54%–75% of adolescents "wish for more sleep" It is widely recognized that many older Americans suffer from a variety of sleep disorders. In fact, more than half of all Americans older than age 65 have a sleep problem, and disturbed sleep is among the most frequently cited problems affecting institutionalized older Americans. As the population ages, it is estimated that at the end of this decade nearly 80 million Americans will ... Read More

Pharmacotherapy Antidepressant medication has been surprisingly inefficacious for adolescents. In contrast to open studies, placebo-controlled, double-blinded research protocols have failed to demonstrate any benefit of medication over placebo for adolescent depression. Up to 60% of adolescents recover while receiving placebo; up to 70% recover using medication. This finding applies to traditional tricyclic antidepressants, such as imipramine, desipramine, and nortriptyline, and also to serotonin reuptake ... Read More

Cognitive therapy strategies. During several 20-minute sessions scheduled about every 2 weeks, cognitive behavioural therapy can be introduced to teens in a psychoeducational style (Table 2).   Table 2. Steps in cognitive therapy COGNITIVE THERAPY IN THE OFFICE Introduce the concept • Thought patterns promote ... Read More

Psychotherapy Table 1 outlines psychotherapeutic approaches to adolescent depression. The emphasis is on cognitive therapy and behavioural strategies that not only help to resolve the current episode but will also make enduring changes in social and cognitive behaviours in order to prevent recurrent depression in high-risk individuals.   Table 1. Psychotherapy COGNITIVE THERAPY ... Read More

Résumé (French Language) Le traitement de la dépression chez les adolescents comporte de multiples modalités, incluant des interventions de nature pharmacologique, psychothérapeutique, éducative et familiale. Les médicaments ont un rôle limité: leur efficacité est minimale, ils n'influencent pas les facteurs étiologiques et l'inobservance est un problème fréquent chez les adolescents. Les médecins devraient plutôt insister sur les mécanismes d'adaptation et les modalités efficaces de solution de ... Read More

Comorbidity Comorbidity is the simultaneous occurrence of more than one diagnosis. Comorbidity complicates research on the etiology and outcome of a single diagnosis, such as depression, because the comorbid diagnosis might in fact be the main determinant of outcome. Table 3 lists commonly comorbid conditions.   Table 3. Comorbid disorders to suspect • ... Read More

Differential diagnosis If unhappiness is common, how do we know an adolescent is clinically depressed rather than having "normal" teenage moods? Differential diagnosis of depressive symptoms is based on history and mental status examination (Table 2). Obtaining histories from teens can be challenging, and a good sense of rapport and confidentiality will be important before important issues, such as substance abuse, can be evaluated. ... Read More

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 ... Read More

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 ... Read More