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
Once it has been determined that the adolescent has