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 to19 than 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 an adolescent with changes in mood be considered clinically depressed?
Brown 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 observed that the challenge is to identify depressive
sympto matology which may be superimposed on the backdrop of a more transient,
but expected, development storm. Therefore, diagnosis should not lay only in the
physicians 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. In stead 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, 1996), hyperactivity (Blackman, 1995), substance abuse
(Blackman, 1995; Brown, 1996; Lasko, 1996) and suicide (Blackman, 1995; Brown,
1996; Lasko, 1196; 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, withdraw, 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 proposed that formal
psychological testing may be helpful in complicated presentations that do not
lend themselves easily to diagnose. For many teens, symptoms of depression are
directly related to low self-esteem stemming from in creased 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,
1996). Oster & Montgomery 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 suggested the best way to diagnose is to
⌠screen out the vulnerable groups of children and for the risks factors of
suicide and then refer them to treatment. Some of these risk factors include
verbal signs of suicide within the last three months, prior attempts at suicide,
indication of sever mood problems, or excessive alcohol and substance abuse.
Many physicians tend to think of depression as an illness of adult hood. In
fact, Brown, stated that ⌠it was only in the 1980`s that mood disorders in
children were included in the category of diagnosed psychiatric illnessess. 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 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
added that an estimated 2,000teenagers per year commit suicide in the United
States. Making it the leading cause of death after accidents and homicide.
Blackman stated that it is not uncommon for young people to be preoccupied with
issuses 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 has suggested two
main avenues to treatment: psychotherapy and medication. The majority of cases
of adolescent depression are mild and can be dealt with through several
psychotherapy sessions of 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 searches 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 be fatal. Brown added that regardless
of the type 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 teens
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.