A recent poll by the American Psychiatric Association found that 32% of Americans feel that their mental health has been affected by the current pandemic. All humans are affected in some way. Whether by illness, death, fear, isolation, loss of income,  job loss, or a myriad of ways we all have seen the world radically change over the course of the last few months. Many have adapted. Many are growing weary. There are a range of “normal” responses, depending on an individual’s circumstances. So how do you know if your response, or your family member’s is a sign to seek professional help.

Here are some things to watch for:

If you have any concerns, click here for urgent needs, find a local mental health care provider, or you may reach the Centre for Counseling of Aventura at 305-932-5500.

Lee B. Pravder, M.D., Board Certified Child, Adolescent, and Adult Psychiatrist

The Centre for Counseling of Aventura is now seeing patients remotely using secure and private telemedicine technology.

We are pleased to have been named 2018 Best Psychiatrists of Aventura. This award is given to the best business in each category. It is sponsored by an independent organization and there is no entry competition; winners are selected from all businesses in the Aventura area.


Recent surveys indicate that one in five teens suffers from clinical depression. Over the past decade, depression and its cousin, anxiety, have increased dramatically among teens ages 12 and up. A study by professor Ramin Mojtabai at Johns Hopkins Bloomberg School of Public Health showed the incidence of clinical depression among adolescents ages 12 to 17 grew by 37% between 2005 and 2014, with no difference between urban, suburban, and rural teens. Further, the incidence of self-harm behaviors, like cutting, is also on the rise.

The National Institute of Mental Health Estimates that 3 million teens have had at least one major depressive episode in the past year.

Despite its prevalence, teen depression can be difficult to recognize. Often, parents think teens are simply going through a phase or chalk up their teen's symptoms to normal adolescent moodiness. Teens themselves may think their is a reason for their depressed mood, such as problems with peers, pressures at school, or difficulties fitting in.

How to recognize depression in a teen

Adolescence is an unsettling time, with many social, physical, and psychological changes. Teens often overreact when things go wrong at school or home. Perfectionistic teens may feel down when grades or sports performance don't match their internal expectations. Sensitive to the opinion of peers, teens can face devastating rejection on social media and some teens deal with deliberate bullying.

With so much pressure coming at teens from so many sides, it's normal for teens to occasionally feel down or overwhelmed. The critical difference is when a teen's mood interferes with his/her day-to-day functioning, when it results in self-harm behaviors such as cutting, or when a teen begins to have dark thoughts of death and suicide. Parents can suspect depression when a teen shows any of the following symptoms for 2 weeks or more:

  1. Poor grades in school, particularly if the teen has historically gotten good grades
  2. Withdrawal from social activities and friends
  3. Lack of enthusiasm, energy or motivation, especially a loss of interest in hobbies and sports
  4. Displaying sadness or hopelessness, or reacting with anger and rage to minor provocations
  5. Overreacting to criticism and expressing intense feelings of self-doubt
  6. Poor self-esteem or guilt
  7. Restlessness and agitation, including being fidgety, pacing, etc.
  8. Changes in eating or sleeping patterns
  9. Being unfocused, unable to concentrate, or unable to make decision
  10. Using alcohol and/or drugs
  11. Becoming sexually promiscuous or engaging in risky behavior
  12. Displaying problems with authority
  13. Having suicidal thoughts or actions or ruminating about death, which may be seen in poems and art the focus on death, giving away personal belongings, dramatically changing appearance (e.g., many more piercings or suddenly adopting dark clothing and makeup), dramatic changes in personality or bizarre behavior

It is extremely important that a teen with any signs of depression receive prompt, professional treatment. Adolescents are apt to lack self-awareness and to hide their depression from family and friends because they view it as weakness.

The rate of suicide among teens has nearly tripled since 1960 and it is now the third leading cause of death among adolescents. Teens tend to view temporary problems as permanent and can react with impulsive, self-destructive acts. While specific events often trigger a suicide attempts, the real problem is much older and deeper than the trigger. Prompt medical intervention can help teens function at a higher level and be less susceptible to environment triggers such as peer rejection.

