Review of "Adolescent Depression"
By Francis Mark MondimoreJohns Hopkins University Press, 2002
Review by Marilyn Graves, Ph.D. on May 15th 2003
This is an intelligent and well-written guide with a substantial amount of detail especially about medications and how they work. Mondimore first outlines symptoms of depression and provides information about how to tell a genuine mood disorder from expected adolescent turmoil. He then reviews medication issues and explains the basics of how the medications work. He provides a chapter on types of counseling along with guidelines for when medication and counseling are indicated. Finally, Mondimore reviews special issues like dual diagnoses and dangerous behaviors.
Figures from a 1996 study from the National Institute of Mental Health indicate that about 5 percent of adolescents have a major depressive disorder. This is a very serious depressive condition, not the moodiness of adolescence. Mondimore provides some guidelines for recognizing core symptoms of depression like social withdrawal, irritability, decreased concentration, and sleep disturbance. He explains terms like constricted affect, a symptom that might go unnoticed by many parents. He provides references to literary and autobiographical accounts of depression for readers who may feel less comfortable with clinical material. Mondimore seems to anticipate that many parents may be wondering to what extent identity formation may be a part of a more benign picture of adolescent struggle. He outlines Erickson?s stages of development and explains the concept of identity diffusion.
There is a chapter on the different types of mood disorder like major depressive disorder, dysthymia, and bipolar disorder. He includes a discussion of the Diagnostic and Statistical Manual of Mental Disorders, the descriptive manual of psychiatric disorders that is used as the basis for making some decisions about treatment and type of medication which might be used.
For those who are interested, Mondimore includes information about the discovery of some of the current medications used to treat depression. It seems that antidepressant medications were accidentally discovered when an antiepilepsy medication divalproex was found to help cases of mania. Antihistamine medications were also found to have therapeutic effects for psychiatric symptoms.
Mondimore explains why medications work. There is a substantial but non-jargon account of how neurotransmitters work. There is also an explanation of how Lithium may work at a cellular level inside the neuron and how structures called G proteins may function. There is a section about possible side effects from medications and information about why some older medications like the tricyclics are now rarely used. There is specific information about why some medications and dosages must be differently administered in adolescents than in adults as well as guidelines about when medical tests like blood levels are necessary.
Another classification of medications is called antipsychotic medication or major tranquilizers. Adolescents can have a severe depressive episode which includes features like hallucinations, delusions or other disturbances in thinking. Severe disorganization in thinking and behavior may first be noticed by others as agitation. Antipsychotic agents block dopamine receptors in the brain. The first of these medications chlorpromazine was originally used as a surgical anesthetic but was found to alleviate some symptoms in schizophrenics and manics. Mondimore reviews some of the newer of these medications. He mentions possible side effects like movement disorders and drops in white blood counts. Mondimore also reviews some of the more nontraditional approaches and has a positive opinion of the use of electroconvulsive therapy in some situations.
Mondimore?s coverage of psychotherapy as a treatment is briefer. He spends 69 pages explaining medication treatment but only 14 pages on psychotherapy. He does however explain the basics of the different types of psychotherapy like cognitive behavioral, interpersonal, and insight ?oriented treatments. He also discussed situations where a combination of therapies is best and disorders like bipolar disorder where psychotherapy alone is not recommended.
Mondimore includes a section on special problems and issues. The first of these is the situation where there is a coexisting depressive disorder and an attention deficit disorder. At one time ADHD was called minimal brain dysfunction and was originally studied in patients with very severe exacerbations some of whom had documented brain damage. Today, people are more likely to be referring to instances where no such brain dysfunction is suspected. ADHD is thought to be somehow related to underfunctioning of the frontal lobes, the part of the brain that controls executive functioning and is involved in sustaining attention and inhibiting impulsiveness. The stimulant medications commonly used for ADHD can precipitate a manic episode in adolescents who actually have a mood disorder. Given that some adolescent depression presents as irritability, difficulty with concentration, and lack of behavioral control, it may be difficult to make an accurate initial diagnosis, yet the consequences in prescribing the wrong medication are alarming.
Substance abuse is covered, touching on the most common types. Substance abuse may look like other disorders as well as being co-morbid with them. Eating disorders with there compulsive fixation on food regulation are examined. Perhaps the most frightening of all for parents are instances where adolescent self-mutilation or suicidal risk are involved.
Mondimore gives information about various types of professionals who may be a part of a treatment team for an adolescent as well as guidance about when hospitalization or emergency services may be needed. He talks about the role of the family providing assistance and in limiting negative influences in the adolescent?s social environment.
All in all, this provides parents with a starting point. If they suspect their child may have a depressive disorder they can get an idea of what typical symptoms may be, what diagnostic criteria are used, and what the treatment possibilities exist. There is also practical advice about how to assess emergencies and how to locate a provider with the proper credentials.
© 2003 Marilyn Graves
Marilyn Graves, Ph.D. is a clinical psychologist in private practice working with children, adolescents, and adults.
