Depression

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The symptoms of depression are frequently disruptive to classroom instruction. Depression is a growing diagnosis among school children, especially adolescents, and its implications place students at risk for many externalizing behaviors (Kauffman, 2005).

Kazdin (1990) points out that there is a difference between depressed mood, which commonly occurs in everyday life, and depression as a disability. Teachers can play a significant role in identifying depression in students and are frequently the first professionals to notice a problem (Maag & Forness, 1991).

There is no test for depression, but some behaviors serve as warning signs that a student may need support in dealing with depression. The American Psychiatric Association (2000) lists the following behaviors that are typically linked to depression in children and adolescents:

• Sadness and/or irritability
• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Feelings of worthlessness or hopelessness
• Poor concentration and difficulty in making decisions
• Thoughts or talk of suicide

Depression is included in a category called mood disorders by the American Psychiatric Association (2000). Depression, obviously, refers to a significantly depressed mood. Dysthymia refers to a less severe type of depression that is not disabling. But mood disorders also include significantly elevated moods or euphoria known as mania, and a third condition called bipolar disorder for individuals who experience "rapidly alternating moods" from one mood (depression) to the other (manic) (American Psychiatric Association, 2000, p. 333). Individuals now labeled bipolar were once considered manic-depressive and may show these behaviors:

• Abrupt, rapid mood swings
• Periods of extreme hyperactivity
• Prolonged, explosive temper tantrums or rages
• Exaggerated ideas about self or abilities

Factors that may place students at risk for depression include a family history of mental health disabilities, abuse within the family (physical, emotional, or sexual), and parental divorce.

There is a lot of confusion and overlap when it comes to students with mental health disabilities. Depression, for example, may overlap with conduct disorders, attention deficits, impulsivity, and aggressive and other inappropriate behaviors. Many of these students today are lumped together into the attention deficit disorder category that seems to have become a catchall for students who exhibit any misbehavior (see Maag & Forness, 1991; Reynolds, 1991).

Common Causes and Antecedents of Depression

Sarason and Sarason (2005) identify five risk factors for depression:

• Heredity: Twin studies demonstrate the strong association between depression and biological closeness.
• Age: The risk for the first unset of depression is highest for women between the ages of 20 and 29; the risk for the first onset of depression for men is between the ages of 40 and 49.
• Gender: Women are twice as likely to suffer from depression as men.
• Negative life events: Examples include divorce or the death of a family member. Depression among divorced men and women is significantly higher than among married men and women.
• Lack of social support: From spouse, family, and/or good friends, when needed.

Kauffman (2005) and others outline two primary causes of depression: endogenous (genetic or biological etiology) and reactive or situational (a response to environmental events).

Interventions for Depression

Treatment methods for depression have centered around psychotherapy or counseling and medication with antidepressant drugs. Usually a combination of therapy and medication is recommended as most effective in working with students who have emotional or behavioral disorders (Forness, 2005). Recently, however, some antidepressant drugs have been linked to suicide among children and young adults. Thus, interventions such as counseling (cognitive and behavioral therapy), social skills training, cognitive restructuring (learning new thinking patterns), and even advice on nutrition, exercise, and sleep may be the best first steps before prescribing powerful antidepressant drugs to children.

It is not the purpose of this text to provide an extensive review of interventions for mental health disabilities. Readers are recommended to seek other sources for a more complete discussion of mental health issues of children and adolescents (see, e.g., Kauffman, 2005; Jensen, 2005; Sarason & Sarason, 2005).