Adolescent depression
Per the National Institute of Mental Health, in 2021, an estimated 5.0 million adolescents aged 12 to 17 in the United States had at least one major depressive episode, representing 20.1% of the U.S. population aged 12 to 17. Additionally, an estimated 3.7 million US adolescents aged 12 to 17 had at least one major depressive episode with severe impairment that year. This number represented 14.7% of the U.S. population aged 12 to 17. 1
Undiagnosed and untreated depression places people at increased risk for illness and interpersonal and psychosocial difficulties. In addition, depression is associated with an increased risk of suicide, which is among the leading causes of death among youth aged 10 to 24 and the second leading cause of death for those aged 10 to 14.2
Adolescent depression resources
Bipolar disorders
In 2019, approximately 1 in 150 adults (40 million people, or 0.53% of the global population) were living with bipolar disorder 3. It is typically diagnosed during late adolescence or early adulthood, though symptoms can occasionally appear in children. According to the American Psychiatric Association, thoughthe specific causes of bipolar disorder are unclear, there are both biological factors, including a family history of mood disorders (80-90% of individuals with bipolar disorder have a relative with bipolar disorder or depression), psychotic disorders, substance misuse, and environmental factors that increase the risk for bipolar disorder. 4
While symptoms may vary over time, bipolar disorders usually require lifelong treatment. If left untreated, the illness usually worsens and can cause severe disruptions in a person’s daily life.
According to the World Health Organization, people with bipolar disorder are more likely to smoke, use alcohol, have a physical health condition (such as cardiovascular or respiratory disease), and experience difficulties in accessing health care. On average, people with bipolar disorder die more than 10 years earlier than the general population 5. Additionally, approximately 15–20% of people with bipolar disorder die by suicide globally, with 30–60% making at least one attempt (using more lethal means than attempts within the general population). Despite an overall decline in global suicide rates, the rates among those with bipolar disorder are not decreasing. 6
Bipolar disorders resources
Depression
Depression is a common mental disorder that affects approximately 280 million people worldwide.9 It affects individuals differently and can be experienced as a single-episode disorder or as recurring episodes throughout their life. When depression is recurrent, it can become a serious health condition and affect the person’s daily life and function and can even lead to suicide.
The evidence is compelling that individuals with depression are less well off than individuals without depression in terms of overall health and function. Depression causes societal costs in healthcare expenditures and productivity that require structured programming aimed at identification, education, and intervention to reduce the incidence of depression and its associated conditions.
Depression resources
Depression Screening Program Description
Patient Health Questionnaire (PHQ-2) in English
Cuestionario sobre la salud del paciente‐2 (PHQ‐2) en español
Patient Health Questionnaire (PHQ-9) in English
Cuestionario sobre la salud del paciente (PHQ-9) en español
Patient Health Questionnaire (PHQ-9) in additional languages
Postpartum or Peripartum Depression
According to the American Psychiatric Association, an estimated 10-15% of white women experience postpartum depression. Estimates for women of other racial/ethnic backgrounds are higher 8
Untreated perinatal depression impacts the health and quality of life for the individual and can also affect the baby’s health. Premature birth, low birth weight, problems with bonding and sleeping/feeding problems for the baby are all possible. Longer term, children of mothers with perinatal depression are at greater risk for cognitive, emotional, developmental/verbal deficits and impaired social skills. 9
Postpartum depression is a subset of perinatal depression, and both are common and treatable. Between 11% and 18% of Americans report symptoms of depression after giving birth, a percentage that climbs to 25% among low-income parents and 40%-60% for low-income adolescents.
Left untreated, depression can hurt parents’ ability to bond with and care for their baby and lead to discontinued breastfeeding, family dysfunction and an increased risk of child abuse and neglect. Untreated depression also can affect a baby’s brain development by increasing the risk of toxic stress, which delays the infant’s language, cognitive and social-emotional development.
Postpartum depression resources
Treatment Resistant Depression
Major Depressive Disorder is considered Treatment-resistant depression (TRD) when at least two different antidepressants don’t improve a person’s symptoms 10. The prevalence of TRD ranges from 21.7% to 44%, with those affected incurring higher direct treatment costs, as well as greater indirect expenses such as family care, hospitalization and lost wages 11
Here are some key points about TRD:
- Diagnosis: TRD is diagnosed when patients show minimal or no improvement after trying multiple standard treatments for depression.
- Causes: The exact causes of TRD are not fully understood, but factors may include genetic predispositions, biological and brain chemistry differences, underlying mental health conditions, and external stressors. Another cause is non compliance or gaps in compliance with medication, with the mean amount of antidepressants taken at 65%
- Treatment Approaches: Various strategies may be pursued for TRD:
- Medication Adjustments: This may involve switching antidepressants, combining medications, or augmenting with other drugs like mood stabilizers or antipsychotics.
- Psychotherapy: Cognitive-behavioral therapy (CBT), interpersonal therapy, or other forms of psychotherapy might be employed, often in conjunction with medication.
- Electroconvulsive Therapy (ECT): ECT may be considered in severe cases where rapid response is required, or other treatments have failed.
- Transcranial Magnetic Stimulation (TMS): This non-invasive treatment uses magnetic fields to stimulate nerve cells in the brain.
- Ketamine Therapy: Ketamine and esketamine (a derivative) have shown promise in rapidly reducing symptoms of depression.
- Lifestyle Modifications: Alongside medical treatments, lifestyle changes such as regular exercise, a healthy diet, adequate sleep, and stress management techniques may also support the treatment plan.
- Regular Monitoring and Support: Ongoing assessment and support from healthcare providers, along with involvement from family and friends, are crucial in managing TRD effectively.
- Patient Education: advising patient that partial compliance leads to only partial response and/or relapse.
TRD is a complex and challenging condition, but with a personalized and comprehensive treatment plan, many individuals can find relief from their symptoms.
While there are several treatment options available for TRD, in 2022, the FDA approved Auvelity for treating MDD in adults, the first and only oral medication with a fast onset of action 12.
Rapid-acting oral drug (Auvelity) for major depressive disorder
Dextromethorphan-bupropion (Auvelity) for the Treatment of Major Depressive Disorder
Management of Treatment Resistant Depression: Challenges and Strategies
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1 National Institute of Mental Health: Major Depression (last updated July 2023) nimh.nih.gov
2 Center for Disease Control and Prevention: Children’s Mental Health - Anxiety and depression in children: Get the facts (August 19, 2024): cdc.gov.
3 World Health Organization: : Bipolar Disorder (July 8, 2024): who.int
4. American Psychiatric Association: What are Bipolar Disorders? (last review April 2024): psychiatry.org.
5 World Health Organization: Bipolar Disorder (July 8, 2024): who.int
6 Michigan Medicine Heinz C. Prechter Bipolar Research Program: Suicide and bipolar disorder: opportunities to change the agenda (June 18, 2024): medicine.umich.edu
7 World Health Organization: Mental Disorders ( March 31, 2023): who.int.
8, 91 American Psychiatric Association: What is Peripartum Depression (formerly Postpartum)? (last review Oct 2023): psychiatry.org.
10 Cleveland Clinic: Treatment-resistant depression (last reviewed 5/16/2023): my.clevelandclinic.org
11 Journal of Affective Disorders: The complexity of treatment-resistant depression: A data-driven approach (August 2024): sciencedirect.com
12 Annals of Medicine and Surgery: Rapid-acting oral drug (Auvelity) for major depressive disorder (Oct 2022): journals.lww.com/annals-of-medicine-and-surgery
