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Diagnosing and Treating Teen Depression
Depressive disorders can have far reaching effects on the functioning and adjustment of young people, these include bipolar disorder (manic-depression), dysthymic disorder (chronic, mild depression), and major depressive disorder (unipolar depression). Depressive disorders increase the risk for illness and interpersonal and psychosocial difficulties that persist long after the depressive episode is resolved, attributing to a higher percentage of substance abuse and suicidal behavior among both children and adolescents. Often the signs accompanying a depressive disorder in young people are viewed as part of the normal adolescent development. The stigma of being diagnosed with a mental illness early in life and the long reaching effects it may have on health related information later in life sometimes deter health professionals from making a determination of mental disorder. It is however important that an early diagnosis and treatment of depressive disorders are engauged to ensure healthy emotional, social, and behavioral development.
Considerably less prolific than literature discussing adult depression, literature discussing the treatement of adolescent depression has increased over the last five years. Studies undertaken in that time frame have proven the safety and benefits of treating adolescent depression early. Additional treatment trials are needed to determine the most effective treatments for youngsters, and their incorporation into primary care practice.
Involving a psychologist or psychaitrist specializing in the treatment of adolescent is advisable when evaluating, diagnosing, and treating a child or adolescent that is showing signs of depression.
Severity of the situation
Statistics from recently conducted studies in the U.S. have report a percentage rate of depression of up to 2.5 percent of children and up to 8.3 percent of adolescents. A recent study sponsored by NIMH estimates that the frequency of any depression is more than 6 percent in a 6-month period, with 4.9 percent having major depression in the ages of 9 to 17. The onset of dpression is also occuring earlier in life currently than in decades past according to current trends. Additional factors regarding the early onset of adolescent depression have been observed in studies including persistence, recurrence, and contination into adulthood, indicating that teen and pre-teen depression may also be a precursor more severe illness in adult life. Other mental disorders, most commonly anxiety, disruptive behavior, substance abuse, physical illnesses, often occur in conjucnction with depression in youth.
Suicide incidence and behavior in adolescents and children is increased with the onset of depression. Adolescent boys who exhibit conduct disorder or chemical and or substance abuse, in addition to depression, are at an increased risk of exhibiting suicidal behavior or attempting suicide. Researchers supported by NIMH have found that up to 7 percent of adolescents may commit suicide in the young adult years ranging from 17 - 24 years of age.
Ongoing research is continuing to refine and discover suiced intervention methods specifically aimed at helping children and young adults. Diagnosis at an early age along with precicse mental evaluation, enables parents and caregivers to limit the exposure to and access of chemical and mechanical means to commit a suicidal act.
Clinical Characteristics
Diagnosing depressive disorder in children and adolescents is similar to diagnosing adults except for the manner in which the sypmptoms are expressed. Depending on the mental stage of development a child or teenager may struggle with identifying and expressing theirmood or inner emotional state. Often the acting out toward others in an irritable or vioent manner may by seen as disobedience or misbehavior especially when observed by parents, teachers, or guardians.
Symptoms of Major Depressive Disorder Common to Adults, Children, and Adolescents
Persistent sad or irritable mood
Loss of interest in activities once enjoyed
Significant change in appetite or body weight
Difficulty sleeping or oversleeping
Psychomotor agitation or retardation
Loss of energy
Feelings of worthlessness or inappropriate guilt
Difficulty concentrating
Recurrent thoughts of death or suicide
Persistence of 5 or more of the above symptoms for 2 or more weeks may indicate the ocurrence of a major depressive disorder and should be evaluated by a trained psychotherapist or psychologist specializing in treatment of childhood and or adolscent depression.
Signs That May Be Associated with Depression in Children and Adolescents
Frequent vague, non-specific physical complaints such as headaches, muscle aches, stomachaches or tiredness
Frequent absences from school or poor performance in school
Talk of or efforts to run away from home
Outbursts of shouting, complaining, unexplained irritability, or crying
Being bored
Lack of interest in playing with friends
Alcohol or substance abuse
Social isolation, poor communication
Fear of death
Extreme sensitivity to rejection or failure
Increased irritability, anger, or hostility
Reckless behavior
Difficulty with relationships
The recovery rate in children and adolescents from a single episode of major depression is quite high, further recurrence of depressive episodes may manifest, making awareness of the symptoms important to parents, and those treating the youngster paramount in importence. Youth who are diagnosed with dysthymic disorder are at risk for developing major depression making the prompt identification and treatment of depression critical in reducing the duration and severity and associated functional impairment.
Screening
There are several tools that are useful for screening children and adolescents for possible depression. They include the Beck Depression Inventory (BDI) and the Center for Epidemiologic Studies Depression (CES-D) Scale, the Children's Depression Inventory (CDI) for ages 7 to 17. A positive screening based upon any of the above screening methods should be followed by a comprehensive mental evaluation by a certified mental health professional. The evaluation should include interviews with the youth, parents, and when possible, other informants such as teachers and social services personnel.
Risk Factors
While early on boys and girls trend equal in the risk of diagnosis of depressive disorders, girls reaching adolescent age are doubly at risk than males are in developing depression. A family history of depressive disorders also factor toward the amount of risk individual children may experience depression at an early age especially if a parent has experienced the same event as a child. Depression in adolescents with a family history of depression, also trend higher in instance of depressive disorder though the correlation is not as high as it is for children.
Other risk factors include:
Stress
Cigarette smoking
A loss of a parent or loved one
Break-up of a romantic relationship
Attentional, conduct or learning disorders
Chronic illnesses, such as diabetes
Abuse or neglect
Other trauma, including natural disasters
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