Treating teen depression

Treating teen depression usually involves a combination of medication and cognitive behavioral therapy. Often, anxiety coexists with depression so both disorders must be treated at the same time. Until the late 1980s, no effective medication was available to treat teen depression. That has changed and today there are numerous medications that can help teens overcome the brain chemistry component of depression.

Cognitive behavioral therapy is helpful in teaching teens how to see current problems as temporary. It can deal with many of the underlying issues that contribute toward depression, such as low self-esteem, unrealistic self-expectations, or sensitivity to peer rejection. In other words, cognitive behavioral therapy improves the teen's perspective and ability to cope.

If you are concerned about your teen, trust your gut instinct and seek professional help. Break a confidence if necessary in order to make sure your teen (or one of your teen's friends) receives the proper medical intervention.  Don't be afraid to act; teens rely on adults for mature guidance and direction. At no time is this more important than when a teen shows symptoms of depression.



At some point, everyone will go through a period of sadness, grief, or loneliness. Unhappiness in a normal reaction to loss, namely life events like the death of a loved one, the breakup of a relationship, or other stressors such as poor health or financial difficulties.

Normal grief isn't pleasant, but people continue to function and know they'll get through it. Generally, the most intense feelings of grief fade within 6 to 8 weeks, although the entire process can take up to 4 years.

Depression isn't normal grief

Normal grief can involve many of the same symptoms seen in depression. There may be difficulty concentrating, trouble sleeping, changes in appetite, loss of interest in pleasurable activities, a sense of fatigue, and feelings of guilt, anger, or loneliness.

However, normal grief improves over time, with an increasing number of "good days" versus "bad days." Depression stagnates and soaks into the psyche, becoming a fixed state of mood. In some cases, normal grief can tip over into depression.

What is depression?

Depression isn't just a passing mood. It involves changes in the brain that can be seen on functional magnetic imaging (fMRI) and positron emission tomography (PET) scans. The amygdala, the thalamus, and the hippocampus are regions of the brain thought to play a role in depression. In one study, the hippocampus was 9% to 13% smaller in depressed women. Likewise, activity in the amygdala is higher in  clinically depressed people than in normal control groups. Other studies have linked depression to low levels of neurotransmitters. Antidepressants trigger the growth and branching of nerve cells in the hippocampus over a period of weeks, which is why patients often do not feel better until they have taken an antidepressant for several weeks or longer. Many different kinds of neurotransmitters play a role in depression, including serotonin, norepinephrine, dopamine, acetylcholine, glutamate, and gamma-aminobutyric acid (GABA).

9 signs of clinical depression

There is no blood test for depression. Diagnosis relies on reported symptoms. A person with major depression (clinical depression) has at least 5 of the 9 signs of depression for 2 weeks or longer:

  1. A depressed mood most of the time
  2. Loss of interest in pleasurable activities, including sex
  3. Changes in appetite with a loss or gain of more than 5% of weight
  4. Excessive sleeping or insomnia, including early awakening and fitful or troubled sleep
  5. A constant state of fatigue, no energy, and feeling physically run down
  6. Feeling restless and engaging in activities like pacing, or feeling listless
  7. Having difficulty concentrating and making decisions
  8. Feeling worthless or guilty
  9. Having thoughts of death or suicide

If you or someone you know has signs of clinical depression, you should immediately seek medical help at a behavioral health crisis unit or with a psychiatrist.

Depression and the risk of suicide

A  2000 study of 100 suicides by the Mayo Clinic found that the risk of suicide in people diagnosed with depression is nearly one in ten. The risk is highest in people who have thoughts of death or suicide. Many people do not verbalize these thoughts, so it is imperative to obtain psychiatric help for a loved one who seems withdrawn, blue, and shows changes in eating or sleep patterns.

Risk for depression

The risk of depression is higher for some people than others. Depression has a genetic component, so it runs in families. People with low self-esteem, who have a pessimistic outlook, or who are overwhelmed easily by stress tend to be more at risk for depression. The incidence of depression is also higher in those who have endured ongoing childhood neglect and abuse, exposure to violence, or poverty.

