Adolescent Depression

Depression is a severe medical condition that affects millions of people, including adolescents, in today's society. Adolescent depression is a complex psycho physiological disorder that is a widespread and misunderstood disease throughout the world. Over twenty years ago, depression amongst adolescents and children was uncommon and nearly unknown. (2006, Depression Learning Path). Health professionals and medical research teams were unaware of the insidious dangers and consequences depression may cause in adolescents until medical studies were recently conducted. Medical statistics state one in eight adolescents may suffer with moderate to severe depression. Functionally impairing depression has been found in 2-10% of adolescents, which is a much more serious case of depression. (2006, Dopheide, p. 233). The majority of adolescent's suffering with depression does not receive adequate attention and treatment from health care professionals. Judy Battle (2002) reports, "Of all these children and teens struggling with emotional and behavioral problems, a mere 30% receive any sort of intervention or treatment. The other 70% simply struggle through the pain of mental illness or emotional turmoil, doing their best to make it to adulthood." (p.1).
Depression amongst adolescents may be caused due to changes in the body such as low epinephrine, neurotransmitters, or serotonin levels. Another theory emphasizes the role of environmental or post-traumatic stresses. The separations of parents, change of schools, loss of a loved one, or perhaps child abuse are also possible triggers. (National Institute of Mental Health, 2001). Adolescents may express outward warning signs and symptoms that indicate moderate to severe depression. The side-effects and symptoms of depression affect one's behavior, emotions, state of mind, and bodily functions. Noticeable changes in attitude, appetite, sleeping patterns, and social interaction often occur during a moderate level of depression. Attitude changes may include irritability, worthlessness, outbursts of anger, and a lack of enthusiasm. Appetite alterations tend to include binging or under eating, which may result in a serious eating disorder such as; anorexia or bulimia nervosa. Common changes in sleeping patterns are; insomnia, frequent napping, or restlessness during the night. Withdrawal of social interaction tends to include lack of school and personal activities with fellow peers. Clinical depression is considered a far more severe level of depression that includes harsh warning signs and symptoms. Alcohol and chemical substance abuse with over-the-counter and/or prescription drugs, as well as illegal recreational drugs may occur. Self-injury techniques such as; burning, cutting and other self-mutilation methods is also a common sign of clinical depression. A far more serious side-effect of depression is suicidal thoughts and actions. Judy Battle (2002) reports, "The consequences of untreated depression can be increased incidence of depression in adulthood, involvement in the criminal justice system, or in some cases, suicide. Suicide is the third leading cause of death among young people ages 15 to 24. Even more shocking, it is the sixth leading cause of death among children ages 5-14." (p.1). Some of the symptoms to watch for that would indicate a teenager is contemplating suicide according to Family First Aid (2001) are: obsession with death, poems referring to death, dramatic changes in personality or appearance, bizarre behavior, and giving away personal belongings." (p.2.)

Treatment Options and Methods
Adolescent depression may be difficult to recognize during initial stages, but it is absolutely imperative to obtain a proper diagnoses and immediate treatment. Maureen Empfield, M.D., states, "In fact, early onset depression is not normal, and can predict numerous unhappy life events for youngsters, including school failure, teenage pregnancy, and suicide attempts if not treated." Medical research has provided a variety of treatment options that may include specialized therapy sessions and/or prescribed medication. An effective psychotherapy method most commonly used throughout the medical community is known as cognitive-behavioral therapy (CBT). John Winston Bush, PhD (1996) claims cognitive behavioral therapy to be, "...the preferred treatment for most emotional and behavioral problems." (p. 1). The therapy is based on believing depression stems from negative thinking. A psychologist or psychiatrist begins cognitive behavioral therapy by teaching a patient to establish rational thoughts. This enables an adolescent to recognize irrational thoughts that may cause further continuance of depression. The child is also taught critical thinking, problem solving, decision making, and coping skills. Two other methods of treatment are interpersonal and psychotherapy techniques.
The pharmaceutical industry offers a vast selection of antidepressants tested and approved by the Food and Drug Administration (FDA). Selective Serotonin Reuptake Inhibitors (SSRI's) antidepressants are the most commonly prescribed medications available on the market. Amir Raz (2006) states, "Selective serotonin reuptake inhibitors have become the top-selling drug category since being introduced in the U.S. in 1989." (p. 35). The second top-selling drugs are tricyclic based. Tricyclic drugs work by combining electrical and chemical connections through cells. The chemical imbalance within the brain is corrected by transmissions of impulses sent from one cell to another. Monoamine Oxidase (MAO Inhibitor) is another category option of drugs for effectively treating depression. An MAO is an enzyme that breaks down and corrects imbalanced neurotransmitters in the human body.
The most commonly known, prescribed, and effective antidepressants approved for kids are; Celexa, Elavil, Paxil, Prozac, Wellbutrin, Zoloft, Luvox, and Effexor. Physicians typically prescribe these brands of antidepressants for a four to 6 month cycle. However, in more severe cases, antidepressants are prescribed for longer periods of time. Antidepressants work by slowing the removal of chemicals from the brain called neurotransmitters. The use of antidepressants may reduce symptoms of feeling helpless, worthlessness, extreme sadness, and other side-effects from depression. Adolescents that have suffered with depression for a number of years may develop severe mental disorders aside from depression. Atypical antipsychotic drugs are often prescribed to older teenagers with severe depression, Bipolar Disorder and Schizophrenia. The six antipsychotic drugs on the market are Clozaril, Risperdal, Zyprexa, Seroquel, Abilify, and Geodon. (2006, Elias). Physicians and health professionals tend to avoid prescribing antipsychotic medications to adolescents due to reported severe risk factors. Some of the more serious side effects are the possibility of seizures, development of blood disorders, and rapid heartbeat and other heart conditions.
Health care providers often combine therapy techniques and medication into a patient's treatment option. The skills learned through specialized therapy sessions, along with being monitored throughout taking medication, will benefit a child suffering with depression and eventually will result in recovery.

