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Adolescent Depression

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Adolescent Depression

Mental disorders represent the number one health problem for the United States and probably for the entire human population. Some studies estimate that approximately one-third of all Americans suffer from some sort of emotional disturbance. Depression will affect as many as twenty percent of all of us one time or another in our lives. Severe anxiety is even more common. Depression has been a part of human existence since ancient times.

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 that adolescent depression is strongly linked to teen suicide. Adolescent suicide is now responsible for more deaths in youths aged fifteen to nineteen 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 that 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 overlooked 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 that 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 lie only in the physician's hands but be associated with parents, teachers and anyone who interacts with the patient on a daily basis.

Depression can be a transient mood change in response to many stimuli. In adolescents, depression is common because of the normal maturation process, the stress associated with it, and independence conflicts with parents. It may also be a reaction to a disturbing event such as the death of a friend or relative, a breakup with a boyfriend or girlfriend, failure at school, or for no apparent reason. Medical or psychiatric illness or medications may also cause depression.

According to Yapko, normal behavior in adolescents is marked by both up and down moods, with alternating periods of feeling "the world is a great place" and "life's a bummer". These moods may alternate over a period of hours or days. Persistent depression with no interspersed periods of happiness, faltering school performance, failing relations with family and friends, substance abuse and other negative behaviors may indicate depression. Teenagers may also mask depression with a put-on front of happiness but acting-out and risk-taking behaviors indicate the underlying problem.

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 (Yapko, 1997). Mood disorders are often accompanied by other psychological problems such as anxiety, eating disorders, hyperactivity, substance abuse and suicide all of that 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.

Key indicators of adolescent depression include a drastic change in eating and sleeping patterns, significant loss of interest in previous activity interests (Blackman, 1995), constant

boredom, 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 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 that could include decreased family support and perceived rejection by parents (Shamoo et al, 1993). Yapko (1997) 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



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