Motivation and emotion/Book/2015/Depression in adolescence

Overview
Major depressive disorder (MDD) is a frequent problems that plagues many adolescents and young adults. Depression entails a wide array of factor of symptoms and causes affecting, cognitive, somatic, social, and affective processes (Burton, Westen & Kowalski, 2012). Subpar academic performance, poor peer relationships, behavioral problems, parental conflict, and substance abuse are some of the consequences of depression or anxiety in this age group (Burton, Westen & Kowalski, 2012).

MDD in adolescence and young adults is common worldwide but often goes unrecognised. Most notable in girls, the incidence rises dramatically after puberty, and by the conclusion of adolescence, MDD will be prevalent in over 4% of the youth population for cases exceeding one year. One in seven people will experience depression at some stage of their lives across Australia. The burden is highest in low-income and middle-income countries (Thapar, Collishaw, Pine, & Thapar, 2012; WhiteCloudFoundation, 2015).

Definition
The DSM-V suggests Major Depressive Disorder or MDD currently as the most severe form of depression. Adolescences' that fall into the category of severely depressed will generally show disturbances in healthy habits, like sleep wake cycles and appetite and in many cases, anxiety. If left untreated can result in suicide. A typical depressive episode lasts about 5 months. Sadly, the trend depression only appears to be on the rise. There are no transparent gender differences in depression rates in prepubescent children, but, after the age of 15, girls and women are about twice as likely to be depressed as boys and men. The causes of depression across genders have been found to be largely concurrent, however, these causes become more prevalent in girls than in boys in early adolescence. Girls are more likely than boys to carry risk factors for depression even before early adolescence, but these risk factors lead to depression only in the face of challenges that increase in prevalence in early adolescence (Nolen-Hoeksema & Girgus. 1994). Stimulation for depressive episodes generally revolves around a loss or a change of some description, loss of a loved one, a relationship breakup social isolation and such (AIHW; Goldney, Eckert, Hawthorne & Taylor. 2010).

Identifying Depression
Depression is subjective and varies from person to person, however there are some common signs and symptoms in individuals. It’s important to remember that these symptoms can simply be a part of life’s normal downs. Depression is characterized by more symptoms occurring simultaneously, a much larger associated strength, and a further longevity. This increases the likelihood that it is depression that is being dealt with. When these symptoms become overwhelming and disabling, that's when it's time to find help.

Symptoms

 * Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
 * Loss of interest in daily activities. No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
 * Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
 * Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
 * Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.
 * Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
 * Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
 * Reckless behavior. You engage in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.
 * Concentration problems. Trouble focusing, making decisions, or remembering things.
 * Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

Further Information
The term mental illness is associated with the emulation of a condition that causes serious disorder in a person's behaviour or thinking (Hammen, 2005). As our grasp on medical understanding and corresponding advancements expands, our comprehension of how mental illness is characterized as well as the effects to the body, so too has our comprehension of just what causes mental illness and how it and psychological perspectives correlate, however some illnesses still allude our capabilities (Hammen, 2005). In the modern era, our understanding of physical and mental health has grown astronomically when compared with medicine of past decades. Major depressive disorder (MDD) is described as being a mental disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and a loss of interest in pleasurable activities.

Depression is typically associated with substantial present and future unease, drastically heightening the risk of suicide (See Youth Suicide for more information). The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress. Inherited risks, developmental factors, sex hormones, and psychosocial adversity forms interactions that increase risk through hormonal factors and associated perturbed neural pathways. Although many similarities between depression in adolescence and depression in adulthood exist, in adolescents the use of antidepressants is of concern and opinions about clinical management are divided. Effective treatments are available, but choices are dependent on depression severity and available resources. Prevention strategies targeted at high-risk groups are promising (Kaltiala-Heino, Fröjd, & Marttunen, 2010).

