HEALTH: CHILDREN & TEEN DEPRESSION (SYMPTOMS & TREATMENT)
What is Children Depression?
Children depression is different
from the normal "blues" and everyday emotions that occur as a child
develops. Just because a child seems depressed or sad, does not necessarily
mean they have depression. But if these symptoms become persistent, disruptive,
and interfere with social activities, interests, schoolwork and family life, it
may indicate that he or she has the medical illness called depression. Keep in
mind that while depression is a serious illness, it is also a treatable one.
It is estimated that 2.5% of
children in the U.S. suffer from depression. Depression
is significantly more common in boys under the age of 10. But by age 16, girls
have a greater incidence of depression.
Studies have found that first-time
depression in children is occurring at younger ages than previously. As in
adults, it may occur again later in life. Depression often occurs at the same
time as other physical illnesses. And because studies have shown that
depression may precede more serious mental illness later in life, diagnosis,
early treatment, and close monitoring are crucial.
As a parent, it is sometimes easier to deny that your child has depression. You may put off seeking the help of a mental health care professional because of the social stigmas associated with mental illness. It is very important for you -- as the parent -- to understand depression and realize the importance of treatment so that your child may continue to grow physically and emotionally in a healthy way. It is also important to seek education about the future effects depression may have on your child throughout adolescence and adulthood.
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Also see: DEPRESSION BIPOLAR
DISORDER/MANIA POSTPARTUM DEPRESSION (PPD) DYSTHYMIA
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The symptoms of depression in
children vary. It is often undiagnosed and untreated because they are passed
off as normal emotional and psychological changes that occur during growth.
Early medical studies focused on "masked" depression, where a child's
depressed mood was evidenced by acting out or angry behavior. While this does
occur, particularly in younger children, many children display sadness or low
mood similar to adults who are depressed. The primary symptoms of depression
revolve around sadness, a feeling of hopelessness, and mood changes.
Signs and symptoms of depression in
children include:
- Irritability or anger
- Continuous feelings of sadness, hopelessness
- Social withdrawal
- Increased sensitivity to rejection
- Changes in appetite -- either increased or decreased
- Changes in sleep -- sleeplessness or excessive sleep
- Vocal outbursts or crying
- Difficulty concentrating
- Fatigue and low energy
- Physical complaints (such as stomachaches, headaches)
that do not respond to treatment
- Reduced ability to function during events and
activities at home or with friends, in school, extracurricular activities,
and in other hobbies or interests
- Feelings of worthlessness or guilt
- Impaired thinking or concentration
- Thoughts of death or suicide
Not all children have all of these
symptoms. In fact, most will display different symptoms at different times and
in different settings. Although some children may continue to function
reasonably well in structured environments, most kids with significant
depression will suffer a noticeable change in social activities, loss of
interest in school and poor academic performance, or a change in appearance.
Children may also begin using drugs or alcohol, especially if they are over the
age of 12.
Although relatively rare in youths
under 12, young children do attempt suicide -- and may do so impulsively when
they are upset or angry. Girls are more likely to attempt suicide, but boys are
more likely to actually kill themselves when they make an attempt. Children
with a family history of violence, alcohol abuse, or physical or sexual abuse
are at greater risk for suicide, as are those with depressive symptoms.
Warning
signs of suicidal behavior in children include:
- Many depressive symptoms (changes in eating, sleeping,
activities)
- Social isolation
- Talk of suicide, hopelessness, or helplessness
- Increased acting-out behaviors (sexual/behavioral)
- Increased risk-taking behaviors
- Frequent accidents
- Substance abuse
- Focus on morbid and negative themes
- Talk about death and dying
- Increased crying and reduced emotional expression
- Giving away possessions
HOW TO OVERCOME DEPRESSION
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As in adults, children depression
can be caused by any combination of factors that relate to physical health,
life events, family history, environment, genetic vulnerability, and
biochemical disturbance. Depression is not a passing mood, nor is it a
condition that will go away without proper treatment.
Children with a family history of
depression are at greater risk of experiencing depression themselves. Children
who have parents that suffer from depression tend to develop their first
episode of depression earlier than children whose parents do not. Children from
chaotic or conflicted families, or children and teens who abuse substances like
alcohol and drugs, are also at greater risk of depression.
f the symptoms of depression in your
child have lasted for at least two weeks, you should schedule a visit with his
or her doctor to make sure there are no physical reasons for the symptoms and
to make sure that your child receives proper treatment. A consultation with a
mental health care professional who specializes in children is also recommended.
A mental health evaluation should
include interviews with you (as the parents) and your child, and any additional
psychological testing that is necessary. Information from teachers, friends,
and classmates can be useful for showing that these symptoms are consistent
during your child's various activities and are a marked change from previous
behavior.
