never once heard anybody use terms like depression, anxiety or self-harm.
Now, 20 years later, much has changed. I get emails from teenagers who read this column, telling me they take antidepressants, they're seeing counsellors or therapists, their friends are depressed too, there are self-harm epidemics at their schools. One 16-year-old girl wrote asking for help because her best friend jumped in front a train and now she felt like doing the same. Another, only 15, emailed saying her parents had no idea that she cut herself every day and that she was writing to me because she had no one else to turn to. And a 14-year-old girl wrote saying that she and a group of friends met in the playground at school once a week during lunch time to hold what she called "self-help meetings", at which they shared tips - gleaned from the internet - on ways to cope and feel better.
Reading these emails, I realise that though we are talking more about mental illness, rates of adolescent depression continue to rise, making it more vital than ever that parents don't misread depression as teenage moodiness.