Relationship With Anxiety
Anxiety is common in depression patients and generally causes feelings of dismay and anxiousness within an individual. Those affected my constantly feel on edge or worried. Feeling overwhelmed, frightened or even panicked is also common (BeyondBlue, 2015) (Kendler, K. S., Karkowski, L. M., & Prescott, C. A. 1999). Effects are not limited to psychological. A range of physical symptoms like high heart rate, butterflies in the stomach, muscle tension, shaky hands, even feelings of nauseous are not atypical. A common feature of anxiety conditions is to think about things a lot more than one would normally (obsessive compulsive thinking) (BeyondBlue, 2015). Adolescents may find that what you are thinking about is unhelpful or perhaps even irrational or silly, but you are unable to stop these intense and sometimes overwhelming thoughts. This thinking tends to be repetitive, damaging, and more than often, negative, causing your feelings of anxiety or fear to ensue.

Effects on Everyday Life
Natural instinct in individuals avoids situations that cause us anxiety or stress. When an anxiety condition develops, those affected might begin to avoid lots of things that cause worry. It might be places, people or specific situations. Beginning to avoid things might cause individuals to slowly spend less time with friends and other once pleasurable activities (BeyondBlue, 2015)(Nolen-Hoeksema & Girgus. 1994). Beginning also to find going to school, taking part recreational sport or work becomes challenging. Insomnia isn’t far from extraordinary in such situations. Constant thinking and worrying tends to leave individuals without the amount of sleep that they would normally require omitting lacking energy. An absence of sleep can often mean that it’s harder to think clearly about things that are on your mind and if left untreated can leave to other sleep deprivational effects such as lacking motor control, lowered body temperature and weakened immune defences (Burton, Westen & Kowalski, 2012) (Nolen-Hoeksema & Girgus. 1994).

History
Depression has only recently begun to be recognized as a form of mental unrest following the publication in the DSM-I in 1958. At the time was considered to be “Depressive reaction” (in previous eras known as “Meloncholia”) (Radden, J. 2003). Despite its difficulty to diagnose, evidence suggests it has been an issue for people long before its official entry to the DSM. The debate over the major cause of MDD is still a large talking point in mental illness today, whether it is nature or nurture that ultimately decides if you are susceptible to depression.

The period of Adolescence


Adolescence is the period following the onset of puberty during which a young person develops from a child into an adult. This age typically begins around 10 to 12 years and extends until adulthood begins (around the age of 18). Schooling for adolescents typically revolves around at the ages of 12 to 18 years, whilst a child attends secondary school. How a child socializes can be predetermined long before they are even exposed to environments with like peers. Referring to the theory of attachment, the style of attachment that is built between caregiver and child can affect how an individual is able to socialize in later life. Attachment is broken down into four distinct styles: secure, anxious-resistant, anxious-avoidant and disorganised. Secure attachment is the most likely to be shown in infants and the most associated with normal social interactions in later life whereas down the spectrum, disorganised attachment tends to lead to impulsive and disruptive behaviours in the classroom (Kaltiala-Heino, Fröjd, & Marttunen, 2010).

Acceptance
Peers and like peer acceptance play a large part in granting adolescence with the social skills and confidence need to maintain healthy relationships in later life resulting from mental states and psychological well-being in the earlier stages of life. Bullying is a largely traumatic experience that can manipulate the confidence and sense of acceptance in an adolescent (Kaltiala-Heino, Fröjd, & Marttunen, 2010). Victimisation transpires to be a traumatic event that has the capacity to form a depressive state or cause anxiety and stress. Depression also predicts experience of victimisation and of being left alone against one’s wishes causing feelings of loneliness. Depression may impair an adolescent’s social skills and self-esteem so that the adolescent becomes victimised by peers. However, depression and angst also have the capacity distort and adolescent’s experiences of social interactions (Kaltiala-Heino, Fröjd, & Marttunen, 2010) (BeyondBlue, 2015).

Loneliness and Social Isolation


Loneliness is a subjective feeling and is possible to also be experienced in the presence of others (Holvast, Burger, De Waal, Van Marvijk, Comijs, & Verhaak, 2015). In a year, one in ten people will experience loneliness (BeyondBlue, 2015). This could be due to death of loved ones and also a lack of contact with family and friends who may be busy, bullying and peer pressure can lead to social isolation (Holvast et al., 2015).

