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Depression Among Adolescents

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What is depression? Have you ever suffered from it? Do you know someone who has? How can you tell? Almost 20 percent of all Americans have depression, most without knowing it. Many of these that suffer are children. Many people don't realize how common depression is among adolescents or how serious it can be. Depression is a disease that affects the psyche causing a person to act and react abnormally toward others as well as themselves. It is often thought of as excessive sadness when it is actually the inability to feel any emotion strongly. It has long been overlooked and under diagnosed. Because adolescence is already a time of emotional turmoil, mood swings, gloomy thoughts and heightened sensitivity, depression in adolescents has been greatly under diagnosed. Until recently, many physicians thought of depression as an adult disorder. In actuality, 7-14% of children will experience an episode of major depression before the age of 15. Brown (1996) stated, "It was only in the 1980's that mood disorders in children were included in the category of diagnosed psychiatric illnesses." 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." In a random sampling of 100,000 teenagers, two to three thousand will have mood disorders out of which 8-10 will commit suicide (Brown, 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; Oster & Montgomery, 1996) and suicide (Blackman, 1995; Brown, 1996; Lasko et al., 1996; Oster & Montgomery, 1996) all of which can hide depressive symptoms. 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. But, it is very important to be sure this is all that is going on because adolescent suicide is now responsible for more deaths in youths aged 15 to 19 than cardiovascular disease or cancer (Blackman, 1995). As a matter of fact, in the past 25 years, while the general incidence of suicide has decreased, the rate of suicide for those between 15 and 19 has quadrupled. Despite this increased suicide rate, depression in this age group is greatly under diagnosed and leads to serious difficulties in school, work and personal adjustment, which may often continue into adulthood. Sometimes the symptoms of mood disorders take on different forms in children than in adults. Because of this, diagnosis should not be left up to physicians alone. It should 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). 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). Major warning signs 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) recommended "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, 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. 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



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