Adolescence is a developmental age where the youth undergoes a number of challenges in society and academics. There is a need for intimacy and increased responsibilities towards society an academics. One in every six adolescents experiences depression at least once in a lifetime and nearly one third reflect the symptoms of their behavior. Females are more susceptible to major depressive disorders as compared to males.
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Definition

Depression is a chronic and recurrent mood disorder characterized by reduced functioning in more than one major area of life i.e. academic, familial, and peer relationships.

Epidemiology

According to the World Health Organization statistics, 350 million people across the globe suffer from depression in 2015.

3 million teenagers in the United States had at least one major depressive episode in the year 2015. One in every 6 people experiences depression at least once in a lifetime. Women are more likely to suffer from depression as compared to men.

Major depressive episode

The presence of 5 or more symptoms of depression during same two weeks.

Major depressive disorder

2 or more major depressive episodes are an indication of the major depressive disorder.

Risk Factors for Depression

Social factors:

  • The family history of depression (Individuals whose parents have depression are 3 to 4 times more likely to suffer depression as compared to offsprings of healthy parents.)
  • Parental neglect
  • Bullying in school
  • Issues related to family relationships
  • Negative life events
  • Peer rejection

Psychological factors:

  • Low brain levels of serotonin (monoamine) can cause depression.
  • Pessimistic personality and low self-esteem
  • Exposure to violence and abuse
  • Poor socioeconomic status

Biological factors:

  • Major mental or physical illness
  • Physical anomaly
  • Major Hormonal imbalances at puberty
  • Low brain levels of serotonin (monoamine) can cause depression.

Resilience

Two individuals under similar condition may react to a situation in a different manner. One may develop depression while others may not. Even in the presence of risk factors, some people cope well and escape depression. This ability is termed as resilience. High intelligence, emotionally stable personalities, better coping mechanisms, healthy relationships with family, and peer support are positive resilience factors.

SIGECAPS — Symptoms of depression

S — Sleep disturbance

I — Loss of interest in different activities

G — Guilt

E — Loss of energy

C — Loss of concentration

A — Appetite changes

P — Psychomotor agitation

S — Suicidality

Other symptoms

  • Rebellious behavior
  • Use of alcohol or drugs
  • Promiscuous sexual activities
  • Crying episodes
  • Sadness and tearfulness
  • Hopelessness
  • Persistent boredom
  • Social isolation
  • Poor communication
  • Low self-esteem
  • Sensitivity to failure or rejection
  • Irritability
  • Frequent headaches, back pain, and stomachaches
  • Decline in academic performance
  • Apathy
  • Difficulty with relationships
  • Forgetfulness
  • Weight loss or weight gain
  • Changes in eating habits/eating disorders
  • Efforts to run away from home
  • Self-destructive behavior
  • Substance abuse majorly alcohol and smoking

Physical findings

  • Change in body weight
  • Signs of self-injury

Diagnosis

Diagnosis is based on interview questions. Symptoms of depression may last at least two weeks.

  • Different questionnaires are used for screening depression in adolescents
  • Two-item patient health questionnaire (PHQ-2)
  • Short mood and feelings questionnaire
  • Children’s depression inventory

Medical conditions like thyroid problems, CNS lesions, anemia, vitamin deficiency, and obstructive sleep apnea should be ruled out as these conditions are likely to mimic depression.

Differential diagnosis

  • Adjustment disorder
  • Dysthymic disorder
  • Bipolar disorder
  • Schizophrenia

Comorbidities

Around two-thirds of individuals with depression have at least one comorbid psychological condition commit suicide when depressed at the end stage of life. 10 to 15 percent of the individuals have 2 or more comorbid psychological conditions have 2 or 3 suicidal attempts. There are 3 to 6 times more chances of substance abuse in patients with depression.

  • Syndrome of severe mood dysregulation
  • Generalized anxiety disorder
  • Moreover, autistic spectrum disorders, eating disorders, and ADHD is likely to get more complicated in the presence of depression.

Individuals with depression are more at risk of developing disruptive behavior disorder and anxiety issues.

Treatment

  • Cognitive behavioral therapy (CBT)
  • Interpersonal psychotherapy (IPT)
  • Antidepressants (medicines are continued for at least 6 months even after the symptoms have improved)
  • SSRIs (selective serotine reuptake inhibitors) are a preferred selection for treatment
  • Electroconvulsive Therapy (ECT): It is the brief electrical stimulation of the brain. The patient is under anesthesia during this procedure. ECT is typically reserved for severe depression cases which fail to respond to other treatment options.
  • Patient Health Questionnaire (PHQ-9) is used to monitor the response to treatment.
  • Comorbidities like anxiety, eating disorders, and substance abuse are treated separately.

Self-help

Following activities can help improve depression:

  • Regular exercise
  • Healthy diet
  • Abstinence from alcohol and smoking
  • Abstinence from mobile and television overuse or misuse
  • Quality sleep

Suicide

Suicide is the third leading cause of death among the adolescents of age between 15 and 24 years. The suicidal rate in young girls is higher than boys.

Common Methods used in suicides

  1. Firearms
  2. Suffocation
  3. Poisoning

Risk factors

Some of the risk factors identified by researchers are as follows:

  • Previous attempts to suicide
  • Behavioural changes such great irritability or complete indifference from the society
  • Eating disorders
  • History of substance abuse such as alcohol or smoking
  • History of sexual or physical abuse
  • Low self-esteem
  • Depression, anxiety and other health problems
  • Stressful life event social and academic
  • Loss of a loved one
  • Ease of access to lethal drugs
  • History of interpersonal violence such as cutting or biting oneself
  • Mental illness
  • Family history of suicide
  • Teens lacking social and family support

Protective factors / Preventive measures

  • Reflective and deep thinking skills
  • Effective community programs for mental illness and substance abuse disorders
  • Ease of access to psychiatric help by regular supportive counseling sessions
  • Support from friends and family
  • Cultural programmes that discourages suicide
  • Religious beliefs (omonistic faith in god and religious activities)
  • Indulging in constructive activities such as sports or artistic field like painting and drawing.

In early school age, suicides, depression and alcohol use should be monitored as noticeable phenomenon for every teenage as they together are third cause of adolescent death. Thus, prevention programs target on risk factors to reduce adolescent mortality and enhance well being.

National Suicide Prevention Lifeline
Call 1-800-273-8255
Available 24 hours everyday
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