Depression and bipolar disorder in adolescents

Depression in Adolescents

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.

Teen depression

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).

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 "non-pharmacological, psychosocial" interventions should be attempted before giving any adolescent medication. This would include trying to understand the factors behind the teen's social-emotional development. Impaired language skills, family psychiatric history and traumatic emotions like grief can all have a significant impact on the degree of adolescent depression.

Koplewitz (2002) echoes the need to emphasize "psychoeducation" before attempting to medicate people with mental illness, particularly adolescents. For Koplewitz, the most important step in treating depression in adolescents is to recognize that there is a problem. Often, Koplewitz notes, a depressed adolescent is dismissed as being "difficult" or "moody." In many cases, however, families refuse therapy, worried by the stigma associated with mental illness or the inconvenience of regular therapy. The unfortunate result is the worsening of what is otherwise a highly treatable disease (Koplewitz 2002).

The treatment of depression depends on the evaluation and the severity of the patient's illness. Those with mild forms of depression can benefit from psychotherapy. Others could be prescribed mild antidepressant medication such as selective seratonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). These medications target the brain's physiology and help alleviate any physiological causes that give rise to depression (Lebowitz 1997).

Treatment via medication is notoriously difficult, however, since the dose has to be calibrated individually, often through trial and error. Many patients experience severe side effects, such as dry mouth, nausea and agitation. These side effects contribute to the high rate of non-compliance among teens regarding their medications.

Towards this, Beardslee, Gladstone, Wright and Cooper (2003) suggest a "family-based approach" to addressing the symptoms of depression in children and adolescents. In families with a history of the disease, the researchers recommend a prevention approach, one that emphasizes positive interactions between parents and children. Parents are educated regarding mood disorders, in order to give them the skills to recognize the symptoms and to communicate information regarding the illness to their children. The study found that such an approach has significant positive long-term effects, particularly in terms of recognizing depression as an illness (Beardslee et al. 2003). This study can have significant implications, especially in light of the fact that many depressed adolescents are misdiagnosed, under treated or do not comply with their medication.

Physicians are cautious about using medications to treat mood disorder, since adolescents are experiencing hormonal changes associated with puberty. Currently, teens suffering from depression and other forms of mental illness are treated with antidepressants like flouxetine such as Prozac and paroxetine, more commonly known as Paxil. However, such drugs do not address the underlying psychological causes of depression, such as grief or other problems at school and at home. Thus, even adolescents on medication need to undergo therapy to help them developing further coping skills (Eggers 2003).

Conclusion

In summary, there is a growing trend of depression among adolescents in the United States, a trend that has been ignored. An untreated depression impairs their ability to fully-function and enjoy their lives. Many teens have even hurt themselves through suicide attempts.

Furthermore, while many experts recommend individual and family therapy, many families turn to antidepressants.

The stigma of mental illness continues to prevent many teens from seeking treatment altogether. As a result, depressed adolescents suffer in silence from a disease that, in its earliest stages, is highly treatable.