Elsevier

Epilepsy & Behavior

Volume 8, Issue 1, February 2006, Pages 102-114
Epilepsy & Behavior

Review
Adolescent depression: Description, causes, and interventions

https://doi.org/10.1016/j.yebeh.2005.10.012Get rights and content

Abstract

Depression is one of the most prevalent of the psychiatric disorders and is common among individuals with epilepsy. Depression often begins in adolescence. The present review focuses on adolescent depression. In particular, this review first summarizes the definition, description, and classification of adolescent depression. Next, potential causes of adolescent depression are reviewed from a vulnerability–stress perspective. This part of the review focuses on the role of stressors and how stressors interact with genetic, biological, cognitive, personality, and interpersonal vulnerabilities to predict adolescent depression. Last, clinical aspects of adolescent depression are reviewed, including treatment and prevention of depression and the relation to epileptic disorders in adolescence. In sum, a substantial percentage of youth with epilepsy and seizures exhibit depression, and many are not diagnosed or treated in a timely manner. The present review shows that there are valid, empirically based assessments, treatments, and preventions for depression in adolescence that hold promise for reducing the significant burden associated with depression.

Introduction

Depression is one of the most commonly occurring of the major psychiatric disorders, and it has become increasingly recognized that depression over the life span often begins in adolescence. It is a prototypical multifactorial disorder that profoundly affects individuals’ emotions, thoughts, sense of self, behaviors, interpersonal relations, physical functioning, biological processes, work productivity, and overall life satisfaction. Indeed, given the multiple effects that depression has, it has been ranked as the fourth leading cause of disability and premature death worldwide [1]. Given these factors and its typical onset during adolescence, this review focuses on three main issues: definition and description, causes, and interventions.

Section snippets

Definitions, diagnostic criteria, and classification issues in depression

According to the official psychiatric classification system (the Diagnostic and Statistical Manual, fourth edition, DSM-IV-TR) [2], an episode of major depression can be diagnosed on the basis of the same symptoms in childhood and adolescence and in adulthood (e.g., sleep changes, appetite changes, feelings of worthlessness, concentration difficulties), except that irritability can be applied as a mood symptom along with depressed, sad mood and anhedonia (loss of pleasure) in youth. DSM-IV-TR

Prevalence and development of depression over the life course

The rate of prevalence of depression has been examined in many studies with different age groups and with different methods and samples. In this review, community samples are emphasized for estimating rates of prevalence of depression because samples drawn from psychiatric clinics may be biased in various ways (e.g., actively seeking treatment, exhibiting greater severity, and revealing higher comorbidity), and these biases can artificially inflate the rates of prevalence of depression.

Potential causes of the development of depression: Vulnerabilities and stress

To understand what may cause depression in youth, a vulnerability–stress framework, in which recent stressful events trigger an underlying predisposition, may be one of the most promising approaches [56]. In this section, the role of stressors is considered first, then depression vulnerabilities are reviewed. These vulnerabilities are reviewed separately, even though it is most likely that a developmentally sensitive, integrative theoretical model can and should combine these disparate

Interventions for adolescent depression

Broadly considered, intervention includes treatment of youth diagnosed with depression, as well as prevention prior to onset of depression. Many studies have investigated various treatments (e.g., see [160], [161], [162] for reviews) and preventions (e.g., see [161] for reviews) for adolescent depression. This review briefly considers the findings from the largest randomized clinical trial to date on treatment of adolescent depression, the Treatment of Adolescent Depression Study [163], and a

Conclusion

Depression in adolescence is a prevalent mental illness with significant burden and costs in terms of social, educational, interpersonal, economic, and impaired future developmental outcomes. Adolescent depression can be identified and evaluated reliably and validly in various ways, and this is important for diagnosis and eventual treatment or prevention. Many vulnerability factors increase the risk of adolescents experiencing depression, especially when in the face of stressful life events. As

Acknowledgment

This work was supported by a NIMH Grant MH 066845 to Benjamin L. Hankin.

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