MENDOZA, ARGENTINA – When it comes to adolescents with depression, psychiatrists would do well to tailor treatment to the individual needs of each patient, Dr. Harold I. Eist said at the 6th World Congress on Depressive Disorders.
Adolescence is a turbulent period with enormous biologic, psychological, and social changes, said Dr. Eist, a psychiatrist in private practice in Bethesda, Md., and a past president of the American Psychiatric Association. The brain of the adolescent is immature–“an impulsive, aggressive, thrill-seeking brain,” he said. “There are simple reflective exercises that this brain has limited capacity to accomplish.”
The DSM uses a categorical classification for diagnosis of depression, and Dr. Eist said he does not necessarily agree with the DSM-IV criteria. “Most clinicians add a dimensional element,” he said.
For example, in a dimensional classification, symptom intensity would also be taken into consideration in making a diagnosis. Also, the DSM requirement that the symptoms continue for a 2-week period seems inappropriate for diagnosis of mood disorders in teenagers, since mood changes in this age group are normal.
“I would recommend avoiding the trap of an arbitrary time limit,” Dr. Eist said. “I have examined and treated thousands of adolescents over the years, and I do not remember one who has remained in a dark mood for 2 weeks–other than a few who were seriously suicidal and hopeless.”
Adolescents require more sleep than do adults, and insomnia can be a sign of a mood disorder in an adolescent. It is critical to take a careful sleep history with all patients, but particularly with adolescents, Dr. Eist said. The number of hours that the adolescent sleeps each night is less important for diagnosis of depression than the amount of time it takes to fall asleep. Inability to fall asleep within 30 minutes is a sign of depression.
Major depression in adolescents often goes undetected because the rapidly changing moods fool both the adolescent and family members into believing that the adolescent is just “being a teenager.” In other cases, negativism and pessimism may be hidden by perfectionism. A chronically dissatisfied youngster is seen as not measuring up to his own high standards, rather than as having depression.
When it comes to adolescents, an inability to fall asleep within 30 minutes is a sign of depression. DR. EIST