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Depression

Introduction

"Behind the mask of a difficult adolescence, is the face of a society difficult, hostile and do not want to understand," A. Aberasturi "(Rivero, s.f. to. 1)

The issue of depression is very controversial because it refers to a mental disorder characterized by feelings of worthlessness, guilt, sadness, helplessness and hopelessness, which is presented in both men and women of all social classes. Speaking of depression, no doubt, is a topic that is not exhausted given the impact it has on every act of our daily lives. Depression in adolescents is more common than is supposed, especially today where our society and the nuclei more direct influence on the adolescent, such as family and school, did not have the appropriate limits, not allow to define their identity and this frustration often leads to depression.

Specifically, the issue of depression helps us as teachers, given our relationship with adolescents (students) to understand why certain behaviors and / or attitudes, while giving us guidelines to assist in the best of our ability to a student with depressive symptoms. Therefore we sought to analyze the most relevant points first trying to understand the depression itself, its nature, existing types and symptoms presented by the person suffering from depression, for avocar podernos hence further in the depression during adolescence, prevention and treatment. It was also considered important to address the issue of suicide, common in adolescent depression.

The sources include books but most of all articles that focus specifically on teen depression, symptoms characteristic for identification and risk factors. We drew attention to two articles in particular: that of Christman, a researcher at the UNAM that focuses on the problem of suicide and the Strock which makes a thorough analysis of the different treatments. Similarly, it sought to review the current situation in Mexico in relation to depression in adolescence.

Depression

Concept and nature

Already in antiquity, Hippocrates described the psychological state would later be called depression and that he appointed as melancholy. While not necessarily a disease, depression is often related to mental and physical disorders and is considered the most common psychiatric disorder. It directly affects mood presenting a decrease in the daily activities of life. "It manifests itself through lack of will to work, tasks and other activities. In the affective side, is expressed with sadness, existential emptiness, self-blame and loneliness in the mind creates obfuscation, pessimism, dark thoughts and insecurity. " (Anonymous, 2001, June 6, para. 2).

Edward Bibring proposed a model of depression based on the conflict involving the emotional expression which leads to both a state of desvalidamiento and helplessness of the self. According to Bibring ess characteristic of people with depression:

A. - "The desire to be valued, loved and appreciated.

2. - The desire to be strong and be safe.

3. - The desire to be good and kind. "(Quoted in Rivero, nd to 3)

These desires to be accepted socially contradict the fact that the depressed person tends to be isolated.

Multiple factors are associated with the onset, duration and recurrence of depression.

a) Biological factors: children or adolescents with a depressed parent or both parents have two to four times more likely to develop a depressive disorder, respectively. Frequently associated with low brain neurotransmitter, serotonin more than the adrenaline caused by alterations in the functioning of the hypothalamus and the secretion of hormones by taking above normal endocrine and immune to (Guerra, 2000).

b) Socio-cultural factors: external factors such as family and include parental depression, conflict and early death or divorce of a parent, situations that create stress and affective disorders caused by loss of the bonds.

c) Psychological factors: conflicts arising from or arising from childhood disorders, as this is the stage at which the child is susceptible to disorders that can be presented as sleepwalking, night terrors, phobias, shyness, which if not treated may be presented as problems of personality and behavior that are compounded over time (Guerra, 2000) These are externalized as feelings of worthlessness, guilt, sadness, helplessness and hopelessness deep. It can be accompanied by "several concomitant symptoms, including disturbances of sleep and food, loss of initiative, self-punishment, abandonment, inactivity and inability to pleasure.

Types of depression

The three most common types of depression are:

a) Severe depression or greater is presented with a combination of symptoms that interfere with or diminish the ability to work, study, sleep, eat. It's not to enjoy once pleasurable activities. Usually when there is very disabling and may be once or several times (Catholic Health System, 2005).

b) Dysthymia, a type of depression is less severe, symptoms disabling chronic but less impairment interferes with the functioning and welfare of the person suffering from Catholic Health System, 2005).

c) Bipolar disorder, also known as manic depression, is characterized by cyclical changes in mood, rapid or gradual euphoric state or high spirits to depression or low mood. In the depressive phase, the person may have one, several or all symptoms of depression while in the manic phase may have a large amount of energy that results in hyperactivity. At this stage often affected the thinking and judgment of the person. This type of depression is not as common as the other two cases (Catholic Health System, 2005).

