Depressive disorders during youth occur frequently. During childhood there are an estimated one to two percent of children between the ages of six and twelve that have a Major depressive disorder. That rate changes to two to five percent in adolescents or ages thirteen to eighteen. Fourteen to twenty five percent of youth experiences at least one episode of major depression before adulthood. Depression has been diagnosed at a much higher rate than in the past few decades. Episodes of major depression will reoccur within a five year time period.
Depression is often combined with anxiety disorders, dysthymia, disruptive disorders and, or substance abuse and is associated with increased risk taking behavior that could lead to sexual transmitted infections or pregnancy. Depression in youth can last for several months and is often circular and returns. Some studies show that many adolescents that have depression grow up to be depressed adults. The lack of care and identification of depression from pre-adolescent depression is also a factor the leads to adult depression.
Some researchers suggest that the care given to a child while transitioning into adulthood is not consistent so there is a loss in continuity from child to adult depression. Other data suggest that children with major depression continue to experience high rates of depression into adulthood and through out there lives. Many youth that have depression often have substantial impairment in social functioning, including poor school achievement and problems with both family and peers. Depressed youth also have a higher rate of suicide.
Other psychosocial impairment growths with increasing severity of depression; however, even minor depression is associated with much social impairment. Although in many cases depression in youth will be recognized and treated, there are still fewer than half of youths with major depression receiving treatment before the age of 18 years. There are two main approaches offered the medical approach or the system approach. They are the medical approach to depression focus on the depression.
Systems approach focus on the whole person and their systems. With medical approach to depression the depression is the focus, because the depression is the issue. In the medical approach it takes many visits to the doctor to come up with an accurate diagnosis of depression. It is difficult to find the best medication for the client. If the client has other medical conditions like heart or kidney disease then using psychotropic medicines can be unsafe and or ineffective for the client.
Once the doctor prescribes the correct psychotropic medication it often takes a few months to find the correct dosage. If the dosage is to low then the effect of the medication is minimal, if the dosage is too high then the side effects become bigger issues both too high or too low can lead to failure to treatment. According to a study from the National Institute of Health in 2006 only around 30% of patients that have been diagnosed with depression go into full remission from taking their round of psychotropic medications.
The marketing of psychotropic drugs plant the belief in patients that a pill can make them feel better and that their life will blossom. What often happens is that the first psychotropic medication does not work it is either the wrong dosage or the patient does not respond as well as expected. Most psychotropic medications come with the black box warning from the food and drug administration. The black box warning indicated that taking the medication can increase the risk of suicidal thoughts. Suicidal thoughts are the opposite effect of what the psychotropic drug is developed for.
The main types of medications used to treat depressions are: Selective serotonin reuptake inhibitors (SSRIs), Serotonin and norepinephrine reuptake inhibitors (SNRIs), Tricyclic antidepressants (TCAs), Monoamine oxidase inhibitors (MAOIs), Bupropion, Mirtazapine and trazodone. SSRIs came out in the mid and late 1980’s. They are the most common psychotropic used for depression. Some brand names the fall under SSRIs include Celexa, Lexapro, Paxil, Prozac and Zoloft. These classes of SSRIs have mild side effects that include fatigue, dizziness, insomnia, sexual problems, headaches and weight gain.
SNRIs are a newer class of psychotropic drug. That includes Effexor, Pristiq, and Cymbalta. The side effects from this class are upset stomach, insomnia, sexual problems, fatigue and anxiety. TCAs were the first medications use for depression. Examples of this class of psychotropic drug are Elavil, Norpramin, Adapin, Tofranil and Pamelor. Side effects from this class can include dizziness, upset stomach, dry mouth, changes in blood pressure and blood sugar levels. MAOIs block and enzyme, monamine oxidase. Brand examples are Nardil,
Parnate, Marplan and EMSAM. MAOIs work well but have a higher risk of dangerous reactions. They also have serious interactions with certain foods and other medications. Bupropion is a psychotropic medication that only weakly effects brain chemicals. A brand name example is Wellbutrin. Some side effects include stomach ache, headache and anxiety. The systems approach to depression is not to only focus on the child but to focus on the whole family system. It focuses on the “why”. Why is there depression? Where does it come from?
The system approach looks at the whole family and looks at how everybody’s role in the system impacts the other. With the system approach the counselor encourages the whole family or the whole system to be involved in the care or process of changing. The system approach believes that if the system is not fixed or addressed then the depression will not be fixed. If a child is depressed then there is a flaw in the system that needs to be addressed. Once that flaw is addressed then the depression will start to dissipate.
This is important to have the awareness of how the emotional system functions which will increase the levels of differentiation so that the client can focus on making changes for self instead of trying to change others. With the system approach there are three stages that the clients must go through. Stage one reduces anxiety about what the symptom, by teaching them that the symptom is part of their pattern of learning. Stage two focus on self-issues to help increase and recognize differences, this goes against the force of togetherness that the family feels.
In the third and final stage differences will be easily recognized which should lead to a greater self-responsibility and decrease anxiety. With the system approach is more of a holistic approach and the use of medication would be a last resort. The medical and systems approach to therapy both have a place, often better results can be obtained if they work together. Form a future counselor perspective the systems approach would be a stronger approach due to the involvement of the whole system.