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 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