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by Francis Mark Mondimore
Johns Hopkins University Press, 2002
Review by Marilyn Graves, Ph.D. on May 15th 2003

Adolescent Depression

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.