There are no specific tests --
medical or psychological -- that can clearly show depression, but tools such as
questionnaires (for both the child and parents) combined with personal
information can be very useful.
Health: Bipolar Disorder in Children and Teens
Both children and teens can
develop bipolar disorder. It is more likely to affect the children of parents
who have the illness.
Unlike many adults with bipolar
disorder, whose episodes tend to be more clearly defined, children and young
adolescents with the illness often experience very fast mood swings between
depression and mania many times within a day. Children with mania are more
likely to be irritable and prone to destructive tantrums than to be overly
happy and elated. Mixed symptoms also are common in youths with bipolar
disorder. Older teens who develop the illness may have more classic,
adult-type episodes and symptoms.
Bipolar disorder in children and teens can be hard to tell apart from other problems that may occur in
these age groups.
For any illness, however, effective treatment depends on appropriate diagnosis.
Children or teens with emotional and behavioral symptoms should be
carefully evaluated by a mental health professional. Any child or adolescent
who has suicidal feelings, talks about suicide, or attempts suicide should be
taken seriously and should receive immediate help from a mental health
specialist.
Health: Treatment Options for Children Depression
Treatment options for children with
depression are similar to those for adults, including psychotherapy
(counseling) and medicine. The role that family and the child's environment
play in the treatment process is different from that of adults. Your child's
doctor may suggest psychotherapy first, and consider antidepressant medicine as
an additional option if there is no significant improvement. Currently, there
are no good studies documenting the effectiveness of medicine over
psychotherapy in children.
However, three studies do show that the antidepressant Prozac is effective in treating
depression in children and teens. The drug is officially recognized by the FDA
for treatment of children 8-18 with depression.
Health: Recognizing Teen Depression
It is common for teens to occasionally feel unhappy. However, when the unhappiness lasts for more than two weeks, and the teen experiences other symptoms typical of depression, then he or she may be suffering from depression.
Estimates on how many adolescents experience depression vary from 3% to 6%. At any given time, from 2% to 10% of school-age children are thought to be suffering from depression.
There are many reasons why teens become unhappy. High stress environments can lead to depression. Teens can develop feelings of worthlessness and inadequacy over school performance, social interaction, sexual orientation, or family life. If friends or family, or things that the teen usually enjoys, don't help to improve his or her sadness or sense of isolation, there's a good chance that he or she is depressed.
Depression also tends to be more common in teens who have a history of depression in their families.
If you believe your teenager is suffering from depression, you should seek help from a qualified health care professional.
Health:
Symptoms of Teen DepressionOften, depressed teens will display a striking change in their thinking and behavior, lose their motivation, or become withdrawn. The following are the major signs of depression in adolescents:
- Sadness, anxiety, or a feelings of hopelessness and self-hatred
- Loss of interest in food or compulsive overeating that results in rapid weight loss or gain
- Staying awake at night and sleeping during the day
- Withdrawal from friends and family
- Rebellious behavior, sudden drop in grades, or cutting school
- Complaints of pains including headaches, stomachaches, low back pain, or fatigue
- Use of alcohol or drugs and promiscuous sexual activity
- A preoccupation with death and dying
Other signs of depression in teens:
- Criminal behavior (such as shoplifting)
- Depressed or irritable mood
- Difficulty concentrating
- Difficulty making decisions
- Episodes of memory loss
- Excessively irresponsible behavior pattern
- Excessive or inappropriate feelings of guilt
- Loss of interest in activities
- Persistent difficulty falling asleep or staying asleep (insomnia)
- Plans to commit suicide or actual suicide attempt
- Preoccupation with self
- Temper (agitation)
- Obsessive fears or worries about death
If these symptoms last for at least 2 weeks and cause significant distress or difficulty functioning, get treatment.
Health: Causes and Risk Factors of Teen Depression
Depression can be a temporary response to many situations and stresses. In adolescents, depressed mood is common because of:
- The normal process of maturing and the stress associated with it
- The influence of sex hormones
- Independence conflicts with parents
It may also be a reaction to a disturbing event, such as:
- The death of a friend or relative
- A breakup with a boyfriend or girlfriend
- Failure at school
Teens who have low self-esteem, are highly self-critical, and who feel little sense of control over negative events are particularly at risk to become depressed when they experience stressful events.
Adolescent girls are twice as likely as boys to experience depression.
Risk factors include:
- Child abuse - both physical and sexual
- Chronic illness
- Family history of depression
- Poor social skills
- Stressful life events, particularly loss of a parent to death or divorce
- Unstable care-giving
Depression is also associated with eating disorders, particularly bulimia.
