Adolescence Depression
Psychology Depression is a disease that
afflicts the human psyche in such a way
that the afflicted tends to act and
react abnormally toward others and
themselves. Therefore it comes to no
surprise to discover that adolescent
depression is strongly linked to teen
suicide. Adolescent suicide is now
responsible for more deaths in youths aged
15 to 19 than cardiovascular disease
or cancer (Blackman, 1995). Despite this
increased suicide rate, depression in
this age group is greatly under
diagnosed and leads to serious difficulties in
school, work and personal
adjustment which may often continue into adulthood.
How prevalent are
mood disorders in children and when should an adolescent with
changes in mood
be considered clinically depressed? Brown (1996) has said the
reason why
depression is often over looked in children and adolescents is
because
"children are not always able to express how they feel."
Sometimes the
symptoms of mood disorders take on different forms in children
than in
adults. Adolescence is a time of emotional turmoil, mood swings,
gloomy
thoughts, and heightened sensitivity. It is a time of rebellion
and
experimentation. Blackman (1996) observed that the "challenge is
to
identify depressive symptomatology which may be superimposed on the
backdrop of
a more transient, but expected, developmental storm." Therefore,
diagnosis
should not lay only in the physician's hands but be associated with
parents,
teachers and anyone who interacts with the patient on a daily basis.
Unlike
adult depression, symptoms of youth depression are often masked.
Instead of
expressing sadness, teenagers may express boredom and
irritability, or may
choose to engage in risky behaviors (Oster &
Montgomery, 1996). Mood
disorders are often accompanied by other
psychological problems such as anxiety
(Oster & Montgomery, 1996), eating
disorders (Lasko et al., 1996),
hyperactivity (Blackman, 1995), substance
abuse (Blackman, 1995; Brown, 1996;
Lasko et al., 1996) and suicide
(Blackman, 1995; Brown, 1996; Lasko et al.,
1996; Oster & Montgomery,
1996) all of which can hide depressive symptoms.
The signs of clinical
depression include marked changes in mood and associated
behaviors that range
from sadness, withdrawal, and decreased energy to intense
feelings of
hopelessness and suicidal thoughts. Depression is often described as
an
exaggeration of the duration and intensity of "normal" mood changes
(Brown
1996). Key indicators of adolescent depression include a drastic change
in
eating and sleeping patterns, significant loss of interest in
previous
activity interests (Blackman, 1995; Oster & Montgomery, 1996),
constant
boredom (Blackman, 1995), disruptive behavior, peer problems,
increased
irritability and aggression (Brown, 1996). Blackman (1995) proposed
that
"formal psychologic testing may be helpful in complicated
presentations
that do not lend themselves easily to diagnosis." For many
teens, symptoms
of depression are directly related to low self esteem
stemming from increased
emphasis on peer popularity. For other teens,
depression arises from poor family
relations which could include decreased
family support and perceived rejection
by parents (Lasko et al., 1996). Oster
& Montgomery (1996) stated that
"when parents are struggling over marital
or career problems, or are ill
themselves, teens may feel the tension and try
to distract their parents."
This "distraction" could include increased
disruptive behavior,
self-inflicted isolation and even verbal threats of
suicide. So how can the
physician determine when a patient should be
diagnosed as depressed or suicidal?
Brown (1996) suggested the best way
to diagnose is to "screen out the
vulnerable groups of children and
adolescents for the risk factors of suicide
and then refer them for
treatment." Some of these "risk factors"
include verbal signs of suicide
within the last three months, prior attempts at
suicide, indication of severe
mood problems, or excessive alcohol and substance
abuse. Many physicians tend
to think of depression as an illness of adulthood.
In fact, Brown (1996)
stated that "it was only in the 1980's that mood
disorders in children were
included in the category of diagnosed psychiatric
illnesses." In actuality,
7-14% of children will experience an episode of
major depression before the
age of 15. An average of 20-30% of adult bipolar
patients report having their
first episode before the age of 20. In a sampling
of 100,000 adolescents, two
to three thousand will have mood disorders out of
which 8-10 will commit
suicide (Brown, 1996). Blackman (1995) remarked that the
suicide rate for
adolescents has increased more than 200% over the last decade.
Brown
(1996) added that an estimated 2,000 teenagers per year commit suicide in
the
United States, making it the leading cause of death after accidents
and
homicide. Blackman (1995) stated that it is not uncommon for young people
to be
preoccupied with issues of mortality and to contemplate the effect
their death
would have on close family and friends. Once it has been
determined that the
adolescent has the disease of depression, what can be
done about it? Blackman
(1995) has suggested two main avenues to treatment:
"psychotherapy and
medication." The majority of the cases of adolescent
depression are mild
and can be dealt with through several psychotherapy
sessions with intense
listening, advice and encouragement. Comorbidity is not
unusual in teenagers,
and possible pathology, including anxiety,
obsessive-compulsive disorder,
learning disability or attention deficit
hyperactive disorder, should be
searched for and treated, if present
(Blackman, 1995). For the more severe cases
of depression, especially those
with constant symptoms, medication may be
necessary and without
pharmaceutical treatment, depressive conditions could
escalate and become
fatal. Brown (1996) added that regardless of the type of
treatment chosen,
"it is important for children suffering from mood
disorders to receive prompt
treatment because early onset places children at a
greater risk for multiple
episodes of depression throughout their life
span." Until recently,
adolescent depression has been largely ignored by
health professionals but
now several means of diagnosis and treatment exist.
Although most
teenagers can successfully climb the mountain of emotional and
psychological
obstacles that lie in their paths, there are some who find
themselves
overwhelmed and full of stress. How can parents and friends help out
these
troubled teens? And what can these teens do about their constant and
intense
sad moods? With the help of teachers, school counselors, mental
health
professionals, parents, and other caring adults, the severity of a
teen's
depression can not only be accurately evaluated, but plans can be made
to
improve his or her well-being and ability to fully engage
life.
Bibliography
Blackman, M. (1995, May). You asked about...
adolescent depression. The
Canadian Journal of CME [Internet]. Available
HTTP: http://www.mentalhealth.com/mag1/p51-dp01.html.
Brown, A. (1996,
Winter). Mood disorders in children and adolescents. NARSAD
Research
Newsletter [Internet]. Available HTTP:
http://www.mhsource.com/advocacy/narsad/childmood.html.
Lasko, D.S., et
al. (1996). Adolescent depressed mood and parental
unhappiness.
Adolescence, 31 (121), 49-57. Oster, G. D., &
Montgomery, S. S. (1996).
Moody or depressed: The masks of teenage
depression. Self Help & Psychology
[Internet]. Available HTTP:
http://www.cybertowers.com/selfhelp/articles/cf/moodepre.html.