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Depression is a serious illness that can affect anybody, including teenagers. It affects your thoughts, feelings, behavior, and overall health. Most people with depression recover with treatment. Over 18 million Americans are depressed. As many as two million of these are adolescents. The biological tendency toward depression runs in a family, in some cases, depression brought on by life stress. American families today are busy with parents, especially nuclear families, need to work long hours to provide financial support.

A depressed teen sense the parent’s stress or preoccupation, and feel guilty about burdening the parent with his own problems. Increasingly, adolescents have been seeking each other out when they are confused, depressed or in trouble. They form an elaborate network of support for a depressed or suicidal peer. At its best, this can be a valuable early warning system for troubled teens. Many times, it involves sharing antidepressant medications, hiding a runaway, or avoiding needed psychiatric help. There is also risk for the adolescent helpers.

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These helpers may be trying to cope with their own drug abuse or emotional problems. They often feel a great sense of responsibility toward the depressed individual. If their friend does commit suicide, the survivors are left with tremendous guilt. In children and adolescents, the most frequently diagnosed mood disorders are major depressive disorder, dysthymic disorder, and bipolar disorder. (CDC, 1999) Because mood disorders such as depression substantially increase the risk of suicide, suicidal behavior is a matter of serious concern for clinicians who deal with the mental health problems of children and adolescents.

The incidence of suicide attempts reaches a peak during the mid adolescent years, and mortality from suicide, which increases steadily through the teens, is the third leading cause of death at that age. Major depressive disorder is a serious condition characterized by one or more major depressive episodes. In children and adolescents, an episode lasts on average from seven to 9 months (Birmaher et al. , 1996) Dysthymic disorder is a mood disorder like major depressive disorder, but it has fewer symptoms and is more chronic. (Klein et al. , 1997).

Because of its persistent nature, the disorder is especially likely to interfere with normal adjustment. The onset of dysthymic disorder also called dysthymia is usually in childhood or adolescence (Akiskal, 1983) Early symptoms of adolescent depression can be difficult to diagnose because they appear to be a normal part of the difficulties adolescents face. Depression is indicated if an adolescent experiences an unusual degree of the following symptoms: Changes in eating and sleeping habits. Significant weight gain or loss. Missed school, poor school performance or a sudden decline in grades.

Withdrawal from friends and family. No longer enjoying activities that were once pleasurable. Indecision, lack of concentration or forgetfulness. Feelings of worthlessness or guilt. Overreaction to criticism, Irritability. Feeling that nothing is worth the effort. Frequent health complaints when no physical ailment exists. Anger, rage and anxiety. Lack of enthusiasm and motivation. Drug or alcohol abuse, thoughts of death or suicide . Symptoms such as insomnia, panic attacks, delusions or hallucinations can indicate extreme depression, with particular risk for suicide.

Depression is associated with school and interpersonal problems. It is also correlated with increased incidence of suicidal behavior, violent thoughts, alcohol, early pregnancy, and tobacco and drug abuse. Depression can lead to an increased chance of suicide attempts and successful suicides. The rate of suicide among children 10 to 14 years of age increased 100% during 1980-1996. Among youngsters 15-19 years of age, the rate of increase was 114%, making suicide the fourth leading cause of death for this age group (U. S.

Department of Health & Human Services, 1999). While suicide rates among adults have steadied or declined over the past few decades, suicide rates of young people have increased (Teenage Suicide, 2000). The warning signs of suicide change with age. The warning signs of suicide in children include preoccupation with death or suicide or a recent breakup of a relationship. Teens with depression are at particularly high risk for suicide and suicide attempts. In the United States, approximately 2,000 teens commit suicide each year. (A P, 2001).

While teen girls attempt suicide almost twice as often as teen boys, boys more likely succeed because girls usually use less lethal means and survive the attempt. Suicide attempts in children younger than age 12 are uncommon (Garber J, McCauley E, 2002). A young person is at increased risk for suicide attempts if he or she has current suicidal thoughts, mental health or disruptive disorders, such as conduct disorder, Impulsive or aggressive behaviors and Feelings of hopelessness. A history of past suicide attempts, a family history of suicidal behavior or mood disorders, a history of exposed to family violence or abuse.

