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.