
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. <br><br><b>Bibliography</b><br><br> 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. 
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