This underlines the importance of an adolescences drive to achieve peer acceptance. Although loneliness can be associated with poorer outcomes for depression, depression can also cause loneliness (Holvast et al., 2015). Parents and friends should strive to remain aware of their childs social standing and friendship groups in order to prevent the negative impacts of loneliness on their child/friend and assist them to overcome any ensuing depression without any other factors in the way. Chao (2011) stated that having large social network and frequently keeping in contact with family and friends can lead to a reduction in depressive symptoms. To put in perspective for children, having a larger network of friends and a good relationship with their caregivers should allow the effects of loneliness to be negated or at least drastically lowered (BeyondBlue, 2015).

Antisocial Behaviour and Peer Pressure
To follow from the effects of loneliness, the causes are now drawn into the spotlight. It is key to avoiding feelings of loneliness and to minimise chances of anxiety and depression by maintaining relationships with those held close (Holvast et al., 2015). Antisocial behaviour such as substance abuse, alcoholism and addictions can all stem from and/or causes social isolation (Ialongo, Werthamer, Kellam, Brown, Wang & Lin, 1999). Peer pressure is of paramount importance at this age. How one is expected to act or react and what traits make an individual a likeable peer, ultimately are decided by the majority around the individual. For an adolescent, the pressure is generally focused around their schooling life and the relationships that stem. Antisocial behaviour can have one of two outcomes when this concerned. Depending on the peers, a certain level of acting out can be seen as a positive trait; however, this is open to interpretation depending on the group themselves. There is always also line that dictates how much acting out is favoured and acceptable to the group. Too much will rend children outcasts (Kendler, K. S., Karkowski, L. M., & Prescott, C. A. 1999).

Coping Strategies and Treatment
There are various known ways to combat the effects of a depressive state. Generally treatments take a pathophysiological form of sorts, meaning that it is a physical chemical change is required within an individual adolescent.

Physical Activity and Exercise


Through the research of such figures as Barr Taylor, James & Sallis (1985), modern medicine is able to comprehend the gravity of psychological well-being and the roles that exercise plays in maintaining quality of life. There has been significant research to suggest that exercise can offer near endless benefits when it comes to counteracting stress and depression (Brown, 1991). Physical activity and exercise is able to assist in keeping a balanced mental well-being by affecting levels of anxiety in an individual as prolonged exertion allows endorphins to be produced within the body. The strongest evidence found that this bodily chemical produced most frequently while engaging in physical activity and exercise most probably has the power to alleviate some symptoms of mild to moderate depression as well (Barr Taylor, James & Sallis, 1985). Endorphins are chemicals that have the capacity to elevate mood, reduce pain and in some cases create the illusion of a higher state (Burton, Western & Kowalski, 2012). Narcotics have since emulated endorphin’s effects in an attempt to reproduce similar effects.

Diet
Evidence suggests that diets rich in fruits, vegetables, wholegrains and fish are associated with lowering the risk of depression and various other mental disorders (Chan, Chan & Woo, 2014). It is no mystery that what we put into our bodies can affect our physical and mental health. Due to the compound antioxidants in fruit and vegetables entail, they have been proven to reduce the neuronal harm caused by oxidative-stress. Also, long-chain omega 3 polyunsaturated fatty acids found in fish can affect mood by a change of the brain serotonergic function and its immune-neuroendocrine effects. It is important that as parents and guardians they are aware of what they're child is eating and make better executive decisions for promoting healthy eating. A healthy diet starts in the home so it is critical that parents provide a healthy breakfast, healthy packed lunches and a healthy dinner inclusive of fruits, vegetables, wholegrains and fish.

Medicine
Considerable evidence has accrued to support the hypothesis that alterations in serotonergic neuronal function in the central nervous system occur in patients with major depression (Owens & Nemeroff, 1994). In order to correct this, adolescents may be advised to take a course of serotonergic drugs with the aim of balancing the neuronal functions and allowing homeostatic balance in the brain (Baldwin & Rudge, 1995). The serotonin reuptake inhibiting (SSRI) group of drugs came on stream in the late 1980s and has since proves vastly effective when combatting the effects of depression and anxiety those of all ages (Healy, 2015) (Baldwin & Rudge,1995).

