The Under Acknowledged Disease 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 underdiagnosed 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.
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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
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