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Depression and suicidal thoughts in young people are common, but these feelings should be taken very seriously.
Remember kids lack skills for communicating their feelings; so when they feel down, they often express themselves through moodiness and behavioral problems. The class clown could be covering up sadness; the rebel could be hiding inadequacy feelings; the drug user or drinker may feel more normal when using; early sexual activity could be a way to feel less alone.
Treatment begins with a careful assessment of the symptoms and the family. Because youthful depressions are so often masked by behavior problems, uncovering the underlying depression may take many hours of exploration.
Depression in youth is treatable with psycho-therapy, cognitive behavioral therapy, family therapy, and, sometimes, medication.
Sometimes, removal of the stressors behind the depression, sharing feelings, receiving family support, and improvement in the family situation may resolve the depression. The counselor will help the family make these changes.
Psychotropic medication often helps the more severe cases and may also be tried in other cases in order to get the person moving and functional sooner. Tricyclics (such as Amitrip-tyline, Nortriptyline, Desipramine) and SSRIs (Selective Serotonin Reuptake Inhibitors, like Prozac, Paxil, Zoloft) are the most commonly used types of meds for depression. You may see other meds for depression being tried, such as Bupropion, Lithium, Valproate. Drugs for behavior management or thinking problems may be used in combination with antidepressants. All these medications work more effectively when taken for at least 4-6 weeks and they may be taken for an extended period of time to prevent recurrence of symptoms.
DEPRESSION SYMPTOMS IN YOUTH
When 3 or more of these symptoms are present, adolescent depression may be present:
- Emotionally sensitive, over-responds to loss, failure, disappointment
- Mood swings
- "Anhedonia", the inability to enjoy life or feel pleasure
- Feels sad, alone, uncared about, rejected, low
- Difficulty concentrating
- Boredom, agitation
- Flattened emotions, dull mood without much joy
- Sees self as inadequate, bad, unacceptable, inferior
- Self-reproach, cuts self down
- Guilt feelings, self-blame for family problems
- Changes in the care taken in appearance and grooming
- Fatigued, constant tiredness, excessive sleeping, blahs, lays around for hours
- Sleep changes, "nothing to get up for " feeling, or suddenly begins staying up very late
- Loss of energy
- Physical pain may express emotional pain -headache, stomach ache
- Loss of appetite, weight loss (sometimes, rapid weight gain occurs)
- Feels no one understands or listens
- Dropping out of familiar interests and activities
- Withdrawal from friends and family, such as extended time alone in bedroom
- Shift in friends and activities, which may include truancy, drugs, and drinking, group drug use
- Onset of behavior problems, "acting out "
- Drop in grades and poor concentration in school
- Difficulty joining in during humor
- Gravitates to other depressed youth
- Irritable with others
INNER FEELINGS DURING DEPRESSION
Depressed youths feel the same things as depressed adults.
- a failure to achieve valued goals, often goals set too high
- a deep sense of loss
- helplessness and hopelessness
- disappointment
- overly high standards
- self-blame and guilt over family problems
- a burden to others
- unloved
- weak and inadequate
- deeply alone
TYPES OF ADOLESCENT DEPRESSIONS
- Normal or Reactive Depressed Feelings. Brief upsets, moodiness, or sadness, often over disappointments and losses. These states are temporary and they do not undermine self- image. Includes Reactive Depression, known as Exogenous Depression or Adjustment Disorder with Depressed Mood, which is the result of the loss of a relationship or of the hope of attaining an important goal or accomplishment. Adjustment-reaction depressions, for example, might occur after failure to make a team, moving away from cherished friends, ending a dating relationship, developing a serious illness.
- Major Depression. Often incapacitating, lasting for weeks, showing four or more of the symptoms of depression. Known as Clinical Depression and sometimes as Endogenous Depression. May feel "I have nothing to live for". Can range from Mild (just a few symptoms) to Severe (presence of many of the symptoms of depression).
- Dysthymia. One-two year period of mild-to moderate depressed mood. Can function in daily life, however; in contrast, the Major Depression leads to impairment in ordinary functioning.
- Bipolar Disorder. Swings from periods of depression to one or more periods of euphoria, agitation, lack of sleep. Also known as Manic-Depressive Illness.
- Cyclothymia. Milder than Bipolar, swings from periods of excessively up moods to excessively down moods.
- Drug-Related Depression. Many drugs produce depression. Regular use of alcohol, marijuana, cocaine, and other drugs produce down moods either when using the drug or afterwards during the crash. Because the mood problems often clear up after stopping use, accurate evaluation of the depression requires several weeks of abstinence.
- Depression May Be Preliminary to Suicide. Depression is the most common precursor to suicide attempts. Suicide rates have doubled among adolescents in the past two decades. All references to suicide, such as giving away possessions, wishing to be dead, and threats of self-harm should be taken seriously and should be discussed with a mental health professional.
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