Symptoms of depression

People who suffer from depression have certain characteristic symptoms that occur repeatedly over a period of two weeks minimum. These symptoms allow us to identify the person with depression. The most common in adolescents, especially in pubertal stage are:

Oppositional or antisocial 1.Conducta clearly.

2.Steals

3.Aggresiveness

4. Alcohol and / or drugs use

5.<arching home

1.Feelings to be understood with

2.Irritability

3. No cooperate in family

4.Withdraw into their own room

5.Disinterest in hygiene

6.School issues

7. Hypersensitivity response to the rejection especially in romantic relationships

8.Trastorno mood, demoralization and lack of joy.

9.Disinteresr for things that attracted him/her before. 

Depression in adolescence

During adolescence, depression may occur. This is characterized by persistent feelings are of sadness and despair that also commonly occurs a loss of self esteem and a lack of interest in daily activities, in the case of adolescent schoolgirls. Usually in these, depression is transient and is a common reaction to many situations and factors that generate stress. "This state is common in adolescents as a result of normal maturation process, the stress associated with it, the influence of sex hormones and independence conflicts with parents" (Goldenring, 2005, para. 2). On the other hand, external factors that accentuate stress as a death, child abuse, the break with the boyfriend or girlfriend, abuse by peers and even school failure associated with low self-esteem and a negative perception of life can trigger depression. This can have effects on growth and development, school performance, relationships with peers and family and can even lead to suicide (Bhatia & Bhatia, 2007; Davis, 2005).

However, despite the external factors are basically the hormonal changes that occur during puberty and its effects on mood and psychological causes of the present can be somatology of depression. "At this time there is an increased emotionality, which is caused by the need experienced by the human being to abandon old habits of thought and action and to establish new ones." (Rivero, s.f. to. 8). They are very common at this stage of development changes in mood. There are times when the adolescent world is a wonderful place and the next moment he hates everything that is around him. Similarly, the teenager is misplaced in time. He lives primarily in the present and seeks to manage it. All these situations are common to their psychological development making it difficult to diagnose depression.

It is also considered that genetic factors influence depressive symptoms unknown whether the cause is genetic or learned behavior of depressive father. Biological factors affecting neurotransmitters are related, as a deficiency in norepinephrine or serotonin. Similarly, the disease is associated with hormonal abnormalities such as hypersecretion of cortisol, a hormone that enables you to control stress. (Davis, 2005).

In adolescence depressive symptoms come to manifest in different ways. Some young people tend to dress in black, however this can also be a fad, or write poems like melancholic music depressive content. Many adolescents have sleep problems. They get to spend all night watching TV and then have trouble getting up in the morning or fall asleep during the day. Often also change in eating habits, this being more common in girls. They no longer interested in activities they previously enjoyed and begin to socially isolate (Santrock, 2004). Additionally, during this transition period the adolescent is in search of their identity and seeks to define its own values. All this tends to make the most "capable and have wrong thoughts and suicidal ideation, easy search for solutions that allow them to forget about the problem as drugs and crime, and so on." (Any, s.f. to. 100).

Generally, adolescent depression manifests differently in adults. They are more reluctant to express their feelings and the symptoms observed may be common to the typical adolescent as boredom or search for new activities. Some symptoms of depression known as hidden can be "drug addiction, promiscuity, crime and the pursuit of danger" (Any, nd, para. 70).

Risk factors of being depressed can be biomedical or psychosocial. Approximately two thirds of young people with major depression have other mental disorders. The most common is dysthymic disorder, anxiety, attention deficit and hyperactivity, as well as substance abuse like drugs (Bhatia & Bhatia, 2007). Often these disorders secondary to depression hide the symptoms of the same making diagnosis more difficult.

