The suicide rate for adolescents has increased more than 200% over the last decade. Recent studies have shown that greater than 20% of adolescents in the general population have emotional problems and one-third of adolescents attending psychiatric clinics suffer from depression. The majority of teenage depressions can be managed successfully by the primary care physician with the support of the family, says Maurice Blackman MB, FRCPC.
Adults with psychiatric illness are 20 times more likely to die from accidents or suicide than adultsIs depression in adolescents a significant problem?20% of adolescents in the general population have emotional problems and one-third of adolescents attending psychiatric clinics suffer from depression. 3 Despite this, depression in this age group is greatly underdiagnosed, leading to serious difficulties inWhy is depression in this age group often missed?Adolescence is a time of emotional turmoil, mood lability, gloomy introspection, great drama and heightened sensitivity. possible suicidal ideation. What are the common symptoms of adolescent depression?Adolescent depressionmay also present primarily as a behavior or conduct disorder, substance or alcohol abuse or as family turmoil and rebellion with no obvious symptoms reminiscent of depression. How can suicide risk be determined?significant acute crisis in the teenager’s life and may also involve concomitant depression.
Significant stressors include divorce, parent or family discord, physical or sexual abuse and alcohol or substance abuse. The teenager who exhibitsHow can the physician best manage the patient?The teenagerTeenagers can be oppositional and negative whendepressed. The teenager is an active participant in the treatmentprocess and the physician must identify the problem to the patient and parent, offer hope and reassurance, outline treatment options and arrive at a mutually agreed-upon treatment plan. How should depression in adolescents be treated?There are two main avenues to treatment: psychotherapy and medication. Issues ofFormal family therapy may be required to deal with specific problems or issues. obsessive-compulsive disorder, learning disability or attention deficit hyperactive disorder, should be searched for and treated, ifpresent.
When should medication be used?For the more serious and persistent depressions, particularly those with vegetative symptoms or suicidal ideation, medication isSSRIs are well tolerated by teenagers because oftheir fairly rapid action and low tendency to cause side effects. patient population. Most teenagers canside effects. If the physician cannot engage in conversation with thesuggested. This is particularly important if the depression is judged to be severe or if there have been some suicidal concerns. be managed successfully by the primary care physician with the support of the family.
1. Murphy, JM, Monson, RR, Olivier, DC, et al: Affective disorders and mortality: A general population study. Psychiatry 44:470, 1987. 2. Hodgma, CH, McAnarny, ER: Adolescent depression and suicide: Rising problems.
3. Kovaks, M: Affective disorders in children and adolescents. 1. Lewinsohn, P, Gregory, M, Clark, N, et al: Major depression in community adolescents: Age, episode duration, and time ofJ Am Acad ChildAdolesc Psychiatry 31(6):1003,1992. Acad Child Adolesc Psychiatry 32(1):28,1993.