In 1996, the age-specific mortality rate from suicide was 1. 6 per 100,000 for 10 to 14 year olds, 9. 5 per 100,000 for 15 to 19 year olds. About six times higher than in the younger age group, in this age group, boys are about four times as likely to commit suicide than are girls, while girls are twice as likely to attempt suicide, compared with 13. 6 per 100,000 for 20- to 24-year-olds (CDC, 1999). Hispanic high school students are more likely to attempt suicide (CDC, 1998). The reasons for depression can vary in each adolescent. Many times depression results from a confluence of factors.

Significant events such as the death of a loved one, parents’ divorce, moving to a new area, or breaking up with a girlfriend or boyfriend can prompt symptoms. Adolescent depression can occur from neglect, prolonged absence from someone who is a source of care and nurturance, abuse and bullying, damage to self-esteem, or too many life changes occurring too quickly. In some teenagers, any major change may provoke depression. Earlier traumatic experiences such as abuse or incest often emerge and cause great distress, as the child becomes a teen.

This is because as a young child the victim did not have the life experience or language to process these painful experiences, or to protest. When such memories emerge in adolescence, the distress compounded if adults deny or discount the information. Stress, especially if the adolescent lacks emotional support. Hormonal or physical changes that occur during puberty also cause new and unexpected emotions. Moodiness and melancholy often experienced and labeled as depression. Medical condition hypothyroidism affects hormone balance and mood. Chronic physical illness also causes depression.

When the medical condition diagnosed and treated by a doctor, the depression usually disappears. Substance abuse can cause changes in brain chemistry. Allergies to foods such as wheat, sugar, and milk cause or exacerbate symptoms of depression. Nutritional deficiencies caused by an amino acid imbalance or vitamin deficiency. Genetics predispose a teen to depression when the illness runs in the family. Many teen behaviors or attitudes that are annoying to adults are actually indications of depression: Drug and alcohol use- depressed teens often use substances in an attempt to self-medicate their symptoms.

Low self-esteem – depression can intensify feelings of ugliness and unworthiness. Eating disorders – anorexia, bulimia, binge eating, or yo-yo dieting are often signs of unrecognized depression. Self-injury – cutting, burning, head banging, or other kinds of self-mutilation are usually associated with depression. Acting out – depression in teenagers may appear as agitation, aggression, or high-risk behaviors rather than or in addition to gloominess. Suicidal thoughts or attempts – teens seriously depressed or despondent often think, speak, or make “attention-getting” attempts at suicide, which must be taken seriously.

Risk factors for suicide in teenagers: An alarming and increasing number of teenagers attempt and succeed at suicide. Suicide is now the third highest cause of death in adolescents, and children as young as five been reported to commit suicide. It is also probable that suicidal statistics for teens is under reported, as they might overlook those whose reckless or dangerous behavior resulted in death, or those in which the cause is not definitely identified. There are several high-risk factors associated with teen suicide: Previous suicidal behavior.

History of psychiatric disorder or substance abuse. Family history of suicide, Psychiatric disorder or substance abuse. Loss of parent. History of abuse, violence or neglect. Social isolation or alienation, including because of being gay or being bullied. There is good evidence that over 90 percent of children and adolescents who commit suicide have a mental disorder before their death (Shaffer & Craft,). Adolescence is typically a time of extreme moods, as hormonal changes and academic and social challenges escalate.

Suicidal behavior in adolescents is precipitated by events or challenges that the teenager finds too difficult to tolerate. Even things that seem minor to an adult can be major to a young person, who does not have the life experience to put them into perspective or the coping skills that an adult has honed. Some common precipitants of suicidal behavior in teenagers like death of a family member or close friend particularly if by suicide. Loss of a romantic relationship or a good friendship, loss of a parent through divorce or separation. Loss of a pet, treasured object, a job or opportunity.

Fear of punishment, physical, sexual or psychological abuse, unwanted pregnancy, poor grades, fight or argument with family member or loved one, belief one has harmed or brought harm to a family member or friend, embarrassment or humiliation, concerns about sexuality or suicide of a friend, acquaintance, or celebrity also known as “copycat” suicide. Teenage moodiness is a normal part of adolescent development, caused by hormonal changes that cause moods to fluctuate. Just knowing that these mood swings are normal can help reduce the anxiety that often accompanies the intense feelings.