Different degrees of depression. At some point in their life up to 15% of children and adolescents have depressive symptoms. Major depression in children and adolescents takes place in an average of seven to nine months. Or severe major depression is present in the 3 to 5% of adolescents. The incidence of depression increases during puberty in girls and cases of depression are twice that of children, this probably related to hormonal changes. (Bhatia & Bhatia, 2007; Davis, 2005). "What worries psychologists and psychiatrists is the fact that the risk of depression among young people is 10 times greater now than at the beginning of the century. This is largely due to frustration at the lack of a productive labor and social "(Anonymous, 2001, June 6, para. 6). Here is also influenced by social context. The young people from low socioeconomic half, where families are dysfunctional as in the case of divorce and also if one parent is unemployed, have little hope of having a happy and profitable.

Depression can occur in two different ways. The first, similar to a state of distress, characterized in that the adolescent perceives a lack of feeling and a sense of emptiness because that can not handle or express. The second is triggered by external factors of experience of defeat or failure.

Adolescence being a critical stage in the conflict and adolescent development, especially in the often emotionally inappropriate behavior they exhibit and show their lack of maturity, especially in relation to the management of social relations. It is the stage where they have to part with their parents in search of its identity. Often depressive reaction could be detected because a "hostility directed toward parents, is diverted to himself and self-deprecating tendencies ultimately relate to the desire to destroy the idealized image of the parents, for whom the child feels betrayed "(Rivero, nd, para. 12). Often these symptoms are confused with normal adolescent reactions as fluctuations in their mood. His state of dependency to their parents is not resolved then you can see "intense dyadic relationship with the mother that sometimes produces a link-type dependent and symbiotic, at other times is seen as a sadomasochistic relationship full of hostile attacks family and external authorities "(Rivero, nd, para 13). Parents are often unable to diagnose depression as they consider a common rebellious attitude of the adolescent. The same situation may occur in the school where the teacher still has less knowledge about the psychological problems of adolescents and he also misinterprets the reactions.

Depressive symptoms experienced during adolescence can predict with great accuracy similar problems in adulthood (Santrock, 2004). It is therefore very important to take seriously the adolescent depression. Adolescents who are diagnosed with depression are more likely to experience a recurrent problem in adulthood than those who were not diagnosed the problem. It is estimated that 50% of adults suffering from depression, had symptoms in childhood or adolescence (Davis, 2005). "The depressions of adolescence equal to those of adulthood in severity, self-destructiveness and show outweigh still the hallmark of its concomitant with the development process" (Rivero, nd, para. 10).

Depression and suicide

Suicide is the act of killing yourself voluntarily. It is the ultimate form of escape from a life situation and emotional tension intolerable. "Suicidal behavior in childhood is rare but its incidence increases significantly to reach adolescence. Currently, suicide is the third leading cause of death among American teenagers 13 to 19 years" (National Center for Health Statistics, 2000, cited in Santrock, 2004, p. 400). In Mexico it is estimated that depression in adolescents and children are present among the "10 and 15% of the population. Suicide is between the second and third leading cause of death between 15 and 25, and 75% of onset cases of mental illness is at that age "(House, 2003, para. 1). Suicide in children and adolescents has increased markedly in recent years in Mexico. "According to statistics from INEGI, in 2001 in Mexico City there were 269 cases" (House, 2003, para. 2). Additionally, there are statistics showing that "40 percent of adolescents who commit suicide have depressive disorders, 10 to 30 percent have personality disorders and 50 percent abuse drugs and alcohol" (Cortes, nd, para. 29).

Therefore the most important action that should be carried out is prevention. More and more young people in desperation attempt suicide. It is crucial to your health care provider if you have one or more of the following warning signs of potential suicide.

• "Withdrawal, with urge to be alone, isolation

• Moodiness

• Changes in personality

• Threat of suicide

• Delivery of the most cherished possessions to others "(Goldenring, 2005, para. 21)

Suicide is a complex phenomenon that includes physical, social and psychological which interact with each other. However, the manner in which the young man relates with his environment and how this affects their personality, are the grounds for determining that the individual tries to commit suicide or not. In adolescence, young people are subject to feelings of stress, confusion, self-doubt, pressure to succeed, financial worries and other fears while growing up. For some teenagers, divorce, the formation of a new family with stepparents and stepsiblings, or moving to a new community can be unsettling and can intensify doubts about themselves. (Jiménez, s.f. to. 21)

They're not happy with their physical environment and above all social. In some cases, suicide appears to be a solution to these problems.

