What is Adolescent Depression?

Posted by Kevin Rosi, MD on Dec 4, 2015 12:28:15 PM

Dr. Kevin Rosi, an adolescent and young adult depression specialist, recently joined TMS Health Solutions. Since graduating from his Child and Adolescent Psychiatry Fellowship at Stanford University in 2007, Dr. Rosi has focused primarily on treating children, adolescents and young adults. He is certified in Adult Psychiatry by the American Board of Neurology and Psychiatry and completed a visiting fellowship in Transcranial Magnetic Stimulation (TMS) at Duke University in 2015.

We will be doing a series of blogs discussing Adolescent Depression (AD) and how it can be different than adult depression. Dr. Rosi has written the first blog to explain AD.

depressed_teenage_girl.jpgTechnically, Adolescent Depression (AD) has no specific definition and the criteria for diagnosing an adult are the same for diagnosing adolescents. However, depression in adolescents is often of very different symptomatology and its response to treatment (medications or psychotherapy) tends to be variable.  This leads to numerous questions, such as “Is adolescent depression a different illness from that of adults?”, “Why do adolescents respond less to medications?”, and “What new treatments can we develop to address this situation?”

We do know that the adolescent brain is in a continuous state of neurological change and that full "maturity" does not occur until the early to mid-20's.  The brain is actively building and reinforcing synaptic connections, as well as pruning away unused connections.  This likely has a prominent impact on the effectiveness of medications and opens the discussion as to what types of changes medications may be influencing in a maturing brain. 

We also understand that adolescents with depression show a higher level of irritability and emotional reactivity when compared to adults, which can lead to less impulse control and greater risk-taking, often in the form of substance use.  An agitated, angered adolescent who is engaging in some type of high-risk behavior should not be viewed solely based on their actions, but rather on what is driving them.  Adolescents are frequently viewed as being "oppositional" and/or "defiant", which may very well be true in many instances, yet should lead to the question of what is going on in that person's life that could be contributing to such actions.  This is what we, as clinicians and parents, need to recognize so that we can intervene and help our children.

But why is addressing adolescent depression so important, especially early in the disease course?  The simple reason seems to be that the earlier you address the problem, the more likely we can eliminate it.  Research has proven that the likelihood of obtaining full recovery from depressive episodes decreases with each successive medication trial and also predisposes someone to future depressive episodes.  It‘s as if the illness is less responsive to treatment after the first exposure to medication.  When you combine this fact with the evidence that children are less responsive to antidepressant medications than adults, you can see how depression in adolescence can be the starting point of a chronic – even building -- illness.  It is imperative that children receive prompt and effective treatment as soon as depression is suspected or diagnosed. 

Look for more on our Adolescent Depression series next week.

Since graduating from a Child & Adolescent Psychiatry Fellowship at Stanford University in 2007, Dr. Kevin Rosi has focused primarily on treating mood and anxiety disorders in children, adolescents and young adults. He is Board Certified in Adult Psychiatry by the American Board of Neurology and Psychiatry, and completed a visiting fellowship in Transcranial Magnetic Stimulation at Duke University in 2015.

Dr. Rosi’s areas of expertise include early onset Bipolar Disorder, ADHD, and eating and developmental disorders. He also has extensive experience in dealing with behavioral disorders, such as Oppositional Defiant Disorder, as well as impulse control and psychotic disorders.

Dr. Rosi believes in building a trusting working relationship with his patients thorough open communication, and in educating them about all available modalities so treatment decisions can be made collaboratively.

Using a holistic approach that emphasizes pharmacologic and non-pharmacologic treatments, such as psychotherapy, neuromodulation and developing healthy living habits, Dr. Rosi works together with his patients toward the goals of symptom elimination and restoring health.

Dr. Rosi joined TMS Health Solutions in 2015 after serving over eight years in a community mental health outpatient clinic and maintaining a private practice in Davis, California.

Topics: Depression, Adolescent Depression

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