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Adolescent Depression

October 27, 2007 Practice of Excellence Michael Torres, PsyD

Learning Goals

Essential stats Developmental considerations Signs & symptoms of Teen depression Causes & Contributors Diagnostic Issues Treatment approaches What we do at Kaiser What you can do

Essential Stats
About 20% of adolescents will experience depression
before they reach adulthood. About 5% of adolescents are suffering from major depression at any given time. As many as 8.3% of teens suffer from depression for at least a year, compared to about 5.3% of the general population. Thirty percent of Teens with depression also develop a substance abuse problem.

Essential Stats
Untreated depression is the #1 cause of Teen suicide. Third leading cause of death in Teens is suicide. Less than 33% of depressed adolescents seek help, and
80% of those treated report improvement. Homosexual and bisexual teens comprise up to 30% of all Teen suicides. Females attempt suicide twice as frequently as males. Males complete suicide five times higher than girls.
- Mental Health: A Review of the Surgeon General, 2007

Developmental Considerations
Adolescents are excessively egoistic, regarding themselves as the center of the universe and the sole object of interest, and yet at no time in later life are they capable of so much self-sacrifice and devotion. They form the most passionate love relations, only to break them off abruptly as they began them. On the one hand, they throw themselves enthusiastically into the life of the community and, on the other, they have an overpowering longing for solitude. They oscillate between blind submission to some self-chosen leader and defiant rebellion against any and every authority. They are selfish and materially minded and at the same time full of lofty idealismAt times their behavior to other people is rough and inconsiderate, yet they themselves are extremely touchy. Their moods veer between light-hearted optimism and the blackest pessimism. Sometimes they will work with indefatigable enthusiasm and at other times they are sluggish and apathetic.
- Anna Freud, 1966

Developmental Considerations

Physical
Bodily
Height/Weight Secondary sex characteristics Circadian rhythms

Sexuality
Self exploration Dating Orientation

Developmental Considerations

Intellectual
Brain transformation

Executive function Cell growth in frontal lobe (ages 13 25) Abstract thought Priority assignment Ability to take anothers perspective Moral/ethical reasoning

Developmental Considerations

Social World
Peers

Affiliation Acceptance Identity Friendships Cultural/ethnic influences Family role(s)
Separation/Individuation

Signs & Symptoms



Irritability Poor attention/focus Self harming behaviors Morbid thoughts Negativity Low self-esteem Changes in appetite/sleep Increased physical complaints Low energy and mood Lack of interest in formerly enjoyed activities

Signs & Symptoms

Thoughts

Feelings

Behaviors

Causes & Contributors

Biology Neurotransmitter(s) Heredity/Genetics Substance abuse Medical condition Environment Abuse Trauma High stress Violence Life Losses Divorce Adjustments to stress Cognitive Theory Core Beliefs/Values Automatic Thoughts Cognitive Distortions

Diagnostic Issues

Major Depression Bipolar Disorder Dysthymia Adjustment Disorder with Depressed Mood Depression NOS

Treatment Approaches
Psychotherapy Lifestyle
Exercise Diet Education Behavioral Mgmt Tx compliance Extracurriculars

Medication
Antidepressants
Prozac Wellbutrin Celexa Zoloft

Individual Family Group

Mood stabilizers
Risperdal Seroquel Zyprexa Depakote Lithium

What We Do At Kaiser
Best Practice Model (2002) Individual, Family, Group Psychotherapies Psychoeducation
Classes, Written Literature, and Online Information

Medication Treatment Substance Abuse Tx Intensive Outpatient Services (IOP) Crisis Intervention (24/7)
Inpatient/Outpatient

Psychiatry Department Phone Numbers



Hayward 510-675 - 4533 Oakland 510 752 - 6544 San Francisco 415 833 - 3136 Richmond 510 307 - 1609 Vallejo 707 645 - 2164 San Rafael 415 444 - 3050 S. San Francisco 650 742 - 2822 Martinez 925 688 - 2100 Redwood City 650 299 - 1140 Santa Rosa 707 571 - 3797 Pleasanton 925 847 - 5340

Walnut Creek 925

295 - 5210

What You Can Do


In the context of a medical assessment
Ask about common depressive symptoms Directly ask about suicidal thoughts Include basic psychiatric assessment into your
medical evaluation Educate parents about depression Trust your instincts Consult with Child Psychiatry

Ways To Support A Depressed Teen


Recognize that depression is real. Take any talk of suicide seriously and notify your Teens physician or
mental health provider immediately. Acknowledge that your Teen is suffering. Dont criticize, pick-on, or blame your Teen for her/his depression. Dont say/do anything that might worsen your Teens poor self image. Express affection, offer kind words, and let your Teen know you care. Recognize the efforts your Teen makes to overcome depression, no matter how small. Dont expect your Teen to just snap out of it. Participate and support your Teens treatment. Encourage healthy friendships and social activities for your Teen. Get support for yourself. This isnt easy for a parent.
- Kaiser Best Practices in Adolescent Depression (rev. 2007)

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