Health:
Diagnosis and Treatment of Teen DepressionTrue depression in teens is often difficult to diagnose, because normal adolescents have both up and down moods. These moods may alternate over a period of hours or days.
The health care provider will perform a physical examination and order blood tests to rule out medical causes for the symptoms. The doctor will also evaluate for signs of substance abuse. Heavy drinking, frequent marijuana (pot) smoking, and other drug use can be caused by, or occur because of depression.
A psychiatric evaluation will also be done to document the teen's history of sadness, irritability, and loss of interest and pleasure in normal activities. The doctor will look for signs of potentially coexisting psychiatric disorders such as anxiety, mania, or schizophrenia. A careful assessment will help determine suicidal/homicidal risks -- that is, if the teen is a danger to him or herself or others.
There aren't any specific tests that can be performed to detect depression . Health care professionals determine if an adolescent is depressed using psychological tests and detailed clinical interviews with the individual and his or her family members, teachers, and peers. The severity of depression and the risk of suicide are determined based on the assessment of these interviews. Treatment recommendations are also made based on the data collected from the interviews. Information from family members or school personnel can often help identify depression in teens.
Treatment options for adolescents with depression include supportive care from a medical provider, psychotherapy, and antidepressant medications. It is important that treatment be customized to the adolescent and the severity of depression symptoms. Families often participate in the treatment of adolescent depression.
MEDICATION
The first medication considered is usually a type of antidepressant called selective serotonin reuptake inhibitors (SSRI). NOTE: SSRIs carry a warning that they may increase the risk of suicidal thoughts and actions in children and adolescents. Teens and families should be alert for sudden changes or increased suicidal thoughts. Talk to your doctor about the benefits and risks of this type of medicine.
Not all antidepressants are approved for use in children and teens. For example, tricyclics are not approved for use in teens.
THERAPY
Family therapy may be helpful if family conflict is contributing to the depression. Support from family or teachers may also be needed to help with school problems. Occasionally, hospitalization in a psychiatric unit may be required for individuals with severe depression, or those who are suicide risks.
Because of the behavior problems that often occur with adolescent depression, many parents are tempted to send their teen to a "boot camp," "wilderness program," or "emotional growth school." These programs often use non-medical staff, confrontational therapies, and harsh punishments. There is no scientific evidence to support such programs. In fact, there is a growing body of research suggesting they can actually harm sensitive teens with depression.
Depressed teens who act out may also become involved with the criminal justice system. Parents are often advised not to intervene, but to "let them experience consequences." This can harm teens by exposing them to more deviant peers and reducing their educational opportunities. A better solution is to get the best possible legal advice and search for treatment on your own. This gives parents more control over treatment techniques and options.
Though a large percentage of teens in the criminal justice system have mental disorders such as depression, few juvenile prisons, "boot camps," or other "alternative to prison" programs provide adequate treatment.
Health: Teen Suicide and Advice for Parents
Suicide is a serious problem within the teen population. Teen suicide is the second leading cause of death among youth and young adults in the U.S. It is estimated that 500,000 teens attempt suicide every year with 5,000 succeeding. These are epidemic proportions.
Warning signs of suicide include:
- Threatening to kill one's self
- Preparing for death, giving away favorite possessions, writing goodbye letters, or making a will
- Expressing a hopelessness for the future
- Giving up on one's self, talking as if no one else cares
If your teen displays any of these behaviors, you should seek help from a mental health care professional immediately.
Suicide is an act of desperation. Depression is often the root cause. It can make problems seem overwhelming and the associated pain unbearable. Family difficulties, the loss of a loved one, or perceived failures at school or in relationships can all lead to negative feelings and depression.
Parenting teens can be very challenging. Some communication techniques can go a long way toward lowering the stress level of your teen.
- When disciplining your teen, replace shame and punishment with positive reinforcement for good behavior. Shame and punishment can make an adolescent feel worthless and inadequate.
- Allow your teen to make mistakes. Over protection or making decisions for teens can be perceived as a lack of faith in their abilities. This can make them feel less confident.
- Give your teen breathing room. Don't expect them to do exactly as you say all of the time.
- Do not force your teen down a path you wanted to follow. Avoid trying to relive your youth through your teen's activities and experiences.
If you suspect that your teen is depressed, take the time to listen to his or her concerns. Even if you don't think the problem is of real concern, remember that it may feel very real to someone who is growing up. It is important to keep the lines of communication open, even if your teen seems to want to withdraw. Try to avoid telling your teen what to do; instead, listen closely and you may discover more about the issues causing the problems.
If you feel overwhelmed or unable to reach your teen, or if you continue to be concerned, seek help from a qualified health care professional.
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Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
