how do adolescents define depression? - cIRcle - University of ...

Chapter II: Literature Review
affect and behavior are largely determined by the way in which he or she structures the world
(Beck et al., 1979).
Pharmacological interventions involve medications such as tricyclic antidepressants
(TCAs), serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). The
combination of the two therapies, psychotherapy and pharmacotherapy, known as multimodal,
has been found to be the most beneficial for the treatment of acute depressive disorders in young
people (AACAP, 1998). Opinions differ regarding the most beneficial order of the treatments
and which is the most efficient modality (Jacobson, Dobson, & Truax, 1996). In fact, the
combination of the two therapies is seldom studied (AACAP, 1998). In North America, the use
of pharmacological therapies has increased over the past decade for both children and
adolescents. There are few studies, however, of the safety and efficacy of most of the medication
prescribed (Emslie et al., 1997; Kurt & Crowley, 2002). Controversy also exists about possible
serious side effects when antidepressants are used to treat depression in adolescents (Garland,
2004a, 2004b).
Treatment of adolescent depression mostly consists of psychotherapy and
pharmacotherapy (Brent et al., 1997; Clarke, Rohde, Lewinsohn, Hops, & Seeley, 1999; Clarke
et al., 2001; Mufson, Weissman, Moreau, & Garfinkel, 1999); however, there is emerging
evidence that early intervention with at-risk offspring adolescents of adults treated for depression
may prevent depression (Clarke et al., 2001). Furthermore, protective factors may even hedge
depressive symptomatology. Studies indicate that influences of family and school attachments
can protect adolescents against harmful behaviors associated with mental health problems (Ma &
Zhang, 2002; Resnick et al., 1997). For example, the B.C. government initiated planning and
providing for improved early intervention, working with community organizations and
institutions (e.g., Child and Youth Mental Health Plan for BC; Ministry of Children and Family
Development, 2004). In the Adolescent Health Survey of over 36,000 students in grades 7 to 12
in the US, Resnick, Harris, and Blum (1993) report that the three protective factors for "quietly
disturbed behaviors" (e.g., poor body image, emotional stress, suicidal involvement, p. 4) were
family connectedness, school connectedness, and low family stress.
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