Depression Symptoms Treatment

Risk factors

An awareness of risk factors can help a physician detect the potential for clinical depression in a particular young person. Risk factors for depression in young people are many (Table 1). They can be integrated into a model of biological risk and psychological style interacting with developmental and environmental stressors to produce a final common pathway. Three times as many women as men develop clinical depression.

The genetic risks for early onset depression indicate that physicians should be more vigilant in assessing young people with depressed parents or siblings. Additional risk is noted when the depressed parent is the mother, suggesting an additive effect of biological risk and learned cognitive or behavioural patterns. Nevertheless, studies of adopted children and twins emphasize the independent role of genetic factors.

Those young people who have struggled with developmental problems, learning disabilities, and attention deficit disorder are more vulnerable to depression, presumably because of fragile self-esteem and learned helplessness.

Children with a chronic medical illness are vulnerable, and depressive symptoms can be challenging to elicit in the face of physical or pharmacologic causes of fatigue, sleep disturbance, and somatic complaints. Recognition and treatment of concurrent depression will improve quality of life and functioning for medically ill children.

Young people with constitutionally high anxiety and anxiety disorders are prone to depression. A neurochemical basis for chronic anxiety, involving the depletion of neurotransmitters, might lead to secondary depression. Independent of this, the psychological effect of chronic anxiety promotes depression. Somatic anxiety and cognitive worry interfere with concentration and coping, eroding self-confidence. The experience of anxiety promotes the catastrophic cognitive distortions known as the "depressogenic" cognitive style. Anxiety can interfere with acquiring social skills and hence hinder success in various domains important to self-esteem. Anxiety disorders increase the risk for relapse and chronic depressive disorders.

Psychosocial stressors increase the risk of developing depression. A common event is parents’ separation, which is a risk factor particularly for adolescent girls, even if the separation occurred many years earlier. Young people develop a sense of helplessness and guilt regarding their inability to prevent marital separation. They do not trust the stability of key relationships and they fear abandonment. A relationship loss might trigger a depressive episode.

Finally, the effect of childhood neglect, abandonment, and abuse is clearly a risk factor.13 This applies particularly to early onset prepubertal depression, which is likely to persist chronically into adolescence as dysthymia, with potential for recurrent superimposed major depressive episodes.

Examination of the risk factors for adolescent depression reveals that a common mechanism is learned helplessness promoted through the tendency to develop overwhelming anxiety and through the experience of being abused, neglected, unsuccessful, repeatedly defeated, or helpless in the face of traumatic stressors. A sense of vulnerability, worthless-ness, and guilt pervade, and coping mechanisms are limited.