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Adolescent Depression: 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
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
Blackman, M. (1995, May). You asked about... adolescent

The Canadian Journal of CME [Internet]. Available HTTP: 

Brown, A. (1996, Winter). Mood disorders in children and
adolescents. NARSAD Research Newsletter [Internet].
Available HTTP: 

Lasko, D.S., et al. (1996). Adolescent depressed mood and
unhappiness. Adolescence, 31 (121), 49-57.
Oster, G. D., & Montgomery, S. S. (1996). Moody or
depressed: The
masks of teenage depression. Self Help & Psychology

Available HTTP: 




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