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12 and HoldingA Guide to Asperger SyndromeA Lethal InheritanceA Mother's Courage: Talking Back to AutismA Parent's Guide to Asperger Syndrome and High-Functioning AutismA Special EducationA Toss Of The DiceA Tribe ApartA User Guide to the GF/CF Diet for Autism, Asperger Syndrome and AD/HDA Walk in the Rain With a BrainABC of Eating DisordersADD-Friendly Ways to Organize Your LifeADHD Grown UpADHD in the Schools: Assessment and Intervention StrategiesADHD NationAdolescence and Body ImageAdolescent DepressionAggression and Antisocial Behavior in Children and AdolescentsAll Alone in the UniverseAlpha GirlsAmericaAnother PlanetAntisocial Behavior in Children and AdolescentsAsperger Syndrome and Your ChildAsperger Syndrome, Adolescence, and IdentityAsperger's and GirlsAssessment of Childhood DisordersAttention Deficit DisorderAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderAutism - The Eighth Colour of the RainbowAutism and MeAutism's False ProphetsAutistic Spectrum DisordersBad GirlBeen There, Done That? DO THIS!Before I DieBetween Two WorldsBeyond AppearanceBig Mouth & Ugly GirlBipolar ChildrenBipolar Disorder in Childhood and Early AdolescenceBipolar DisordersBipolar KidsBlackwell Handbook of Childhood Cognitive DevelopmentBody Image, Eating Disorders, and ObesityBody Image, Eating Disorders, and Obesity in YouthBoy AloneBrain-Based Therapy with Children and AdolescentsBreaking PointBreathing UnderwaterBringing Up ParentsBullying and TeasingBullying PreventionBut I Love HimCan't Eat, Won't EatCaring for a Child with AutismCatalystChild and Adolescent PsychiatryChild and Adolescent Psychological DisordersChild and Adolescent PsychopathologyChild NeuropsychologyChild Well-BeingChildren and SexualityChildren Changed by TraumaChildren with Emerald EyesChildren with Sexual Behavior ProblemsChildren, Sexuality and SexualizationChildren’s Dreaming and the Development of Consciousness City of OneCommunication Issues In Autism And Asperger SyndromeConcepts of NormalityConcise Guide to Child and Adolescent PsychiatryConquering the Beast WithinConsuming KidsContesting ChildhoodCount Us InCrackedCrossesCutCyber-Safe Kids, Cyber-Savvy TeensDamageDemystifying the Autistic ExperienceDescartes' BabyDilemmas of DesireDirtyDisconnected KidsDoing SchoolDon't Bother Me Mom--I'm Learning!Don't Pick On MeDying to Be ThinEarly Intervention Programs and PoliciesEating an ArtichokeEducating Children With AutismEight Stories UpElijah's CupEmerald City BluesEmotional and Behavioral Problems of Young ChildrenEpilepticEthical Dilemmas in PediatricsEvery Girl Tells a StoryExiting NirvanaExploiting ChildhoodEye ContactFacing BipolarFamily HistoryFast GirlsForever YoungFreaks, Geeks and Asperger SyndromeFreewillFrictionGirl CultureGirl in the MirrorGirlfightingGirlhoodGirlWiseHandbook of Evidence-Based Therapies for Children and AdolescentsHandbook of Preschool Mental HealthHealing ADDHelping Children Cope With Disasters and TerrorismHelping Hyperactive KidsHelping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional ProblemsHelping Students Overcome Depression and AnxietyHelping Teens Who CutHollow KidsHope's BoyHow Infants Know MindsHow to Keep Your Teenager Out of Trouble and What to Do If You Can'tHurry Down SunshineI Am Not Joey PigzaIdentifying Hyperactive ChildrenIf Your Adolescent Has an Eating DisorderIn the Company of CraziesIncorporating Social Goals in the ClassroomIntegrated YogaIntrusive ParentingIssues for Families, Schools and CommunitiesJake RileyJoey Pigza Loses ControlJoey Pigza Swallowed the KeyJuvenile-Onset SchizophreniaKim: Empty InsideLearning and Behavior Problems in Asperger SyndromeLearning Disorders and Disorders of the Self in Children and AdolescentsLearning Outside the Lines Let Kids Be KidsLiberation's ChildrenLife As We Know ItLisa, Bright and DarkLook Me in the EyeLoserLove and SexLove That DogMad at SchoolMaking ADD WorkMaking American BoysManicMastering Anger and AggressionMaverick MindMedicating