Roughly nine percent of the population - an estimated 18.8 million Americans -- suffers from depressive disorders, illnesses that affect the body as well as the mind.
The effects of depression are magnified in children, who are experiencing depression in greater numbers. An estimated 8.3% of teenagers in the United States are suffering from depression, a significant leap from two decades ago. To compound the problem, researchers like Farmer (2002) found that about 70% of adolescents suffering from depression are unfortunately not receiving adequate treatment.
This paper examines the growing problem of depression among adolescents. The first part of this paper is an overview of teen depression, looking at its causes and contrasting teen depression with depression in adults. The next part then looks at the depressive symptoms among teenagers, contrasting these with the symptoms of depression in adults. In the last part, the paper examines the various approaches that have been taken to address the problem of depression among adolescents.
Full-blown depression often starts in adulthood. However, Koplewitz (2002) believes that dysthymia or low-grade depression can begin in adolescence or even childhood. Though dysthymia is recognized as a less severe form of depression, it could also prevent a sufferer from functioning well or feeling "happy." Furthermore, the appearance of dysthymia before age 21 is often a sign that the sufferer will experience major depressive episodes later in life.
Dysthymia in adolescents could also be a precursor to the more severe illness of bipolar disorder. An estimated 20 to 40% of teens who experience depression or dysthymia often develop bipolar disorder. Bipolar disorder is rare in childhood but could emerge during adolescence, especially in children with a family history of the disease. Teen sufferers of bipolar disorder can begin to experience the rapid swings of highs and lows that can take adult depression sufferers years to develop (Farmer 2002).
Bipolar disorder is not as common among teenagers as depression, and its symptoms are usually more severe. During the depressed cycle, the bipolar individual will suffer the same symptoms as major depression. However, in the manic state, the sufferers' moods can shift abruptly, leading them to act in ways that are rash or even dangerous (Lewisohn et al. 2003).
At childhood, depression often plagues boys and girls at the same rates.
However, researchers like Lewisohn et al. (2003) found that depression affects the sexes differently. Once they begin to mature, girls are two to three times more likely to suffer from dysthymia and depression than their male counterparts.
Though they differ in degree, teen and adult depression are both rooted in the same potential causes. As with its adult counterpart, teen depression could be triggered by a combination of factors. Adolescents who suffer from bipolar disorder often have a first-degree relatives who also suffer from the same illness. Teens who have parents with bipolar disorder have a 75% chance of becoming bipolar themselves. A study of identical twins shows a stronger link, since a having a twin with bipolar disorder increases one's chances of developing the same illness by 80% (Farmer 2002).
Koplewitz (2002) finds that these familial links show a genetic component to depression. However, no single "depression gene" has been identified. Scientists therefore speculate that that genetics alone do not determine depression. Rather, certain genetic variations could increase an individual's vulnerability, which could be exacerbated by factors like trauma or stress.
Recent brain research has also shown that chemical imbalances could have a significant impact on depression among adolescents.
Through more sophisticated techniques like magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, scientists are able to study more detailed images of the brain. As a result, there are now new theories regarding how the brain helps to regulate memory and mood, both of which are often affected by depression (Koplewitz 2002).
Researchers have thus found that the amygdala, a small oval mass that is part of the brain's limbic system, functions differently in a person suffering from depression. In normal brains, the amydgala's activity is higher only when a person experiences visceral emotions like anger, pleasure or fear. In a depressed person, however, the amygdala shows high activity even without any heightened emotions.
The depressed person's thalamus also plays a role. This part of the brain receives and processes most of the sensory information from outside stimuli before relaying this information to the relevant areas of the cerebral cortex. In a person with bipolar disorder, the thalamus is compromised. Some researchers believe that the malfunctioning thalamus can help contribute to hallucinations in people with bipolar disorder (Koplewitz 2002).
Finally, the hippocampus in health people bridges the transition from short- to long-term memory. Initial research shows that depression affects the interplay between the amygdala and the hippocampus, interfering with this transition. As a result, people suffering from depression could experience blackout periods and memory loss.
Though these causes are often observed in adults as well as teens, the physiological causes of depression could have a significantly worse impact on a developing brain. Physiologists found that the brains of adolescents are not yet fully developed. The regions of the brain that regulate judgment, for example, will not be mature until adulthood. As a result, the malfunctions in brain physiology and chemistry associated with depression can lead to greater incidences of suicidal thoughts among teens. Unfortunately, at this age group, thoughts of suicide are often easily translated into action (Farmer 2002).
Symptoms of depression
Symptoms of depression are easy to overlook, particularly when a person lives alone. However, alert parents, teachers, counselors and even classmates can often detect symptoms of depression in adolescents before the illness escalates.
Teens suffering from dysthymia, for example, can feel depressed during the day. Unlike a major depression, adolescents suffering from dysthymia suffer a continuous "down" feeling that could persist over at least two years and an average of five years (Farmer 2002). During this time, they could continue with normal activities like school, but many could do so with minimal energy.
Furthermore, teens with dysthymia often experience at least two of the following symptoms. First, they feel enervated. They could show trouble making decisions and often experience low self -esteem. They could either overeat or complain of appetite loss. Many dysthymic teens also either suffer from insomnia or have a tendency to sleep too much (Farmer 2002).
Teens with major depression could show the same symptoms as dysthymia, though these symptoms could be magnified. A major depression also causes an adolescent to experience more of these symptoms at a time. In addition to the ones already mentioned, a depressed teen can also show psychosomatic problems such as headaches or digestive disorders (Lewisohn et al. 2003). They could evidence restlessness and may be unable to concentrate on tasks at hand. In addition, depressed teens could have strong feelings of guilt and a sense of worthlessness. These feelings could contribute to thoughts of death and precipitate suicide attempts.
A teen suffering from bipolar disorder swings from episodes of deep depression to times of mania. A manic phase usually lasts a week, during which a teen could experience an intense high period. Manic teens feel a pumped-up sense of self-esteem, giving rise to grandiose ideas. Good judgment is often compromised, and the teens could channel their considerable energies to pleasure-seeking pursuits such as petty crimes or sexual activity. Manic teens are easily distracted and find it difficult to control their racing thoughts.
This manic phase, however, eventually gives way to the depressed stage. In this phase, an adolescent suffering from bipolar disorder will experience the same symptoms of depression. It should also be noted that bipolar disorder affects the sexes differently. Young women are more likely to suffer a major depression as their first bipolar episode. When they mature, female bipolar sufferers experience more depressive episodes on the whole. The opposite is true for young men, who will often experience more manic episodes during their lifetime.
Diagnosis and treatment
To diagnose depression, physicians conduct a physical examination to rule out conditions such as viral infections. After a physical cause is ruled out, the patient is then referred to a psychiatrist or psychologist for further evaluation. A clinician would also conduct an evaluation for substance abuse, since mood disorders could also be caused by heavy drinking or drug abuse. However, since substance abuse itself could be a sign of depression, a responsible clinician will conduct further tests before ruling out depression altogether (Koplewitz 2002).
A complete psychiatric evaluation is also useful in evaluating the history of an adolescent's illness. This evaluate is important, since depression could be accompanied by other psychiatric disorders like schizophrenia. Only when the disease is properly diagnosed can treatment commence.
Depression is an illness that affects each sufferer differently. There is thus no blanket treatment for depression. Instead, individual methods of treatment must be calibrated for every depression sufferer.
This difficulty is compounded in depressed adolescents, whose brains are not yet fully developed. Researcher Helen Egger (2003) cautions that…