Most social scientists agree that suicide is a complex form of behavior that is caused by biological, psychological and social. Others say that some people are genetically more prone to depression and therefore suicide. The predicative symptom of a possible suicide is depression. "All suicides and suicide attempts speak of an emotional crisis, a disturbance in the way we live, a social disagreement." (Christman, s.f. to. 2)

Psychologists and sociologists have found various personal and situational influences that contribute to the pursuit of voluntary death. This often occurs as an escape from painful circumstances or an act of revenge against another person who is accused of being responsible for the suffering that leads to making such a drastic decision. These feelings of despair are often known as notes or letters that come to stop the person before committing suicide. However, the most common cause of suicide is the perception that life is so painful that only death can provide desired relief. Similarly, the loss of a loved one or chronic pain, physical or emotional, can produce a feeling of inability to change these facts leading to a general feeling of hopelessness of any changes where death is apparently the only solution (Cortés, nd).

There are four types of suicidal behavior:

1. Impulsive suicidal behavior that occurs after a disappointment or strong feelings of anger.

2. The feeling that life is not worth it relates to depression.

3. A serious illness that can lead an individual to think that there is no choice.

4. The attempted suicide as a means of communication, common in adolescents where it really does not want to die but wants to communicate something. (Christman, s.f.)

So why do teenagers attempt suicide? There is no simple answer but you have to consider the proximal and distal factors that may be present. Proximal or immediate factors are eg very stressful circumstances such as loss of a boyfriend or girlfriend, doing poorly in school, an unwanted pregnancy or drug use. Distal factors or distant in time are such that the adolescent considered to have a long history of unhappiness and family instability. Similarly, distal factors lack of affection and emotional support, excessive parental control and an excessive demand to surrender in childhood studies and these may lead to depression in teens. Many teenagers who attempt suicide also believe not having friends to support them. Finally, suicidal adolescents often present depressive symptoms (Santrock, 2004).

Although not all depressed adolescents attempt suicide, depression is the factor most consistently associated with suicidal adolescents. Adolescence as a stage of development of the individual, is a painful step for the young man goes through difficult changes that produce anxiety and depression. For this reason, the suicide attempt is one of the most significant behaviors of adolescents. (Christman, s.f.).

Concrete actions for the prevention

Specific actions for the prevention of depression can be carried out both within the family and the school.

Forms of family intervention

Although depression is considered a condition of what can only be cured by clinical means, support and shelter to build the teen's environment is the foundation both for prevention, early detection and intervention. The base is open communication with your teen to help identify early. Recall that one of the roles of parents tells us Santrock (2004) is for them to help children cope with their emotions. Symptoms of depression, as already mentioned, may be confused at first with laziness, carelessness and other bad habits. It is important, therefore, that until security has what is causing these symptoms, the family alert and nonjudgmental a priori. For the adolescent who is experiencing this process is important not to be accused of pretending illness or laziness or expect him or her immediately out of this state without help.

Unfortunately, early detection is not so easy, even though symptoms are evident. Most people who have not experienced a depressive disorder fail to see the effect it causes, and while not intending to hurt, sometimes with what they say and do hurt more. The depressed young man needed emotional support. This means providing understanding, patience, consideration and encouragement, to create spaces to talk but mostly listen. No way you should play down the feelings expressed, but to establish a fair assessment of reality, something which is usually distorted in the depressed person. The family can intervene in different ways according to the causes that may be causing the depression in adolescents.

Forms of teacher

Middle adolescence (15 to 18 years) is the quintessential period of depression. According to Fernandez (1985), this state is given as a result of normal maturation process, the stress associated with it, the influence of sex hormones and independence conflicts with parents.

The boys in this age group are attending the educational level of middle and high school, so that situations related to this stage of development can motivate stressful situations that exacerbate this vulnerability.

It is often difficult to diagnose the real depression in adolescents because of the number of emotional changes inherent to the natural process of development and is characterized by mood changes, with alternating periods of "complete happiness" and "life is horrible" . These moods may alternate over a period of hours or days.