However, teens can become depressed beyond normal moodiness, and need help to get past these feelings. Some people think that talking about sad feelings will make them worse, but the opposite is true. It is very helpful to share your worries with someone who will listen and who cares, especially a trained professional who can guide you to feeling better. It is difficult for caring, concerned parents to see their children struggling. Sometimes parents wonder if their teen is being melodramatic or “just trying to get attention” with challenging behavior.

The first problem is to distinguish between a more serious depression and “normal” typical adolescent moodiness, caused by hormonal changes and brain growth spurts. Rushing to a therapist when symptoms are actually within the range of normal can have several negative effects. The child feels like there must be something wrong with himself or herself, which can tip a fragile balance toward lowered self-esteem, there may be a long-lasting stigma attached to a diagnosis, medications is prescribed unnecessarily, and without careful monitoring.

Many children with depression have one or more other major psychiatric diagnoses. Anxiety Disorder, Substance Abuse, and ADHD are frequently associated with childhood depression. ADHD might be present before the first episode of depression and can complicate the treatment of both conditions. Substance abuse often starts after the first episode of depression, although this can vary in different individuals. The other conditions persist even after the major depressive episode passes, and can render the individual more vulnerable to a recurrent depression.

Children with depression accompanied by ADHD or Conduct Disorder are more likely to have adult criminal records and suicide attempt than individuals with depression. Depressed children often have depressed or stressed parents. A depressed, hyperactive child may be hard to raise. Some parents have more coping skills. A child may learn to give up because parents have not modeled good ways of coping with stressful situations. Some suggest that parental patterns of irritability and withdrawal lead to low self-esteem in the child and that this predisposes the child to depression.

Some suggest that a genetically vulnerable child is more likely to develop depression when exposed to family stress. Parents of depressed adolescents may themselves need support. The single most important thing a parent can do to break down the social isolation that is at the heart of adolescent problems is to listen. Listen when your children talk, listen to their music, spend more time with them and be involved in their activities. Take them to movies and concerts, and discuss them afterward, know their friends.

And listen to them as well, do not lecture or offer unsolicited advice or ultimatums, do not try to talk them out of their feelings or solve their problems, just acknowledge the pain and sadness they are feeling , do not compare your teen’s feelings, reactions or experiences to your own or to someone else’s A parent can and should express their concerns directly. It is not easy to connect with teens in this way, and parents may need professional guidance to assist them. Yes, it is likely that the teenager will get angry and will say harsh things “It’s none of your business! ” “Get out of my room!

” “I hate you! ”, but this kind of response is often an unintentional test to see if you are able to help them. Depressed teenagers will seek answers to the following questions before confiding in an adult. Parents who show their kids that disagreements and painful feelings can safely be expressed and that they can be resolved make it safe for their kids to open up to them. The sharing of confusion, sadness, loneliness, shame, and other strong emotions often decreases the intensity, and opens the way for real communication, which in turn reduces the isolation that is such a large part of depression.

Treatment: Depression is treated with counseling therapy or with therapy and medication. A combination of approaches is usually most effective. Cognitive-behavioral therapy focuses on the causes of the depression and helps change negative thought patterns. Group therapy is often very helpful for teens, because it breaks down the feelings of isolation that many adolescents experience sometimes it helps just to know that “I’m not the only one who feels this way”.

Family therapy as an adjunct to individual therapy can address patterns of communication and ways the family can restructure itself to support each member, and can help the teenager feel like others share the responsibility for what happens in the family. Physical exercise is helpful in lifting depression, as it causes the brain’s chemistry to create more endorphins and serotonin, which change mood. Creative expression through drama, art or music is often a positive outlet for the strong emotions of adolescents. Volunteer work is sometimes helpful for adolescents.

Helping someone else whose problems are greater than one’s own offers a perspective and an opportunity to be helpful, which can increase one’s sense of purpose and meaning. Medication for depression to be prescribed with great caution and only under careful supervision. Recent studies by both the UK government and the FDA have led to warnings that not all psychiatric drugs may be appropriate for teenagers and children. Hospitalization may be necessary in situations where a teen needs constant observation and care to prevent self-destructive behavior.

Hospital adolescent treatment programs usually include individual, group and family counseling as well as medications. Special schools, wilderness challenges, or “boot camps” recommended for troubled teens. These alternatives intended to help adolescents learn coping skills, develop confidence, learn to trust and work with others, improve academics or deal with negative behaviors. Counseling or psychotherapy, means talking about feelings with a trained psychologist who can help you change the relationships, thoughts, or behaviors that are causing the depression. Medicine is prescribed to treat depression that is severe or disabling.

