Depression In Children

Depression in children facts

• Depression is a condition that is more severe than normal sadness and can significantly interfere with a child's ability to function.
• Depression affects about 2% of preschool and school-age children.
• Depression in children does not have one specific cause but rather a number of biological, psychological, and environmental risk factors that are part of its development.
• General symptoms of depression, regardless of age, include having a depressed or irritable mood or loss of interest or pleasure for at least two weeks and having at least five clinical signs and symptoms.
• Suicide is the third leading cause of death in youth 10-24 years of age.
• To diagnose depression, a health-care professional will likely perform or refer for a thorough medical assessment and physical examination and ask standard mental-health questions.
• Treatment for childhood depression may include addressing any medical conditions that caused or worsened the condition. It can also involve lifestyle adjustments, psychotherapy, and, for moderate to severe depression, medication.
• Interpersonal therapy (ITP) and cognitive behavioral therapy (CBT) are the major approaches commonly used to treat childhood depression.
• About 60% of children who take antidepressant medication improve. It may take up to six weeks of treatment with medication at its effective dose to start improving.
• Childhood depression is a risk factor for developing a number of other mental-health symptoms and disorders.
• Depression is the leading cause of disability in the United States in people over 5 years of age.
• Prevention of childhood depression seeks to reduce risk factors and strengthen protective factors using approaches that are appropriate for the child's developmental level.
• Family members and friends are advised to seek mental-health assessment and treatment for the depressed child.
  
  

Childhood Depression Symptoms
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. Depressive disorders are characterized by pervasive mood changes that affect all aspects of an individual's daily functioning.

Symptoms of depression also include

• helplessness,
• guilt,
• feelings of worthlessness,
• hopelessness,
• loss of energy,
• loss of appetite,
• lack of interest in daily activities,
• irritability,
• sleep problems,
• self-loathing,
• thoughts of suicide.
  
  
  
  

What is childhood depression?

Clinically significant depression can be generally understood as being severe enough to interfere with one's ability to function. It is quite common at every age, affecting more than 16% of children in the United States at some time in their lives and thought to be increasing in children and adolescents, both in this country and elsewhere. Other statistics about depression include its tendency to occur at a rate of about 2% prior to the teenage years and at approximately 5%-8% when both adolescents and children younger than adolescence are considered. It is a leading cause of health impairment (morbidity) and death (mortality). About 3,000 adolescents and young adults die by suicide each year in the United States, making it the third leading cause of death in people 10-24 years of age.

dysthymia. Depression may also be part of other mood disorders like bipolar disorder, as a result of psychosis (for example, having symptoms of delusions or hallucinations), as part of a medical condition like hypothyroidism, or the result of exposure to certain medications such as cold medications or drug abuse, like cocainewithdrawal.

teens with a depressed parent are as much as four times more likely to also develop the disorder. Children who have depression or anxiety are more prone to have other biological problems, like low birth weight, trouble sleeping, and to having a mother younger than 18 years old at the time of their birth.

Psychological contributors to depression include low self-esteem, negative body image, being excessively self-critical, and often feeling helpless when dealing with negative events. Children who suffer from conduct disorder, attention deficit hyperactivity disorder (ADHD), clinical anxiety, or who have cognitive or learning problems, as well as trouble engaging in social activities also are have more risk of developing depression.

Depression may be a reaction to life stresses, like trauma, including verbal, physical, or sexual abuse; the death of a loved one; school problems; being bullied; or suffering from peer pressure. Youth who are struggling to adapt to the United States culture have found to be at higher risk for developing depression. Research differs as to whether children who are obese have an increased risk of developing depression.

Other contributors to this condition include poverty and financial difficulties in general, exposure to violence, social isolation, parental conflict, divorce, and other causes of disruptions to family life. Children who have limited physical activity, poor school performance, or lose a relationship are at higher risk for developing depression, as well.

What should parents do if they suspect that their child is depressed?

