Term Paper: Depressed Suicidal Adolescent

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Teen depression, suicide report issued by the American Surgeon General (nd) lists major depressive disorder, dysthymic disorder and bipolar disorder as the most frequently diagnosed mood disorders among the adolescent population. Mood disorders are strongly correlated with suicidal ideation and behavior in the general population, but among the teen community risk for suicide increases. The Surgeon General (nd) calls suicidal behavior a "matter of serious concern" and notes that "incidence of suicide attempts reaches a peak during the midadolescent years, and mortality from suicide, which increases steadily through the teens, is the third leading cause of death at that age." Therefore, parents, educators, and clinicians need to understand the causes and warning signs that may predict suicidal behavior.

Warning signs include those that are associated with major mood disorders such as depression. Early detection and diagnosis of mood disorders is the key way to prevent suicidal behavior because of the clear link between them; suicidal behavior is not classified as a mental disorder but rather as a symptom thereof. Intervention, using the best methods possible and including counseling and maybe medications, can alleviate the underlying condition and save the life of a child or young adult. Almost all adolescents who commit suicide have a mental disorder and so keeping a close eye on emerging symptoms will help clinicians better predict and therefore prevent adolescent suicide (Surgeon General, nd).

Preventing mood disorders or alleviating their symptoms once they arise proves more difficult, because root causes could be biological and genetic, exacerbated by environmental conditions. Moreover, the symptoms associated with mood disorders may manifest differently in each person, are caused by various factors, and may erupt at different ages or stages of development. Some clinicians point out that the depression is often difficult to distinguish from "normal teenage moodiness" and that symptom expressions vary considerably from teen to teen with some mainly withdrawing socially and others acting out aggressively (Smith, Barston, Jaffe, Dumke, Segal 2007). Blackman (1995) notes that depression can be easily overlooked or missed in teenagers because the adolescent stage is characterized by "emotional turmoil, mood lability, gloomy introspection, great drama and heightened sensitivity." A depressed mood may be a "temporary response" and common due to the "normal maturation process of puberty," (Van Voorhees 2007). However, temporary depressed moods and reactions to stress do not constitute clinical depression. Clinical depression and other mood disorders are outlined in the Diagnostic and Statistical Manual (DSM) with specific lists of symptoms and the length of time depressive episodes last.

The reasons for the tumultuous emotional and cognitive states that surface during adolescence are at least in part related to human biology: to the enormous hormonal, neurological, and structural changes taking place in the brain and body. However, stressful life events can trigger depressive episodes and when those episodes become persistent and long-lasting serious depression may be indicated. Added to the pressures of school work, social life, and parental interactions, the hormonal changes taking place in the body can create organic mood disorders: those that arise as a direct result of neurological or biological imbalances. Predilection for mood disorders in teenagers whose parents, grandparents, or siblings suffered from psychiatric illnesses mean increased risk for developing conditions like depression or bipolar disorder.

According to Smith et al. (2007) the "red flags" that warn of depression in adolescents include any "unusual changes in behavior" as well as "new or worsening symptoms of agitation, irritability, or anger." In fact, the symptoms of depression and other mood disorders in adolescents may differ from symptoms expressed in depressed adults. Contrary to popular belief, sadness and melancholy moods are sometimes not associated with teenage depression, which is more likely to be diagnosed due to angry outbursts or rage (Smith et al. 2007). Irritability, persistent anger or bad mood, rage, sensitivity to criticism, and social withdrawal are all features that may distinguish adolescent from adult depression (Smith et al. 2007).

Some teenagers may display psychosomatic symptoms like sudden headaches or stomachaches (Smith et al. 2007). Changes in eating habits, either overeating or undereating or developing an eating disorder may also be signs of depression, and so might be changes in sleeping habits (Van Voorhees 2007). Losing interest in activities the teen once enjoyed, neglecting personal appearance, difficulties concentrating, and boredom are also symptoms of depression (American Academy of Child and Adolescent Psychiatry 2008). Substance abuse and criminal behaviors are also possible signs of a mood disorder (Van Voorhees 2007). Van Voorhees (2007) notes that teenage girls are "twice as likely" as boys to experience depression and to attempt suicide. However, more males than females actually do kill themselves (Counseling Services at the University of Buffalo).

