The suicide rate for adolescents has increased more than 200% over the last decade. Recent studies have shown that greater than 20% of adolescents in the general population have emotional problems and one-third of adolescents attending psychiatric clinics suffer from depression. The majority of teenage depressions can be managed successfully by the primary care physician with the support of the family, says Maurice Blackman MB, FRCPC.



Adults with psychiatric illness are 20 times more likely to die from accidents or suicide than adults

Is depression in adolescents a significant problem?



20% of adolescents in the general population have emotional problems and one-third of adolescents attending psychiatric clinics suffer from depression.[3] Despite this, depression in this age group is greatly underdiagnosed, leading to serious difficulties in

Why is depression in this age group often missed?



Adolescence is a time of emotional turmoil, mood lability, gloomy introspection, great drama and heightened sensitivity. possible suicidal ideation.



What are the common symptoms of adolescent depression?



Adolescent depression

may also present primarily as a behavior or conduct disorder, substance or alcohol abuse or as family turmoil and rebellion with no obvious symptoms reminiscent of depression.



How can suicide risk be determined?



significant acute crisis in the teenager's life and may also involve concomitant depression. Significant stressors include divorce, parent or family discord, physical or sexual abuse and alcohol or substance abuse. The teenager who exhibits

How can the physician best manage the patient?



The teenager

Teenagers can be oppositional and negative when

depressed. The teenager is an active participant in the treatment

process and the physician must identify the problem to the patient and parent, offer hope and reassurance, outline treatment options and arrive at a mutually agreed-upon treatment plan. How should depression in adolescents be treated?



There are two main avenues to treatment: psychotherapy and medication. Issues of

Formal family therapy may be required to deal with specific problems or issues. obsessive-compulsive disorder, learning disability or attention deficit hyperactive disorder, should be searched for and treated, if

present.



When should medication be used?



For the more serious and persistent depressions, particularly those with vegetative symptoms or suicidal ideation, medication is

SSRIs are well tolerated by teenagers because of

their fairly rapid action and low tendency to cause side effects. patient population. Most teenagers can

side effects. If the physician cannot engage in conversation with the

suggested. This is particularly important if the depression is judged to be severe or if there have been some suicidal concerns.

be managed successfully by the primary care physician with the support of the family.







1. Murphy, JM, Monson, RR, Olivier, DC, et al: Affective disorders and mortality: A general population study. Psychiatry 44:470, 1987. 2. Hodgma, CH, McAnarny, ER: Adolescent depression and suicide: Rising problems. 3. Kovaks, M: Affective disorders in children and adolescents. 1. Lewinsohn, P, Gregory, M, Clark, N, et al: Major depression in community adolescents: Age, episode duration, and time of

J Am Acad Child

Adolesc Psychiatry 31(6):1003,1992.



Acad Child Adolesc Psychiatry 32(1):28,1993.