ChildrenMind FieldsMind to MindMommy I'm Still in HereMore Than a LabelMy Flesh and BloodMyths of ChildhoodNew Hope for Children and Teens with Bipolar DisorderNew Look at ADHD: Inhibition, Time, and Self-ControlNo Child Left DifferentNo Two AlikeNon-Drug Treatments for ADHDNot Much Just Chillin'NurtureShockOdd Girl OutOdd Girl Speaks OutOne Hot SecondOne in ThirteenOphelia SpeaksOphelia's MomOur Journey Through High Functioning Autism and Asperger SyndromeOut of the WoodsOvercoming ADHDOvercoming School AnxietyParenting a Child Who Has Intense EmotionsParenting Children With ADHDParenting Your Out-Of-Control TeenagerPediatric PsychopharmacologyPediatric PsychopharmacologyPediatric PsychopharmacologyPeople with HyperactivityPhobic and Anxiety Disorders in Children and AdolescentsPINSPlease Don't Label My ChildPraising Boys WellPraising Girls WellProblem Child or Quirky Kid?Problem GirlsPsychotherapy for Children and AdolescentsPsychotherapy with Children and AdolescentsPurgeRaising a Moody ChildRaising BlazeRaising Generation RxRaising Resilient ChildrenReady or Not, Here Life ComesReclaiming Our ChildrenRedressing the EmperorReducing Adolescent RiskRemembering Our ChildhoodResilience in ChildrenRethinking ADHDReweaving the Autistic TapestryRitalin is Not the Answer Action GuideRitalin NationRunning on RitalinRunning with ScissorsRutter's Child and Adolescent PsychiatrySeeing EzraSex and the American TeenagerSex, Therapy, and KidsSexting and Young PeopleSexual Teens, Sexual MediaShort Term 12Should I Medicate My Child?SmashedSnapshots of AutismSongs Without WordsSophie Spikey Has a Very Big ProblemSpeakStaying Connected to Your TeenagerStick FigureStraight Talk about Psychiatric Medications for KidsStraight Talk about Psychological Testing for KidsStraight Talk about Your Child's Mental HealthStrange SonStudent DepressionSuicidal Behavior in Children and AdolescentsSurvival Strategies for Parenting Children with Bipolar DisorderSurviving OpheliaTaking Charge of ADHD, Revised EditionTaming the Troublesome ChildTemple GrandinThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anti-Romantic ChildThe Bipolar ChildThe Boy Who Loved WindowsThe Boy Who Was Raised as a DogThe Buffalo TreeThe Bully Action GuideThe Bully, the Bullied, and the BystanderThe Burn JournalsThe Color of AbsenceThe Curious Incident of the Dog in the Night-TimeThe Depressed ChildThe Developing MindThe Dragons of AutismThe Einstein SyndromeThe EpidemicThe Evolution of ChildhoodThe Explosive ChildThe Eyes of van GoghThe Fasting GirlThe Field of the DogsThe Flight of a DoveThe Hidden Gifts of the Introverted ChildThe Horse BoyThe Identity TrapThe Inner World of a Suicidal YouthThe Inside Story on Teen GirlsThe Kindness of StrangersThe Last Normal ChildThe Little MonsterThe Medicated ChildThe Myth of LazinessThe New Gay TeenagerThe Nurture AssumptionThe OASIS Guide to Asperger SyndromeThe Other ParentThe Perversion of YouthThe Philosophy of AutismThe Psychoanalytic Study of the ChildThe Real Truth About Teens and SexThe Ride TogetherThe Rise and Fall of the American TeenagerThe Science of ADHDThe Sex Lives of TeenagersThe Survival Guide for Kids With LD*The Unhappy ChildThen Again, Maybe I Won'tTherapy with ChildrenThings I Have to Tell YouThings Tom LikesThrough the Glass WallThumbsuckerTotally WiredTouching Spirit BearTrauma in the Lives of ChildrenTreating ADHD and Comorbid DisordersTreatment of Childhood DisordersTwistedUnder the Wolf, Under the DogUnhappy TeenagersUnstrange MindsWastedWe've Got IssuesWeather Reports from the Autism FrontWhat about the KidsWhat in the World Are Your Kids Doing Online?What Works for Whom?What Would Joey Do?What's Happening to My Body? Book for BoysWhat's Happening to My Body? Book for GirlsWhat's Happening to Tom?When Nothing Matters AnymoreWhen Your Child Has an Eating DisorderWhose America?Why Don't Students Like SchoolWill's ChoiceWinnicott On the ChildWorried All the TimeYou Hear MeYoung Minds in Social WorldsYoung People and Mental HealthYour Child, Bully or Victim?