Family members and friends are advised to seek mental-health assessment and treatment for the depressed child. Adult family members may confer with the child's primary-care doctor or seek mental-health services by contacting one of the resources indicated below. Once the child with depression is receiving treatment, family members can promote good mental health by gently encouraging him or her to have a healthy lifestyle, including encouraging the child to maintain a healthy diet, get enough sleep, exercise regularly, remain socially active, and to engage in healthy stress-management activities. Parents and other loved ones can also be helpful to the depressed child by discouraging him or her from engaging in risky behaviors.

If it is determined that your child is suffering from clinical depression, the health-care professional likely will recommend treatment. Treatment may include alleviating any medical condition that causes or worsens depression. For example, a person who is found to have low levels of thyroid hormonemight receive hormone replacement with levothyroxine (Synthroid). Other aspects of treatment may include supportive therapy, like lifestyle and behavioral changes, psychotherapy, complementary treatments, and possibly medication for moderate to severe depression. If symptoms are severe enough that treatment with medication is appropriate, symptoms tend to improve faster and for a longer period of time when medication is combined with psychotherapy.

Most mental-health professionals will continue treatment of major depression for six months to a year to prevent a reoccurrence of symptoms. Treatment for children with depression can have a significantly positive effect on the child's functioning with peers, family members, and at school. Without treatment, symptoms tend to last much longer, may not improve, or may worsen. With treatment, the chances of recovery are significantly improved.

Psychotherapy
Psychotherapy ("talk therapy") is a kind of mental-health counseling that entails working with a trained therapist to figure out ways to solve problems and cope with depression. It can be a powerfully effective intervention, even resulting in positive biochemical changes in the brain. For babies, music therapy and infant massage have been found to be useful interventions. Two major kinds of psychotherapy are commonly used to treat childhood depression: interpersonal psychotherapy and cognitive behavioral therapy. In general, these forms of treatment take weeks to months to complete and has a goal of alleviating depressive symptoms. More intensive psychotherapy may be needed for a longer period of time when treating very severe depression or for depression that is accompanied by other psychiatric symptoms.

Interpersonal therapy (IPT): This form of psychotherapy seeks to alleviate depressive symptoms by helping child with depression develop more effective skills for coping with their emotions and relationships. IPT uses two strategies to achieve those goals:

• Educating the child, his or her parents, and other family members about the nature of depression: The therapist will reassure the child and his or her loved ones that depression is a common illness and that most people tend to improve with treatment.
• Defining problems (such as abnormal grief or interpersonal conflicts): Once problems are defined, the therapist can help the child set realistic goals for solving these problems and work with him or her and the child's family using different treatment techniques to reach these goals.

Cognitive-behavioral therapy (CBT): This approach to psychotherapy helps to decrease depression and the likelihood it will come back by helping the child change his or her way of thinking about certain issues. In CBT, the therapist uses three techniques to achieve these goals.

• Didactic component: This phase helps to establish positive expectations for treatment and promote the child's participation in treatment.
• Cognitive component: This promotes identifying the thoughts and assumptions that play a role in the child's behaviors, especially those that may predispose the sufferer to being depressed.
• Behavioral component: This uses behavior-modification methods to teach the child more effective ways of dealing with problems.

Medications
The most commonly used group of antidepressant medications prescribed for children is the selective serotonin reuptake inhibitors (SSRIs). SSRI medications influence the levels of serotonin in the brain. For many prescribing professionals, these medications are the first choice because of the significant degree of effectiveness and safety of this group of medicines. Examples of these medications are listed here with the generic name first and the brand name in parentheses.

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Vortioxetine (Trintellix)
• Vilazodone (Viibryd)

Only Prozac and Lexapro are approved by the Food and Drug Administration (FDA) to treat childhood depression and only in those 8 years of age and older for Prozac, 12 years old and older for Lexapro. Any other medications used to treat this condition in children or using an antidepressant in younger children is therefore considered to be being used "off label." In fact, the use of Paxil has fallen out of favor due to what is thought to be its lack of consistent efficacy in the context of the risk of possible side effects.