Nature
“Nature” or the biological perspective refers to the idea the genetic influences, the idea that people are born with a predisposition of vulnerability to certain traits or attributes (Burton, L., Western, D. & Kowalski, R. 2012). The theory that a person’s genetic makeup can predetermine the likelihood of an individual developing MDD, or a predisposition to incur anxiety during the lifecycle may seem outlandish, but there is works that provide merit to the argument. If genetics are the structure of what we will inherit from our parents, suddenly it becomes a lot easier to imagine the link between serious mental illness and heritability. According to Dr R. Uher (2009), mental illness usually has an onset early in the reproductive age unlike general physical disorders. This is associated with substantial reproductive disadvantage. Genetic variants associated with vulnerability to mental illness are predicated upon the common disease/common variant (CDCV) hypothesis (Uher, R. 2009). Two types of evidence have been the central support of the hypothesis that implicates hereditary factors to the etiology of mental illness. In the case of schizophrenia, there are significantly higher incidences of the illness in close relatives of individuals living with schizophrenia and growing incidences in such relatives, which is correlated with a degree of consanguinity (Kety, S. S., Rosenthal, D., Wender, P. H., & Schulsinger, F. 1968). This give merit to the theory that severe mental illness may have a biological basis, however there is little evidence to suggest that these accounts can be generalized to major depressive disorder. Other contributions have included genetic studies of twin pairs (Kendler, K. S., Karkowski, L. M., & Prescott, C. A. 1999), and “natural” experiments that occur when exposure to the event is random and in- dependent of depressive outcomes. Despite intensive research during the past several decades, the neurobiological basis and pathophysiology of depressive disorders remain unknown. Genetic factors play important roles in the development of MDD, as indicated by family, twin, and adoption studies, and may reveal important information about disease mechanisms but a direct link still alludes researchers.

Nurture
If not necessarily biological, if not nature, theorists are left with the alternative. The environment and culture in which a person lives in structures them as individuals. An environment is described as being the surroundings or conditions in which a person, animal, or plant lives or operates. Critical periods in human development are periods of specific sensitivity to sensory stimulation that shape the capacity for future development in early life. If the requirements of any stages are not met, it may have significant effects on the mental development of an individual (Burton, L., Western, D. & Kowalski, R. 2012). There has been extensive recognition of the contribution of childhood stressful experiences to adolescent and adult depression. The impact of child abuse or neglecting and its effects can stretch far beyond the childhood itself through the lifespan. Factors affecting the impact of recurrent abuse or neglect include age, stage of development, severity, frequency and duration. Not all children are affected equally of course. Many can appear resilient to the situation, but on the contrary, there is significant evidence to suggest that neglected and deprived children are far more likely to experience social difficulties and learning impairments later on which may lead to feeling of worthlessness and depressive behaviour and young suicide as well as drug and addition problems (Hammen, C. 2005)(Burton, L., Western, D. & Kowalski, R. 2012).

Suicide
Suicide is a prominent public health concern. From 2009 over a five-year period, the average number of suicide related deaths in the years concerned was 2,461. In the year 2013, 1,885 males (16.4 per 100,000) and 637 females (5.5 per 100,000) died by suicide, a total of 2,522 deaths (10.9 per 100,000), which equates to an average of 6.9 deaths by suicide in Australia each day. The 15-19 year age group (9.9 per 100,000) with 7.1 males and 2.8 females (WhiteCloudFoundation, 2015). The total 15-19 aged equates to 108 male deaths and 40 female deaths as a result of taking ones own life. Depression is growing. Second only to heart disease as the leading medical cause of death and disability in Western civilization, depression is on track to eclipse the disease within the next 20 years (WhiteCloudFoundation, 2015)(Kaltiala-Heino, Fröjd, & Marttunen, 2010).

Conclusion
Although not being the highest group at risk of depression, major depression in adolescents and youth is on the rise. It is important to remain vigilant and aware in regards to loved ones. There are many risk factors leading to depression in adolescents that everyone needs to be aware of such as peer acceptance, social isolation and victimisation, loneliness, lifestyle and behavioural choices. The preventative strategies such as detection, physical activity, socialising, diet and health promotion then need to be put into action in order to improve this issue in the years to come to decrease the number of adolescents suffering from depression within the general population. For the future, more extensive research is needed and support services need to be implemented for this age group suffering depression to be able to grow and develop into adults happily, healthily and just as any child should.