Résumé

(French Language)

Chez les adolescents, la dépression clinique amène une morbidité significative, incluant une détresse somatique et une altération du fonctionnement cognitif, interpersonnel et académique. Les facteurs de risque sont clairement identifiables et les médecins de famille devraient les rechercher attentivement. La dépression est le principal facteur de risque du suicide chez les adolescents.

Depression among young people has received increasing clinical and research attention in the past decade. Community studies have documented an alarming prevalence of clinical depressive syndromes among adolescents, with 4.7% of non-referred adolescents aged 14 to 16 years suffering major depressive disorder and 3.3% suffering dysthymic disorder (chronic minor depression) at any given time. The rate among adolescent girls is at least three times that among boys. The rate is higher and the age of onset is earlier among offspring of parents with major depression. Longitudinal studies confirm an increase in the rate of major depression. One study found that the cumulative probability of having a major depression by the age of 20 is 0.50 among siblings of children with a major depressive episode. More disturbing is the 0.20 cumulative probability by the end of the teen years among those adolescents not judged high risk by family history. The increase has been accompanied by an increase in the rate of adolescent suicide, for which depression is the greatest risk factor.

The high prevalence and alarming cumulative risk of developing clinical depression during adolescence establishes adolescent depression as an important primary care problem. Depressive episodes usually last 6 to 9 months and often recur. Depressed teens are likely to care for themselves poorly, fail in school, and disappoint themselves and others, becoming alienated from both peers and adults. They have persisting deficits in academic functioning, self-esteem, and social competence. The interruption of normal adolescent development by a depressive episode has a high cost, as deficits persist over several years. Because most cases will not be seen by mental health professionals, recognition and treatment by primary care physicians is essential.

Recognition

“Depression” might be a passing mood, a natural reaction to a life event, an excessive reaction of a vulnerable individual to a stressor, or a clinical syndrome of varying severity. The recognized and validated clinical syndromes are dysthymic disorder (chronic mild depression), major depressive disorder, and the depressive phase of bipolar (manic-depressive) disorder. On any given day, about 40% of 14-year-olds will describe themselves as “unhappy”; the actual prevalence of major depressive disorder is about 10% of this figure. Making this distinction is a diagnostic challenge.

Most depressed teens will not come to a family physician’s office complaining of depression but usually of fatigue and various somatic symptoms. Often, parents are concerned when school performance declines and hours are spent in bed. Teachers and parents sometimes see the crisis as behavioural rather than emotional, with the result that these teens do not come to medical attention because they are seen primarily as oppositional and “lazy.” The predominant mood can be irritable rather than depressed. Substance abuse might be suspected. School avoidance is very common; most school-avoiding adolescents are in fact depressed.

The following summary of risk factors, differential diagnosis, and comorbid disorders will assist family physicians in detecting and diagnosing major depressive disorder in adolescence.

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