As with many psychiatric disorders, depression has a high comorbidity rate: the condition often coexists with other problems including drug addiction, eating disorders, and social anxiety. However, suicide remains one of the most common symptoms of teenage depression and incidences are on the rise. Nunley (nd) notes that the suicide rate among adolescents has "quadrupled" during the past twenty-five years and Blackman (1995) claims a 200% increase in the suicide rate among adolescents between 1985 and 1995; a trend that could continue as more teens are given antidepressant medications to treat their mood disorders. Ironically, medications that are used commonly to treat depression and other mood disorders in teenagers can worsen symptoms and increase the risk of suicide (Smith et al. 2007). Arkowitz & Lilienfeld (2007) point out that research reveals a disturbing trend, albeit among a small subset of the adolescent population taking antidepressant medications: in some teenagers the drugs "produce suicidal thoughts, suicide attempts and possibly even suicide."

Therefore, psychiatrists prescribing antidepressant medications to teenagers clearly exhibiting symptoms of mood disorders must closely monitor their patients especially during the first few months of treatment (Smith et al. 2007). The Food and Drug Administration (FDA) advises doctor's visits once a week for four weeks after commencing a course of a new antidepressant medication because the risk of becoming suicidal is especially high during the first month or two of starting treatment (Smith et al. 2007). Furthermore, the FDA mandates warning labels on all antidepressants to underscore the risk of adolescents committing suicide while on antidepressants (Smith et al. 2007). A family history of bipolar disorder, and teenagers diagnosed with bipolar disorder are at increased risk for reacting to antidepressant medications with increased suicidal ideation (Smith et al. 2007).

The National Association for the Mentally Ill classifies depression and other mood disorders as neurobiological brain disorders that invariably have a "biological underpinning." Attributing major depression and other mood disorders that can trigger suicidal behavior to biology is helpful in some ways but potentially problematic in others. By pointing out the biological underpinnings of a mental illness, researchers can develop pharmaceutical interventions and help their patients achieve symptom relief. However, the adolescent brain is not yet fully developed. Introducing neurobiological interventions to a growing brain can cause serious long-term complications and possibly irreversible side-effects. Pharmacological treatments for adolescent depression should be used sparingly if at all. A wealth of non-medical treatment methods is a safer approach toward treating depression in adolescents, if for no other reason than to minimize the risks associated with taking antidepressants. Because suicidal thoughts might not signal clinical depression, teenagers should be evaluated thoroughly and treated by counseling psychologists before their doctors recommend a pharmaceutical intervention. Suicidal tendencies are often but not always correlated with clinical depression. The correlation is anywhere between 35% and 70%, with wide variations in the literature about the relationship between suicide and depression in adolescents (National Strategy for Suicide Prevention nd).

Teenagers often express suicidal ideation. Saying things like "I won't be a problem for you much longer," or "Nothing matters" could indicate suicidal thinking (American Academy of Child and Adolescent Psychiatry). An adolescent who verbally expresses a desire to kill herself or himself is highly likely to be actually considering the act. Obsession with death and imagery associated with death is not necessarily a sign of suicidal ideation but parents should feel free to address tough topics like death with their teenagers (American Academy of Child and Adolescent Psychiatry). Addressing the high prevalence of suicide among college students, the office of Counseling Services at the State University of New York, Buffalo emphasizes the importance of open conversation with those suspected of being suicidal or just depressed. Talking about suicide and/or death will not plant any ideas, notes the Counseling Services office. Rather, broaching the subject will help the suicidal or depressed individual feel cared for and supported. Addressing the matter in a non-judgmental tone and listening to the person carefully will help a suicidal teenager express the underlying feelings and cognitions that are fueling the suicidal thoughts. Moreover, students who decide they want to commit suicide can change their minds (Counseling Services).

For some teenagers, simple lifestyle changes can reduce signs of depression and suicidal behaviors. Exercising, engaging in pleasurable activities, finding creative outlets like art or music, and eating well are all acts that can reduce… [END OF PREVIEW]

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