Related Topics
Adolescent DepressionReview - Adolescent Depression
A Guide for Parents
by Francis Mark Mondimore
Johns Hopkins University Press, 2002
Review by Marilyn Graves, Ph.D.
May 15th 2003 (Volume 7, Issue 20)

This is an intelligent and well-written guide with a substantial amount of detail especially about medications and how they work.   Mondimore first outlines symptoms of depression and provides information about how to tell a genuine mood disorder from expected adolescent turmoil.  He then reviews medication issues and explains the basics of how the medications work.  He provides a chapter on types of counseling along with guidelines for when medication and counseling are indicated.  Finally, Mondimore reviews special issues like dual diagnoses and dangerous behaviors.

Figures from a 1996 study from the National Institute of Mental Health indicate that about 5 percent of adolescents have a major depressive disorder.   This is a very serious depressive condition, not the moodiness of adolescence.   Mondimore provides some guidelines for recognizing core symptoms of depression like social withdrawal, irritability, decreased concentration, and sleep disturbance.  He explains terms like constricted affect, a symptom that might go unnoticed by many parents.  He provides references to literary and autobiographical accounts of depression for readers who may feel less comfortable with clinical material.  Mondimore seems to anticipate that many parents may be wondering to what extent identity formation may be a part of a more benign picture of adolescent struggle.  He outlines Erickson’s stages of development and explains the concept of identity diffusion.

There is a chapter on the different types of mood disorder like major depressive disorder, dysthymia, and bipolar disorder.  He includes a discussion of the Diagnostic and Statistical Manual of Mental Disorders, the descriptive manual of psychiatric disorders that is used as the basis for making some decisions about treatment and type of medication which might be used.

For those who are interested, Mondimore includes information about the discovery of some of the current medications used to treat depression. It seems that antidepressant medications were accidentally discovered when an antiepilepsy medication divalproex was found to help cases of mania. Antihistamine medications were also found to have therapeutic effects for psychiatric symptoms.

Mondimore explains why medications work.  There is a substantial but non-jargon account of how neurotransmitters work.  There is also an explanation of how Lithium may work at a cellular level inside the neuron and how structures called G proteins may function. There is a section about possible side effects from medications and information about why some older medications like the tricyclics are now rarely used.  There is specific information about why some medications and dosages must be differently administered in adolescents than in adults as well as guidelines about when medical tests like blood levels are necessary.    

Another classification of medications is called antipsychotic medication or major tranquilizers.  Adolescents can have a severe depressive episode which includes features like hallucinations, delusions or other disturbances in thinking.  Severe disorganization in thinking and behavior may first be noticed by others as agitation.  Antipsychotic agents block dopamine receptors in the brain.  The first of these medications chlorpromazine was originally used as a surgical anesthetic but was found to alleviate some symptoms in schizophrenics and manics.  Mondimore reviews some of the newer of these medications.  He mentions possible side effects like movement disorders and drops in white blood counts.   Mondimore also reviews some of the more nontraditional approaches and has a positive opinion of the use of electroconvulsive therapy in some situations.

Mondimore’s coverage of psychotherapy as a treatment is briefer.  He spends 69 pages explaining medication treatment but only 14 pages on psychotherapy.  He does however explain the basics of the different types of psychotherapy like cognitive behavioral, interpersonal, and insight –oriented treatments.  He also discussed situations where a combination of therapies is best and disorders like bipolar disorder where psychotherapy alone is not recommended.

Mondimore includes a section on special problems and issues.  The first of these is the situation where there is a coexisting depressive disorder and an attention deficit disorder.  At one time ADHD was called minimal brain dysfunction and was originally studied in patients with very severe exacerbations some of whom had documented brain damage.  Today, people are more likely to be referring to instances where no such brain dysfunction is suspected.  ADHD is thought to be somehow related to underfunctioning of the frontal lobes, the part of the brain that controls executive functioning and is involved in sustaining attention and inhibiting impulsiveness.  The stimulant medications commonly used for ADHD can precipitate a manic episode in adolescents who actually have a mood disorder.  Given that some adolescent depression presents as irritability, difficulty with concentration, and lack of behavioral control, it may be difficult to make an accurate initial diagnosis, yet the consequences in prescribing the wrong medication are alarming. 

Substance abuse is covered, touching on the most common types.  Substance abuse may look like other disorders as well as being co-morbid with them. Eating disorders with there compulsive fixation on food regulation are examined.  Perhaps the most frightening of all for parents are instances where adolescent self-mutilation or suicidal risk are involved.

Mondimore gives information about various types of professionals who may be a part of a treatment team for an adolescent as well as guidance about when hospitalization or emergency services may be needed.  He talks about the role of the family providing assistance and in limiting negative influences in the adolescent’s social environment.

All in all, this provides parents with a starting point.  If they suspect their child may have a depressive disorder they can get an idea of what typical symptoms may be, what diagnostic criteria are used, and what the treatment possibilities exist.  There is also practical advice about how to assess emergencies and how to locate a provider with the proper credentials.

 

© 2003 Marilyn Graves

 

 

 Marilyn Graves, Ph.D. is a clinical psychologist in private practice working with children, adolescents, and adults. 


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