Depression in adolescence
Dr Wrishi Raphael
Sreoshi, a 16 year old girl presents to the chamber of her family physician and a long term family friend Dr Halim, with the chief complain of sleeplessness for several weeks. When she tries to sleep she finds her thoughts go repeatedly over all the stupid things she did today. She has tried things like getting into a sleep routine, cutting back on her caffeine intake and making her room more conducive to sleep. She feels that the lack of sleep has caused her to become more irritable resulting in deterioration of school marks. She also complains that she needs to go through her homework again and again as nothing seems to sink in. Sreoshis mother is always telling her to calm down and not be so jumpy. Dr Halim starts to discuss her psychological symptoms with her but she says I just want to take a tablet I just cannot stand this anymore sometimes I wish I wouldnt wake up. She denies the use of illicit drugs or alcohol and physical examination rules out possibilities of amphetamine or narcotic usage.
Although Sreoshi complains primarily of insomnia, her sleep disorder is only a part of the constellation of other problems which have produced depression. A teenager may be categorized as a depression patient when he or she is exhibiting at least five of the following symptoms for a period of more than two weeks.
Irritable Mood: Sreoshi finds herself to be irritated and angry over her insomnia. Irritable mood is more common among depressed teenagers then depressed adults. Adults with depression present frequently with depressed mood but less commonly with irritability. Senior citizens who suffer depression hardly ever complain of mood swings but they often speak of vague complains like headaches, body aches and social withdrawal.
Initial Insomnia: Initial insomnia is a type of sleeplessness where the patient will find difficulty falling asleep and this pattern is more common among teenagers. Older patients with depression will complain of middle insomnia; a pattern of sleeplessness, where sleep is interrupted in the middle of the night and he/she is unable to sleep again.
Concentration deficit: Sreoshi clearly states her need to go over her homework again and again because nothing seems to sink in.
Agitation: Sreoshis mother keeps telling her to calm down and relax. It is easy for parents to notice agitation in teenagers where kids tend to be excessively moody, argumentative and may exhibit phenomenon like pacing up and down the room etc.
Worthlessness: A teenager is supposed to feel excited and happy over all the new things he or she experiences. A teenager should be more preoccupied with friends, co curricular activities or sports and it is unusual to be obsessing over all the stupid things she did today. The total lack of co curricular activities and sports in teenagers, have led to a feeble and decrepit generation of young people who lack the will or enthusiasm to accept or embrace life for its inalienable worth. Pressure from families, schools, national curriculums, lack of playgrounds and the premature sexualization of children are plagues which continue to rob our children of their childhood and youth only to leave behind an army of living carcasses.
Suicidal Ideation: Sometimes I wish I wouldnt wake up a plea for help cannot get louder than that. In an effort to fend off the frustrations of everyday life we adults tend to conceal all our emotions and teenagers are no different. But their minds are not as pliant as adults and this tends to undermine their ability to deal with the tribulations of everyday life. If left untreated, suicidal ideation is the most ominous sign of depression and may manifest in all manners of self mutilating and destructive behavior.
Kids, who present with such alarming complains, must be re evaluated for signs of drug abuse and parents should be informed about the signs of depression, in a calm and non confrontational manner.
The cornerstones of treating teenage depression are pharmacotherapy and psychotherapy. Some anti depressants are excellent for the acute treatment of depression especially for teenagers who present with suicidal tendency. It is good to treat the vulnerable child initially with anti depressants for some days before he becomes more receptive to psychotherapy.
Teenagers with acute symptoms of depression are less sensitive to psychotherapy then adults. But general practitioners must be cautious about the choice of anti depressants. Selective serotonin reuptake inhibitors like fluoxetine are better for young patients then amitriptyline or venlafaxine and the use of such drugs at home cannot go unsolicited. Once the initial wave of melancholy has passed, psychotherapy should be started without delay. When the patient will start to respond positively to psychotherapy; oral medications may be weaned off slowly over weeks..
The writer can be reached at [email protected]