However, as teachers and daily contact with children may receive persistent mood swings, poor school performance, conflicts in relationships with peers, aggressive behavior (behavioral problems), changes in eating habits (with noticeable increases or decreases in weight) that fall asleep in class, obsession with death.

Since interpersonal relationships and support healthy coping skills can help prevent such periods from leading to more severe depressive symptoms, early identification and treatment can prevent rapid and comprehensive or postpone further episodes.

Open communication with your teen can help identify depression in time but for teachers is really difficult to identify depressed students, however one can identify other crisis situations.

A crisis as Slaikeu (1990) is a temporary state of disorder and disorganization, characterized primarily by an inability of individuals to handle specific situations using the methods used for troubleshooting. A combination of risk situations in the life of a person who meets your psychological disorganization and need of assistance, representing both the danger of disorder and the opportunity for personal development. The final resolution of the crisis depends on many factors including the severity of the precipitating event and the personal and social resources the individual.

Any period of crisis or will be resolved somehow. This solution can be healthy or harmful and it is assumed that the type of solution reached will affect the future performance of the individual. It is important to assimilate the event of crisis so that it is integrated into the fabric of life by allowing the person to be open rather than closed to the future. The primary goal in seeking intervention strategies is to help the person regain the performance level it had before the incident that precipitated the crisis.

Slaikeu (1990) speaks of two types of intervention: the first and second instance. In the case of teachers is more likely that they are prepared to provide psychological first aid (first instance) with the objective of providing support and link to the person in crisis aid resources in this case would be the area of ​​psychology of the institution. The teacher has the ability to detect the crisis at the time and place where that arises. It's like physical first aid as specialized medical help arrives. The psychologist is who will perform the second operation (second instance) as it is the person entitled to assess clinical diagnoses to define depressive adolescents or any other type of condition noting that the presence of alcohol and other drugs complicate any crisis.

In addition, counseling can help teens cope with periods of low mood. You must have the support of a department of psychology and educational institutions have established guidelines to follow to address emotional problems. If the student seeks to master (or if the teacher decides to talk to him), once he hears, you can evaluate and decide what type of support required and can then apply for student support department. So students can get help and follow up immediately.

The teacher assumes functions today (besides teaching) where interpersonal relationships leave deep marks in the way of being of those involved in the educational process. This means being fully aware adviser of their limitations and avoid obviously settle cases out of area or profession. Training is needed in human development, knowledge of intervention tools and above all an attitude committed to the development and growth of students.

Treatments

There are different types of depression and stages of severity. Before determining what treatment is right for everyone, it is essential, the physician first examine, which consists in a physical examination, patient interview and laboratory tests to determine if the cause is biological or psychological. When physical causes are ruled out, it must proceed to an assessment or test of a psychological or psychiatric. (Catholic Health System, 2005). The type of treatment is determined depending on the outcome of that assessment.

According to Dr. Alonso-Fernandez (2001), treatments for depression can be supplied in two different ways. One method is ambulatory, home is where the patient does not come out of its context, lives with his family and remains part of their work, this is the right kind, for the support of loved ones is essential. Psychiatric hospital admission is the other method, but is only used when the crisis is extreme depression, characterized by "social abandonment, suicide risk, danger to others, refusing treatment or indication of a change of scenery" (p. 170).

The treatments are divided into three groups depending on the time the disease manifests itself: Treatment of severe depression, when patients are referred to the hospital until the disappearance of symptoms, maintenance therapy for a minimum of six months to prevent recurrence of symptoms, and preventive treatment or prophylactic measures to avoid recurrence (of what is understood as an emergence of a new depressive episode after six months pre treatment) and relapse (which is defined as the reappearance of symptoms before passing the five to six months).

