By Francis Mark Mondimore Johns Hopkins University Press, 2002 Review by Marilyn Graves, Ph.D. on May 15th 2003
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
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
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