Different types of depression

There are many subtypes of depression, which are based on one's primary symptoms.

Atypical depression

People with atypical depression react strongly to life circumstances. Their mood may lift briefly when something good happens, only to plummet when they experience rejection or other negative situations. They generally experience increased appetite, weight gain, excessive need for sleep, and pronounced fatigue. It is important to rule out hypothyroidism (low levels of thyroid hormone), because it can mimic atypical depression. Despite its name, atypical depression is extremely common.

Melancholic depression

People with melancholic depression display loss of appetite, problems with insomnia, and a diminished ability to enjoy once pleasurable hobbies and activities. Unlike atypical depression, melancholic depression is marked by a lack of mood reactiveness to outside circumstances. The individual's mood stays depressed, even when good things happen.

Single episode vs. recurrent depression

The most common form of depression is a single depressive episode that can start quickly over a few days or slowly over a period of weeks or months. While the individual experience the signs of clinical depression, the majority of these patients will have no further episodes of depression in their lifetimes.

Treatment of single episode depression reduces the risk that it will develop into recurrent depression. Recurrent depression is, as its name implies, is marked by episodes of depression with intervals of normal mood. These symptom-free intervals can last for weeks or for many years.


Dysthymia is diagnosed when an individual experiences depressed mood and related symptoms for at least 2 years. Although the symptoms are usually milder than in major depressive disorder, dysthymia robs life of enjoyment. It usually starts in adolescence and can last for decades. People with dysthymia can also experience episodes of major depression.

Seasonal affective disorder (SAD)

People with SAD usually experience atypical depression during certain seasons, notably fall and winter when sunshine is limited. When the seasons end, the person's mood returns to normal.

Bipolar depression

Bipolar I patients suffer from severe manic episodes that disrupt functioning alternating with depressive episodes. This change is mood can occur over a period of months or years of being in a healthy state, or it can occur very rapidly with fast cycles of mania and depression. Bipolar II patient exhibit less intense mania (hypomania) alternating with depression. In both instances, patients exhibit changes at both ends of the mood spectrum: the elevated mood of mania/hypomania and the down mood of depression. The treatment of depression in these individuals is an exacting science, because many antidepressants can trigger a manic episode.

Depression is treatable

Depression is one of the most common mental disorders and it is also one of the most treatable. Between 80% and 90% of depressed patients respond well to medication. These medications work by adjusting and "normalizing" brain chemistry. It can take several weeks for improvement to be seen, but if a patient feels little to no change, the dose may be altered or another medication may be used.

Cognitive behavioral therapy (CBT) is used with antidepressant medications to help patients recognize the distorted thinking that results from depression. CBT is generally not effective on its own, except for very mild cases of depression. However, it can help people with moderate to severe depression reframe their perspective and develop better coping strategies for dealing with stress and triggers.

When to seek help

If you have experienced any of the following symptoms for several or more days over the past 2 weeks, you should seek professional attention. If these issues have made it difficult for you to get along with other people or at work or home, you should seek help even if you do not experience them often. And, regardless of any other answers, if you have had thoughts of harming yourself or that you would be better off dead, you should seek immediate psychiatric help.

  1. Little interest in doing things
  2. Feeling down, depressed, or hopeless
  3. Trouble falling asleep, staying asleep, or sleeping too much
  4. Feeling tired or having little energy
  5. Having poor appetite or overeating
  6. Trouble concentrating on things like reading or watching television
  7. Moving or speaking so slowly that other people can notice, or being so fidgety or restless that you move around a lot more than usual
  8. Feeling bad about yourself or that you're a failure or have let yourself or your family down (seek immediate psychiatric help)
  9. Thoughts of harming yourself in some way or that you would be better of dead (seek immediate psychiatric help at a crisis center)

Find us

21110 Biscayne Blvd., Suite 304
Aventura, FL 33180

Valet parking available

305-932-5500  •  305-935-0466 Fax
Mon-Thur 8am-6pm and Fri 8am-5pm
Closed for lunch 1pm-2pm daily
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