Antidepressants Warnings and Side-effects
The misdiagnosis of depression in adolescents is very common in today's society. Children have the tendency to misbehave, rebel, or have general mood-swings. A theory is, "It's normal for teenagers to be moody; teens don't suffer from real depression." But the truth is, "Depression is more than just being moody, and it can affect people at any age, including teenagers." (NIMH, p.1). Physicians and parents often mistake rebellious behavior to be depression. It is of great importance for a health professional to thoroughly review a child's case before prescribing antidepressants. Health professionals, pharmaceutical representatives, and parents argue whether antidepressants are effective and safe for adolescents. The Food and Drug Administration (FDA) issued a public health advisory in March 2004 regarding antidepressant use amongst adolescents and children. The advisory cautions health professionals, physicians, and families to monitor adolescent's use of antidepressants. Suicidal behavior and actions have been reported after beginning taking prescription antidepressants. Warnings signs of possible children at risk for potential suicide generally express symptoms of; threats, isolation, cutting, reckless behavior, withdrawal, and personality changes. (2006, Dopheide, p. 233). This claim has decreased prescriptions for antidepressants due to fear of suicidal actions amongst adolescents. The advisory warning has led to decreased antidepressant use and increased adolescent suicide rates. In 2003, a significant drop of 25% for antidepressant prescriptions from pediatric associates was written for adolescents and children. There was a 20% drop in prescriptions the next year in 2004. These numbers greatly reduced the 11 million rates of antidepressants given to children in 2002. (2005, Elias). Side-effects caused by taking antidepressant medication may be severe in certain cases and circumstances. As every medication listed on the pharmaceutical market, antidepressants and atypical antipsychotic drugs have acute to severe side-effects. Antidepressants may be habit forming due to high dosages or prolong use, cause side-effects, and/or not be effective in some cases. General side-effects amongst adolescents taking SSRI antidepressants are typically less severe than antipsychotic drugs. The Depression Learning Path Web site offers a list of the most commonly reported side-effects from antidepressants. These symptoms include; dry mouth, blurred vision, nausea, headache, sleep disruption, weight gain, agitation, dizziness, anxiety, sedation, diarrhea, and constipation. Atypical antipsychotic drug side-effects often include rapid heartbeat, violent outburst, anger, manic episodes, rash, confusion, nausea, paranoia, seizures, and blackouts. (2006, DLP, Side-Effects of Depression). Patricia Shapiro (2003) reports, "Studies are contradictory about the effectiveness of medication In treating depressive symptoms in children before puberty." (A Parent's Guide to Childhood and Adolescent Depression. p.110). However, the risk factors regarding antidepressant use on adolescents suffering with depression are outweighed by the benefits. "Treatment can help most depressed people start to feel better in just a few weeks." (2005, Insel, p.3).
Teenage depression should never be taken lightly, but there is help out there in the medical community for all teenagers who suffer from it. There are many experienced and knowledgeable health professionals aware of the severity of adolescent depression. The right combination of drug therapy can help the teenager return to leading normal and happy lives.

References
Battle, Judy S. (2002). So Your Teen Has Been Diagnosed with a Mood Disorder, Now What? About Teen Depression. http://www.about-teen-depression.com
Bush, John W. PhD. (1996). CBT: The therapy most likely to reward your hopes for a better life. Cognitive Behavior Therapy. http://www.cognitivetherapy.com
Cohen, Jay S. M.D. (2004). Antidepressant Side Effects. Medication Sense. http://www.medicationsense.com/articles/jan_mar_04/antidepress_side_effects.ht ml
Depression Learning Path. (2006). Treating Depression. http://www.clinical-depression.co.uk/Treating_Depression
Dopheide, Julie A. (2006). Recognizing and treating depression in children
and adolescents. American Journal of Health-System Pharmacy. (Vol. 63, p. 233 - 244).
Elias, Marilyn. (2006). Antipsychotic Drugs Carry Risks for Children. USA Today.
Empfield, Maureen. (2001). Teenage Depression: More Common Today Than Ever. Understanding Teenage Depression.
Family First Aid. (2001). Teen Suicide Statistics, Signs, and Facts. Troubled teens. http://www.familyfirstaid.org/suicide.html
Insel, Thomas R. (2005). Working to improve mental health through biomedical research on mind, brain, and behavior. National Institute of Mental Health (NIMH). http://www.nimh.nih.gov/publicat/letstalk.cfm
Murphy, Kathryn. (December, 2005). What can you do to prevent teen suicide?
Nursing. (Vol. 35, p. 43-45).
Raz, Amir. (January, 2006). Perspectives on the Efficacy of Antidepressants for
Child and Adolescent Depression. PLoS Medicine. (Vol. 3, p. 35-41).
Shapiro, Patricia. (2003). A Parent's Guide to Childhood and Adolescent Depression.