Different prototypes of treatments can be classified into five major groups.

a) Drug therapy: Can not determine what type of drug or drug will be the most successful since only 65% ​​of cases a specific function. Sue Breton (1998), says that as with all chemicals, it is believed that antidepressants are as tranquilizers and are addictive. This is a misconception, because unlike tranquilizers also, their effects are not immediate, it takes two to three weeks before showing the desired effect. Antidepressants have side effects such as sedation, increased heart rate, low or high blood pressure, dry mouth, blurred vision and constipation. With the selective inhibitors of serotonin reuptake inhibitors (SSRIs) have been enormous advantages as these inhibitors unlike the tricyclics, has fewer side effects. Only cause mild nausea, diarrhea and headache, effects usually disappear with use, but its main disadvantage is that cause sexual dysfunction. Those who consume antidepressants known as monoamine oxidase inhibitors (MAOIs) are subjected to restricted diet and special precautions.

b) Medicinal herbs. Recently it has been using an herb that is known as the herb St. John's Wort (Hypericum perforatum) whose use is very common in Europe, specifically Germany, is the most widely used antidepressant. It should be noted that its effects have been studied only in the short term, as mentioned by Margaret Strock (2001). Is currently conducting a comparative study to 3 years, including conventional drugs, the herb St. John and the use of placebos. The FDA gave notice in February 2000 on the possible negative interaction of this herb when mixed with drugs to "heart disease, depression, seizures, certain cancers and transplant rejection" (para. 42).

c) Psychotherapy. The first mode is family therapy, mentioned by Glick (1999) who considered indispensable psychoeducation model for both the patient and the family, as it is here where the issue of treatment. This therapy suggests two dimensions, individual and group separately but are used in practice. Within individual therapy is detailed cognitive-behavioral psychotherapy (CBT) based on understanding the functional relationship between the thinking process, behavior disturbances and open mood, while it teaches the patient to optimize resource usage, for the management of depression. As therapy progresses identifies areas of weakness and before finishing techniques are taught to prevent recurrences. This type of therapy can be applied both individually and in groups, and you are living this process is important not to be accused of pretending illness or laziness or expect him or her immediately out of this state without help.

Unfortunately, early detection is not so easy, even though symptoms are evident. Most people who have not experienced a depressive disorder fail to see the effect it causes, and while not intending to hurt, sometimes with what they say and do hurt more. The depressed young man needed emotional support. This means providing understanding, patience, consideration and encouragement, to create spaces to talk but mostly listen. No way you should play down the feelings expressed, but to establish a fair assessment of reality, something which is usually distorted in the depressed person. The family can intervene in different ways according to the causes that may be causing the depression in adolescents.

Forms of teacher

Middle adolescence (15 to 18 years) is the quintessential period of depression. According to Fernandez (1985), this state is given as a result of normal maturation process, the stress associated with it, the influence of sex hormones and independence conflicts with parents.

The boys in this age group are attending the educational level of middle and high school, so that situations related to this stage of development can motivate stressful situations that exacerbate this vulnerability.

It is often difficult to diagnose the real depression in adolescents because of the number of emotional changes inherent to the natural process of development and is characterized by mood changes, with alternating periods of "complete happiness" and "life is horrible" . These moods may alternate over a period of hours or days.

However, as teachers and daily contact with children may receive persistent mood swings, poor school performance, conflicts in relationships with peers, aggressive behavior (behavioral problems), changes in eating habits (with noticeable increases or decreases in weight) that fall asleep in class, obsession with death.

Since interpersonal relationships and support healthy coping skills can help prevent such periods from leading to more severe depressive symptoms, early identification and treatment can prevent rapid and comprehensive or postpone further episodes.

Open communication with your teen can help identify depression in time but for teachers is really difficult to identify depressed students, however one can identify other crisis situations.

A crisis as Slaikeu (1990) is a temporary state of disorder and disorganization, characterized primarily by an inability of individuals to handle specific situations using the methods used for troubleshooting. A combination of risk situations in the life of a person who meets your psychological disorganization and need of assistance, representing both the danger of disorder and the opportunity for personal development. The final resolution of the crisis depends on many factors including the severity of the precipitating event and the personal and social resources the individual.

Any period of crisis or will be resolved somehow. This solution can be healthy or harmful and it is assumed that the type of solution reached will affect the future performance of the individual. It is important to assimilate the event of crisis so that it is integrated into the fabric of life by allowing the person to be open rather than closed to the future. The primary goal in seeking intervention strategies is to help the person regain the performance level it had before the incident that precipitated the crisis.

