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.
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