Antidepressant medications are not “uppers” and are not addictive. When depression is so bad that one cannot focus on anything else, when it interferes with life in an overwhelming way, medication is necessary, in addition to counseling. Research has repeatedly demonstrated that psychotherapy, especially cognitive behavioral therapy, is an effective treatment for depression. In some cases, drug therapy may be needed as well. Most therapists take a comprehensive approach that looks at the child, his family and social group, and the factors that may contribute to his depression.

In addition to counseling the child, a therapist may also suggest family therapy or parent counseling and treatment for any related conditions the child has, such as substance abuse or an eating disorder. (NIH, 2000) Whether children can benefit from drug therapy is decided on a case-by-case basis by the therapist and parents. The FDA strongly advises caution when giving antidepressants to children and teens due to reports of increased suicidal thoughts and suicide attempts in some antidepressant patients under age 18.

In 2004, the FDA strengthened warnings on all antidepressant packaging. Patients on antidepressants should be monitored for a worsening of their depression or the development of suicidal tendencies. This monitoring is particularly important, when the patient first begins taking the drug. Parents who are concerned about the lack of safety data may prefer alternate treatments. Experts also caution that doctors should prescribe anti depressants only in cases of persistent, severe depression, or when therapy is impossible or is not working.

It should not be used to treat kids suffering from painful situations like the death of a friend or relative, family violence, conflicts at home or school, or the loss of an important relationship. In those cases, using drugs can actually mask the real cause of the depression and keep a child from getting effective treatment. (Sung E. Son, Jeffrey T. Kirchner 2000) Although some experts believe drug treatment can be useful, they stress that it must be combined with therapy. Conclusions Educators and parents must turn their attention to the emotional and social needs of youngsters.

It is important to remember that some youngsters may be at risk. According to the American Association of Suicidology, it is urgent to promote and create conditions in the family, school environment, and community that will nurture cognitive and affective needs of young people. References Akiskal, H. S. (1983). Dysthymic disorder: Psychopathology of proposed chronic depressive subtypes. American Journal of Psychiatry, 140, 11–20. American Academy of Child and Adolescent Psychiatry (2001).

Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 40(Suppl 7): 24S–51S. Birmaher, B. , Ryan, N. D. , Williamson, D. E. , Brent, D. A. , & Kaufman, J. (1996). Childhood and adolescent depression: A review of the past 10 years. Part II. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1575–1583. Centers for Disease Control and Prevention. (1998). Youth risk behavior surveillance United States, 1997.

CDC Surveillance Summaries, August 14, 1998. MMWR, 47 (No. SS-3). Centers for Disease Control and Prevention. (1999). Suicide deaths and rates per 100,000 Available: http://www. cdc. gov/ncipc/ data/us9794/suic. htm Craft & Shaffer, D. (1986). A comparison of symptoms and diagnoses in Hispanic and black children in an outpatient mental health clinic. Journal of the American Academy of Child Psychiatry, 25, 254–259. Garber J, McCauley E (2002) Prevention of depression and suicide in children and adolescent. In M Lewis, ed. , Child and Adolescent Psychiatry, 3rd ed. , pp. 805–821.

Philadelphia: Lippincott Williams and Wilkins FDA (2004) Launches a Multi-Pronged Strategy to Strengthen Safeguards for Children Treated With Antidepressant Medications. October 15, 2004. P04-97 Klein DN, et al. (2001). A family study of major depressive disorder in a community sample of adolescents. Archives of General Psychiatry, 58(1): 13–20. Kaslow, Nadine J. ; Adamson, Lauren B. ; Collins, Marietta H. A developmental psychopathology perspective on the cognitive components of child and adolescent depression.

Kluwer Academic/Plenum Publishers: New York, NY, US, 2000. p. 491-510 of xxxi, 813pp. National Institutes of Health, (2000) Depression and Suicide in Children and Adolescents, September 2000, http://www. nimh. nih. gov/publicat/depchildresfact. cfm Sung E. Son, M. D. , Jeffrey T. Kirchner (2000) Depression in Children and Adolescents D. O. American Family Physician, Nov. 15, 2000 Teenager Suicide. (2000) The silent epidemic Education Week, pp. 1, 22-31. U. S. Department of Health and Human Services. (1999). Surgeon General’s Call to Action to

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