Slaikeu (1990) speaks of two types of intervention: the first and second instance. In the case of teachers is more likely that they are prepared to provide psychological first aid (first instance) with the objective of providing support and link to the person in crisis aid resources in this case would be the area of ​​psychology of the institution. The teacher has the ability to detect the crisis at the time and place where that arises. It's like physical first aid as specialized medical help arrives. The psychologist is who will perform the second operation (second instance) as it is the person entitled to assess clinical diagnoses to define depressive adolescents or any other type of condition noting that the presence of alcohol and other drugs complicate any crisis.

In addition, counseling can help teens cope with periods of low mood. You must have the support of a department of psychology and educational institutions have established guidelines to follow to address emotional problems. If the student seeks to master (or if the teacher decides to talk to him), once he hears, you can evaluate and decide what type of support required and can then apply for student support department. So students can get help and follow up immediately.

The teacher assumes functions today (besides teaching) where interpersonal relationships leave deep marks in the way of being of those involved in the educational process. This means being fully aware adviser of their limitations and avoid obviously settle cases out of area or profession. Training is needed in human development, knowledge of intervention tools and above all an attitude committed to the development and growth of students.

Treatments

There are different types of depression and stages of severity. Before determining what treatment is right for everyone, it is essential, the physician first examine, which consists in a physical examination, patient interview and laboratory tests to determine if the cause is biological or psychological. When physical causes are ruled out, it must proceed to an assessment or test of a psychological or psychiatric. (Catholic Health System, 2005). The type of treatment is determined depending on the outcome of that assessment.

According to Dr. Alonso-Fernandez (2001), treatments for depression can be supplied in two different ways. One method is ambulatory, home is where the patient does not come out of its context, lives with his family and remains part of their work, this is the right kind, for the support of loved ones is essential. Psychiatric hospital admission is the other method, but is only used when the crisis is extreme depression, characterized by "social abandonment, suicide risk, danger to others, refusing treatment or indication of a change of scenery" (p. 170).

The treatments are divided into three groups depending on the time the disease manifests itself: Treatment of severe depression, when patients are referred to the hospital until the disappearance of symptoms, maintenance therapy for a minimum of six months to prevent recurrence of symptoms, and preventive treatment or prophylactic measures to avoid recurrence (of what is understood as an emergence of a new depressive episode after six months pre treatment) and relapse (which is defined as the reappearance of symptoms before passing the five to six months).

Different prototypes of treatments can be classified into five major groups.

a) Drug therapy: Can not determine what type of drug or drug will be the most successful since only 65% ​​of cases a specific function. Sue Breton (1998), says that as with all chemicals, it is believed that antidepressants are as tranquilizers and are addictive. This is a misconception, because unlike tranquilizers also, their effects are not immediate, it takes two to three weeks before showing the desired effect. Antidepressants have side effects such as sedation, increased heart rate, low or high blood pressure, dry mouth, blurred vision and constipation. With the selective inhibitors of serotonin reuptake inhibitors (SSRIs) have been enormous advantages as these inhibitors unlike the tricyclics, has fewer side effects. Only cause mild nausea, diarrhea and headache, effects usually disappear with use, but its main disadvantage is that cause sexual dysfunction. Those who consume antidepressants known as monoamine oxidase inhibitors (MAOIs) are subjected to restricted diet and special precautions.

b) Medicinal herbs. Recently it has been using an herb that is known as the herb St. John's Wort (Hypericum perforatum) whose use is very common in Europe, specifically Germany, is the most widely used antidepressant. It should be noted that its effects have been studied only in the short term, as mentioned by Margaret Strock (2001). Is currently conducting a comparative study to 3 years, including conventional drugs, the herb St. John and the use of placebos. The FDA gave notice in February 2000 on the possible negative interaction of this herb when mixed with drugs to "heart disease, depression, seizures, certain cancers and transplant rejection" (para. 42).