Although FDA approved for use in teenagers with schizophrenia rather than for depression, atypical neuroleptic medications like aripiprazole (Abilify) and risperidone (Risperdal) are sometimes prescribed in addition to an antidepressant in children who either suffer from severe depression, fail to improve after receiving a trial of an antidepressant in addition to, or instead of, an antidepressant in children who have bipolar disorder.

Non-neuroleptic mood-stabilizer medications are also sometimes prescribed with an antidepressant to treat children with severe unipolar depression who do not improve after receiving trials of different antidepressants. These medications might also be considered in addition to or instead of an antidepressant in children who suffer from bipolar disorder.

Examples of such non-neuroleptic mood stabilizers include divalproex sodium (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal). Of the non-neuroleptic mood stabilizers, lamotrigine (Lamictal) seems to be unique in its ability to also treat unipolar depression effectively by itself as well as in addition to an antidepressant. However, it is only used in people 16 years of age or older due to potentially serious side effects.

Other antidepressant medications work differently than the commonly used SSRIs. The following medications might be prescribed when SSRIs have not worked: bupropion (Wellbutrin), venlafaxine(Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), or levomilnacipran (Fetzima).

About 60% of children who take antidepressant medication improve and are thought to be highly suggestible to improve (placebo effect). It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better. The prescribing professional will likely assess the depressed child that is receiving the medication again soon after it is started to determine if the medication is being well tolerated and if symptoms have begun to improve. If not, the doctor or other prescriber might adjust the dose of the medication or prescribe a different one.

After symptoms start to improve, the prescribing health-care professional will likely encourage the parents of the depressed child to continue giving the medication for six months to a year because stopping the medication too soon may result in symptoms returning or worsening. Some people need to take the medication for longer to prevent the depression from returning. Stopping treatment abruptly may cause the depression to return or for withdrawal effects (discontinuation syndrome) to occur, depending on which medication is being prescribed.

Side effects of antidepressant medications vary significantly from drug to drug and from person to person.

• Common side effects can include dry mouth, upset stomach, nausea, tremor, insomnia, blurred vision, constipation, and dizziness.
• In rare cases, some people of all ages have been thought to have become acutely more depressed when on the medication, even attempting or completing suicide or homicide. Children and teenagers are thought to be particularly vulnerable to this rare possibility. However, when considering this risk, it is imperative to also consider the risk of the possibly serious outcomes that can result from untreated depression.

Alternative treatments
A number of nonprescription herbal supplements like St. John's wort and dietary supplements like vitamin C and B complex vitamins are used as remedies for depression. There is little known about the safety, effectiveness, or appropriate doses of these remedies, despite their being taken by thousands of people around the world.

• While some of the best-known alternative remedies continue to be studied to see how well they work, there remains little evidence that herbal supplements effectively treat moderate to severe clinical depression.
• Medical professionals are often hesitant to recommend herbs or dietary supplements to treat depression, particularly in children, because they are not regulated by the FDA, as prescription drugs are, to ensure their purity, quality, and effectiveness.

Is it possible to prevent depression in children?

For children, from infancy through the teenage years, strong, healthy attachment between the child and parent can help protect the child from developing depression. Parental behaviors that tend to foster health attachment with their children involve consistent love and care, as well as attentive responsiveness to the child's needs, including age-appropriate steps toward the child's gradual independence.

Preventing depression in childhood tends to involve addressing risk factors, both specific and nonspecific, strengthening other protective factors, and using an appropriate approach for the child's developmental level. Such programs often use cognitive behavioral and/or interpersonal approaches, as well as family based prevention strategies because research shows that these interventions are the most effective.

Protective factors for adolescent depression include involving supportive adults, strong family and peer relationships, healthy coping skills, and emotional regulation. Children of a depressed parent tend to be more resilient when the child is more able to focus on age-appropriate tasks in their lives and on their relationships, as well as being able to understand their parents' condition. For depressed parents, their children seem to be less likely to develop the disorder when the parent is able to demonstrate a commitment to parenting and to relationships.

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