Mood disorders
This is a rather broad term and includes the commoner depression seen in about 3-5% young adolescents as well as Mania / bipolar disorder which affects 1%.
This article focuses on depression in teens
Over past 30 years it was increasingly recognised that depression is not an illness that affected only adults. Adolescents and younger children demonstrate similar signs and symptoms. The features likely to be noted are -
- Low mood / sadness / crying spells
- Irritability / easy annoyance and occasionally agitation
- Loss of pleasure in previously enjoyed activities
- Reduced motivation / drive
- Hopelessness and other negative thinking (poor sense of self esteem / worth)
- Poor self care
- Reduced appetite and weight loss (converse can also happen).
- Poor concentration and decline in academic performance
- Feelings of guilt
- Self harm / not wanting to carry on (suicidal ideation).
- Reduced energy
- Poor sleep (insomnia)
- In severe cases, features of psychosis - delusional thinking and hallucinations may be seen as well.
Causes
Any stressful life event can trigger depression, this may include bullying, parental separation, domestic violence, relational problems, parental mental illness, bereavement..... Depression is more likely in those with family history as stress would trigger expression of the vulnerable genes more easily. Changes in the brain chemistry are known to occur (e.g. decrease in the levels of serotonin) and can be the cause of mood changes in some but not all cases. Medical problems (e.g thyroid dysfunction) and certain medications (e.g. contraceptive pills) or street drugs like cannabis can also induce depression.
Treatment of depression
- Self help is recommended in milder forms
- Cognitive Behaviour Therapy / Inter-personal therapy are first line options as per National Institute of Clinical Excellence (NICE) guidelines.
- Medication i.e. anti-depressants are usually reserved for those who are not responding to talking treatments, when depression is moderate - severe and / or when biological symptoms dominate.
- Fluoxetine is the licensed product and first choice failing which off-label alternatives may be considered.
- Side effects need monitoring via regular reviews.
- Research shows that combination of talking treatments and medication produces best results and longer term outcomes.
- Medication needs to continue when it is found helpful for 6 to 9 months as stopping sooner can increase chances of relapse.