c) Psychotherapy. The first mode is family therapy, mentioned by Glick (1999) who considered indispensable psychoeducation model for both the patient and the family, as it is here where the issue of treatment. This therapy suggests two dimensions, individual and group separately but are used in practice. Within individual therapy is detailed cognitive-behavioral psychotherapy (CBT) based on understanding the functional relationship between the thinking process, behavior disturbances and open mood, while it teaches the patient to optimize resource usage, for the management of depression. As therapy progresses identifies areas of weakness and before finishing techniques are taught to prevent recurrences. This type of therapy can be applied both individually and in groups, and has recently been developed for couples therapy. The average duration of this type of therapy is eight to twenty sessions. There is also the interpersonal psychotherapy or IPT. This is based on helping the patient to identify what their interpersonal conflict causes or leads to depression and in conjunction with the therapist working on repair strategies. Due to its success, is an excellent choice for outpatient therapy, limited time and also worth mentioning that the technique is also used for general practice, as mentioned by Glick (1999), authored by Swartz and Markowitz.

Individual psychotherapy Glick (1999) is suggested for normal depression, and be understood by normal, giving a feeling of sadness or unhappiness. This type of therapy is proposed for people with irrational visions of themselves and others, when everything in your physical and developmental (childhood) is fine, but were victims of a situation so bad that fail to integrate their life without them causes depression or despair. Group psychotherapy, is what is intended, to treat several patients at once. It should be mentioned that within this group there are several methods: support groups, self help groups, crisis groups, group behavioral, and interpersonal psychotherapy.

d) Combined treatment. This type of treatment suggests the use of drugs and psychotherapy, which is the method recommended by the American Psychiatric Association, as mentioned by Glick (1999). Three factors determine the use of this therapy: when a psychiatrist providing both treatments when there is a nonmedical psychotherapist working with a psychiatrist, and when there is a nonmedical psychotherapist working with a doctor not a psychotherapist. The main reason why this therapy is helpful, it is because the etiology of the disease, although because we consider it as biopsychosocial factors, we are attacking the disease from different perspectives with a higher success rate.

e) electroconvulsionante therapy. According to Strock (2001), this therapy is applied only to patients whose depression is severe, "suicide, with severe agitation, psychotic thoughts, excessive weight loss or physically weak as a result of a physical condition" (para. 29), or for those who can not take antidepressants. Treatment was administered under light anesthesia. The patient is placed electrodes on the head and emit electrical discharges occurring with this slight seizure of approximately thirty seconds. It requires several sessions, three per week. It is not known what causes with certainty in the brain, but the effects are very satisfactory.

Conclusion

When talking about risk factors in adolescents, is generally considered the best known or discussed. For those teachers who work with teens who are high social environment, especially if they live in large cities, what is known is the abuse of alcohol, drugs in some cases, the problems of anorexia and bulimia and girls and some cases sexual problems if they have not defined their identity and personality. In less affluent social strata there are drug and alcohol problems and are more common situations of violence, crime, present among youth gangs. or that the girls are exposed to harassment or sexual abuse and end up with an unwanted pregnancy. Few times as parents or teachers we realize that a teen may be suffering from depression.

Unfortunately, depression often goes unnoticed. In adolescence arises from the combination of a number of different factors. It features the teens who have it presented a sad and melancholy with consequent permanent discouragement to continue with their daily activities. The source is subject to the special circumstances of each individual case and the specialist who diagnosed. Because the adolescent in itself is in a stage of physical and psychological characteristic that affects your mood, at this stage the detection of it is much more complicated. Additionally, parents are often absent or are in conflict with them because they can not deal with the situation they seek to challenge them and go beyond the boundaries to define their identity and personality. On the other hand, teachers in middle and high school, usually has very little contact with the student, since many teachers who teach different subjects. Also known family history that at one point could have a normal effect on mood related to adolescent development. As parents or educators, the responsibility to be more observant and perceive situations that could reach adolescents present so that you can intervene early to help prevent irremediable situations. Teachers in particular we can carry out a primary intervention, also called psychological first aid that includes listening to facts and feelings that disrupt the student, show empathy, to examine the dimensions of the problem, promote self-reflection without giving personal opinions, help you examine alternatives solution and if necessary refer it to the psychology department of the institution and further monitoring. The person entitled to make a diagnosis is the psychologist who will provide the required assistance. Therefore, it is extremely important to educate parents and teachers about what is depression, its causes and effects in order to help and to prevent conflict situations that lead even to suicide.

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