Depression in adolescents. Context, manifestations, and clinical management

The phenomenon of adolescent depression combines depressive symptoms with adolescent developmental variables and contextual factors, such as family patterns, ethnic background, socioeconomic status, gender, biologic factors, and individual experience with personal loss. These developmental and contextual factors lead to specific adolescent manifestations of depression, such as academic problems, sexual activity, substance abuse, conduct disorders, pain, eating disorders, and the potential for suicide. Assessment of the depressed adolescent includes specific questions concerning these possible manifestations and problem behaviors. Thorough assessment always includes questioning about the possibility and lethality of suicidal ideation. Modes of treatment include counseling, various forms of individual and group psychotherapy, environmental manipulation, and use of psychopharmacologic agents. Follow-up care is essential for the prevention or early treatment of future depressive episodes. The ultimate goal of care of the depressed adolescent is to prevent suicide and to minimize disruption of the adolescent developmental process.