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 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.