Francis Mark Mondimore - Adolescent Depression: A Guide for Parents

ADOLESCENT DEPRESSION

A Johns Hopkins Press Health Book

Francis Mark

MONDIMORE, MD

Patrick

KELLY, MD

ADOLESCENT DEPRESSION 2nd Edition

A Guide for Parents

Note to the reader: This book is not meant to substitute for medical care of people with depression or other mental disorders, and treatment should not be based solely on its contents. Instead, treatment must be developed in a dialogue between the individual and his or her physician. Our book has been written to help with that dialogue.

Drug dosage: The author and publisher have made reasonable efforts to determine that the selection of drugs discussed in this text conform to the practices of the general medical community. The medications described do not necessarily have specific approval by the U.S. Food and Drug Administration for use in the diseases for which they are recommended. In view of ongoing research, changes in governmental regulation, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert of each drug for any change in indications and dosage and for warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently used drug.

2002 Francis Mark Mondimore

2015 Johns Hopkins University Press

All rights reserved. Published 2015

Printed in the United States of America on acid-free paper

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Library of Congress Cataloging-in-Publication Data

Mondimore, Francis Mark, 1953

Adolescent depression : a guide for parents / Francis Mark Mondimore, MD, and Patrick Kelly, MD. Second edition.

pages cm. (A Johns Hopkins press health book)

Includes bibliographical references and index.

ISBN 978-1-4214-1789-9 (hardcover : alk. paper) ISBN 978-1-4214-1790-5 (pbk. : alk. paper) ISBN 978-1-4214-1791-2 (electronic) ISBN 1-4214-1789-8 (hardcover : alk. paper) ISBN 1-4214-1790-1 (pbk. : alk. paper) ISBN 1-4214-1791-X (electronic) 1. Depression in adolescencePopular works. I. Kelly, Patrick, 1978 II. Title.

RJ506.D4M66 2015

616.85'2700835dc23 2015002501

A catalog record for this book is available from the British Library.

, 3-3, 5-1, 5-2, 5-3, 7-1, 8-1, and 15-1 by Jacqueline Schaffer.

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Johns Hopkins University Press uses environmentally friendly book materials, including recycled text paper that is composed of at least 30 percent post-consumer waste, whenever possible.

The authors dedicate this book to their parents,

Frank and Winifred Mondimore,

and Pat Kelly, Sr., and Vicki Kelly

Francis Mondimores essential publication of the first edition of Adolescent Depression fundamentally changed the conversation among adolescents, parents, and providers when it comes to this condition. He brought to light a different (and correct) view of depression as a biological illness that needs to be taken as seriously as diabetes or any other medical condition, altering forever the way in which parents see their children.

But, as with all things, work in the study and treatment of adolescent depression has progressed, and we thought that you, the reader, could benefit from being brought up to date on the latest information. In the thirteen years that have elapsed since the books initial publication, many changes, large and small, have affected the field of psychiatry. Every chapter in this new edition has been updated to reflect the most current evidence base in terms of diagnosis, treatment, and advice for both parents and children. We cover and explain new treatments, both medication and psychotherapy. In an extensive discussion of bipolar affective disorder in young persons, we attempt to examine rationally how and why this diagnosis, once perceived as extremely rare, has suddenly become so common. We also introduce discussions of new topics, such as the interface between autism and depression. One of the biggest changes in the field of psychiatry, a new version of our basic system of diagnosing patients, has recently rocked the psychiatric field and is an essential change for parents and adolescents to understand so they can have an educated discussion with their physician. We go through the changes relative to young persons and how this new way of looking at psychiatric conditions may change your childs treatment, diagnosisor both.

Nonetheless, the central message of this text remains the same. For a long time, mental health professionals thought that serious depression was an illness only adults were likely to develop. The general belief among psychologists and psychiatrists was that children might get a little sad or upset about some disappointment or frustration, but that they werent emotionally mature enough to experience true depression. Gloominess and angst were thought to be almost universal among adolescents, but only temporary just a developmental stage that they would emerge from unscathed.

Research done in the 1990s demolished these myths. We now realize that young people do indeed get seriously depressed. In fact, as is becoming clear, depressive illnesses and bipolar disorders that start in adolescence may be more serious and more difficult to treat than adult-onset mood disorders. A 2013 study sponsored by the Centers for Disease Control and Prevention estimated that 4 percent of young people between the ages of 3 and 17 years had been diagnosed with a depressive illness, with adolescents more likely than their younger counterparts to be diagnosed (up to 13 percent). Its been estimated that nearly one in five persons will go through a period of serious depression during their lifetime, and research increasingly indicates that many of these people will have had their first encounter with depression as teenagers.

Some parents still struggle with the idea of their child being treated for a psychiatric illness, seeing a therapist, or taking medication for a problem that they may thinkand hopemight be just a phase. We hope to persuade you in this book that serious depression in adolescents is an illnessan illness that can be effectively treated.

Clinical studies have shown that depression is underdiagnosed in young people and undertreated as well. A study in 2000 found that only 20 percent of seriously depressed adolescents in a community sample received any treatment for their problem. The same study found high rates of relapse in these young people, and even more disturbing was the finding that, by their twenty-fourth birthday, many of them had developed other psychiatric problems in addition to depression, most commonly alcoholism and drug abuse.

We now know that depression comes in many forms and is often the symptom of a collection of emotional illnesses that psychiatrists call mood disorders. Some adolescents with a mood disorder are troubled by down and sad feelingsthe feelings people usually think of when they hear the word depression. But other adolescents with a mood disorder have predominantly irritable moods with angry outbursts, temper tantrums, and destructive rages, problems that seem to bear little relationship to what most people think of as depression. Can the same illness really look so different from one young person to the next? Why? These are some of the questions we hope to answer in this book.