Resources
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Articles
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Introduction and Types of Depressive Disorders
- Major Depressive Disorder and Related Conditions
- Classic Symptoms of Major Depressive Disorder
- The Development and Course of Major Depressive Disorder
- Differential Diagnosis and Specifiers of Major Depressive Disorder
- Prevalence and Co-Occurring Conditions
- Disruptive Mood Dysregulation Disorder
- Persistent Depressive Disorder (Dysthymia)
- Premenstrual Dysphoric Disorder
- Related Disorders / Conditions
- Historical and Current Understandings
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Biology, Psychology and Sociology
- Biology of Depression - Neurotransmitters
- Biology of Depression - Neuroplasticity and Endocrinology
- Biology of Depression - Genetics and Imaging
- Biology of Depression - Psychoneuroimmunology
- Psychology of Depression- Psychodynamic Theories
- Psychology of Depression- Behavioral Theories
- Cognitive Theories of Depression - Aaron Beck
- Cognitive Theories of Depression - Ellis and Bandura
- Cognitive Theories of Depression - Seligman
- Sociology of Depression - Effects of Culture
- Social and Relational Factors in Depression
- Lifestyle Factors and Environmental Causes of Depression
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Treatment - Medication and Psychotherapy
- Treatment: When to Seek Professional Help and Where to Find Help for Depression
- Measuring Depression
- Clinician-Rated and Self-Report Questionnaires/Tests for Depression
- Types of Treatment for Depression
- Types of Treatment Continued
- Medications for Depression
- Antidepressants for Depressive Disorders
- Mood Stabilizers for Depressive Disorders
- Non-Medication Medical Therapies for Depressive Disorders
- Psychotherapy - Evidence-Based Treatments for Depression
- Cognitive Behavioral Therapy for Depression
- Cognitive Behavioral Therapy for Depression Continued
- Interpersonal Therapy for Depressive Disorders
- Behavior Therapy for Depressive Disorders
- Psychodynamic Therapy for Depressive Disorders
- Group, Family and Couples Therapy for Depressive Disorders
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Alternative Medicine and Self-Help Resources
- Complementary and Alternative Treatments for Major Depression
- Major Depression and St. John's Wort
- Major Depression and Exercise
- Major Depression and Omega 3 Fatty Acids
- Major Depression Serotonin Precursors: SAMe
- Major Depression Serotonin Precursors: 5-HTP
- Acupuncture for Depression
- Music Therapy and Relaxation Therapy for Depression
- Self-Help Methods for Major Depression
- Community and On-line Self-Help Resources for Major Depression
- Depression Reading List
- Special Issues
- References
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Introduction and Types of Depressive Disorders
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Questions and Answers
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- Is Post Traumatic Stress Disorder Curable?
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- Depressed 19 year old college student
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- Counting ritual - Zami - Aug 30th 2008
- dont understand me
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- Swallowing fear
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- Is there help for a person who has always been a 'little depressed'
- Depression Treatment
- Please help.
- Lovely, however... - Julie C. - Jul 14th 2008
- I am really worried about my mental health (19yr old female)
- Am I depressed?
- Identity Confusion: I don't know what personality disorders I have
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- Is there something wrong with me?
- Will I Ever?
- Worried about my son
- Is There Help Out There? Lonely Mother of Three
- Am I Depressed?
- Help?
- Major Depressive Disorder Severe with Psychotic Features
- OCD- No feeling
- Help!!!: Laci
- Is the memory of my father dooming my relationship?
- Worried about thoughts
- How long will i be on medication for treatment of my depression
- My Mother Won't Go For Depression Treatment!
- Where do i start to get on the road to recovery
- What is wrong with me?
- Stuck in an on-again, off-again relationship for 10 years
- Depression Treatment
- How do I get my dr.s to understand and help me?
- STUCK IN A RUT
- What treatments are available after you've tried the medicines of last resort?
- no one will help!
- Should I seek help?
- A fighting couple
- Do I have a mental health problem?
- Whats wrong with me?
- depression and employment
- how do you treat depression in teenager males?
- Is it ok to feel this way?
- Have DID: Getting Worse Not Better
- Can we contact my mother's doctor?
- anxiety or going crazy?
- ADD, Tourettes or both?
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- Will this ever end
- Get Supported
- Stages of Depression
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- should a depressed person marry?
- Dementia and Depression
- Anger?
- What type of exams can proven that a person has bipolar disorder?
- Stuck in a mental rut...
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- i can't seem to get over any of this
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Book & Media Reviews
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- Depression, the Mood Disease
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- Doctors of Deception
- Down Came the Rain
- Dysthymia and the Spectrum of Chronic Depressions
- Emotional Claustrophobia
- Essential Psychopharmacology of Depression and Bipolar Disorder
- Everything Is Fine
- Experiences of Depression
- Handbook of Depression
- Handbook of Depression
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- How I Stayed Alive When My Brain Was Trying to Kill Me
- In Pursuit of Happiness
- Journeys with the Black Dog
- Killing the Black Dog
- LifeForce Yoga to Beat the Blues--Level 1
- LifeForce Yoga to Beat the Blues: Level 2
- Lifting Depression
- Lincoln's Melancholy
- Lucy Sullivan Is Getting Married
- Malignant Sadness
- Manufacturing Depression
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- Mood Genes
- My Depression
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- New Hope for People with Depression
- On Depression
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- Ordinarily Well
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- Outsmarting Depression
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- Prozac and the New Antidepressants
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- Puppy Chow Is Better Than Prozac
- Quiet Your Mind & Get to Sleep
- Raising a Moody Child
- Reasons to Stay Alive
- Self-Coaching
- Songs from the Black Chair
- Speaking of Sadness
- Spontaneous Happiness
- Student Depression
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- Sunbathing in the Rain
- Swing Low
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- The American Psychiatric Publishing Textbook of Mood Disorders
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- The Antidepressant Era
- The Beast
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- The Breakthrough Depression Solution
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Links
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Videos
- Depression - Let's Talk
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- How to get stuff done when you are depressed
- Tell Me About Depression
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- Depression and its Treatment
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- What is Treatment Resistant Depression?
- Do I Have Depression? Common Symptoms of Depression
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