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