Teen depression often times accompanied by another mental or physical illness

Today’s guest blogger is R. Rao Gogineni,M.D,, head of the division of child & adolescent psychiatry, at Cooper University Hospital and associate professor of psychiatry at Cooper Medical School of Rowan University.

Depression in adolescents has gotten needed attention from the scientific community only in the last two decades. The chance of being afflicted with depression is about 10 percent in a lifetime. Twice as many girls as boys struggle with depression. 

What we’ve also found is that other mental illnesses often times accompany teen depression, including generalized anxiety disorder, panic, social phobia, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD) ,eating disorders, substance use disorders and conduct disorders.

More than 40 percent of patients who had previously experienced trauma developed depressive disorders four months after the trauma, according the National Institute of Mental Health. Studies have found anxiety disorders co-occur 25 to 75 percent of the time with depression, and ADHD and depression co-occur 30 to 40 percent of the time.

Co-occurring illnesses need to be considered, diagnosed and treated properly. They often need a combination of psychotherapy, psychosocial interventions, family education and interventions, and medications. They require longer term treatment and follow up.

A case example, a 16-year-old, tenth grader was referred for irritability, low esteem, feeling bad, declining school grades, worthlessness, excessive guilt and shame, and questioning living, but not suicidal. A comprehensive diagnostic interview and information from her parents revealed a history of lifelong under performance, poor attention span, distractibility, excessive boredom, low self-esteem, much anxiety, excessive worry, and depressive symptoms. 

She was diagnosed with depression, anxiety disorder and ADHD. We successfully treated her with a combination of psycho-education, psychotherapy and medications. The psychotherapy involved psychoeducation of all three difficulties: how having more than one mental illness multiplied her struggles, improving coping strategies, enhancing self-esteem that was wounded by these disorders, and a combination of cognitive and supportive techniques.

There are always normal ups and downs in a teen’s life and sometimes it can be confusing whether feeling down or mood swings are a sign of mental illness.  We need to pay serious attention when these feelings interfere with school, family, social functioning, sleep, or appetite.

Common depressive symptoms include:

  • Depressed/anxious/empty feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment

When I see a patient, I often suspect another mental illness besides depression when the teen doesn’t respond to treatments as expected, there is family history of multiple syndromes, and there are unusual side effects to medications and psychotherapies such as increased regression, irritability, psychosis, mania, and excessive anxiety. The key is careful diagnosis and being open to the possibility of more than one illness. So “when it doesn’t make sense,” I consider co-occurrence as a possibility.

Co-occurrence of medical illness and depression in teens is also not uncommon. About 35 percent of chronically medically ill teens can develop depression. Depression can accompany medical conditions like anemia, brain injuries, diabetes, epilepsy, chronic head ache/pain, hypothyroidism, kidney disease, HIV, and AIDS. Severely obese teens are high risk for depression as well. Depression and some depression medications can cause weight gain.

The impact of suffering from more than one mental illness can be very high. A teen with anxiety and depression is more at risk for substance abuse, suicidality, poor response to treatment and more psychosocial problems. Co-occurrence of depression with medical conditions is likely to result in more severe symptoms of depression and more difficulty adapting to the medical illness.

Once we do find these co-occurrences, we can address them by providing longer term treatment, using a multiple treatment techniques that may involve medications, individual, group therapies, family interventions, and self help/advocacy groups like NAMI, CHADD, AA, and NA along with coordinating with primary care physicians, nurses and school personnel.

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