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Depression, It Occurs in Children

Depression, It Occurs in Children. Ruth E. Imershein, MD RMOP US Embassy Lima. Depression . A state of being depressed, dejected, downcast, sad or gloomy.

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Depression, It Occurs in Children

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  1. Depression, It Occurs in Children Ruth E. Imershein, MD RMOP US Embassy Lima

  2. Depression A state of being depressed, dejected, downcast, sad or gloomy. • Depression is an illness when the feelings are greater or more prolonged than warranted by any objective reason, plus they persist and interfere with an individual's ability to function.

  3. Facts • It is a disorder of mood. • Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders as well as certain chronic medical conditions are at a higher risk for depression. • Earlier onset appears to be associated with more severe symptoms and with depression that extends into adulthood • Depression tends to run in families.

  4. More Facts • Incidence - 2.5% of children and up to 8.3% of adolescents in the U.S. • Prevalence- 6% in a 6-month period of 9-17 year olds, with 4.9 percent having major depression • Onset can be in infancy • It can be a single episode, recurrent or chronic. Most often it is recurrent and chronic.

  5. Why? • The etiology of depression is unknown • These factors play a role in depression: • Biological rhythms • Biogenic amines (neurotransmitters) • Physical illness • Genetics • Psychosocial factors • Other: Depressed parents, child abuse, gender, hormonal changes, poverty, alcoholism and substance abuse

  6. Common Mood Disorders in Children • Normal Moodiness • Adjustment Disorders • With depressed mood • With mixed emotions* • Dysthymia • Major Depression • Double Depression • Bipolar Disorder or Manic Depressive Illness* • Seasonal Affective Disorder (SAD)* *not discussed here

  7. Normal Moodiness • My child is so sensitive that the slightest thing can put him or her in a bad mood • Temperament cannot be changes but its impact can be minimized • My child has been so moody since my mother died, her best friend left, he moved to another school • children go through a period of bereavement or grieving whenever they suffer a loss

  8. Normal Moodiness • My teenager is no irritable and moody that I'm not sure that we will both survive her adolescence • Normal teens actually have very mild mood swings • My daughter has PMS-like mood swings but they seem to come and go more than once a month • Hormones are clearly associated with mood changes. Thyroid dysfunction causes depression. Fluctuating levels of female hormones during teen years is not uncommon until their menstrual cycles are predictable

  9. Normal Moodiness • My child never gets enough sleep; it's no wonder my child is so irritable all the time • Children, even teenagers, need 8 to 9 hours of sleep or more. Chronic sleep deprivation is not normal just because most children suffer from it. It is unhealthy and associated with fatigue, sleepiness, decreased attention span, moodiness, irritability.

  10. What Can a Parent Do? • Patience, tolerance and a positive attitude • The three Ls - love, limits, large muscle • The three Rs - respect for you, respect for your child, responsibility for his or her actions • Enlist the aid of the teachers • To provide a basis of comparison • To lessen the school load • To notify you if the situation gets worse

  11. Adjustment Disorder with Depressed Mood • The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within three months of the onset of the stressor(s) and lasting less than six months. • The symptoms or behaviors are clinically significant as evidenced by either of the following: • Marked distress that is in excess of what would be expected from exposure to the stressor • Significant impairment in social or occupational (academic) functioning

  12. Helping Children After a Trauma • Seek help if child's behavior changes and problems persist • After the initial trauma, check the National Center for Child Traumatic Stress website for age appropriate handouts for parents and teachers - • Reactions and Behaviors • Responses • Examples of what to do and say

  13. Dysthymia • A chronic low grade form of depression in which the symptoms are present for a year or two • Young children don't necessarily recognize sadness or identify themselves as depressed • Children may cry more easily, or have a sad or expressionless face • Children may not express a sense of sadness, but rather be more irritable

  14. Dysthymia • The average duration of a dysthymic period in children and adolescents is about 4 years. • Sometimes children are depressed for so long that they do not recognize their mood as out of the ordinary and thus may not complain of feeling depressed.

  15. Dysthymia - DSM Criteria • The presence, while depressed, of two or more of the following symptoms: • Poor appetite or overeating • Insomnia or hypersomnia (sleeping too much) • Low energy or fatigue • Low self esteem (negative self statements) • Poor concentration or difficulty making decisions • Feelings of hopelessness

  16. Associated Symptoms • Physical Symptoms such as headaches or stomachaches • Change in interests • Change in friendships • Change in school performance

  17. What Should a Parent Do? • Learn the symptoms of depression - it often begins insidiously • Take action when you notice these symptoms • Don't deny the problem or make excuses • Prevent excessive stress - even though it doesn't cause depression, it can worsen the condition • Recognize the signs of suicidal behavior and intervene immediately

  18. Treatment Options • Therapy • Individual, group or family therapy • Cognitive therapy • Behavior therapy • Interpersonal Therapy • Medications – usually antidepressants, most commonly SSRIs • Also – consider a change in school situation or modification of the current school program

  19. Major Depressive Disorder - MDD • Population studies show that at any point in time 10 to 15 percent of children and adolescents have some symptoms of depression. • In children and adolescents, an episode lasts on average from 7 to 9 months. • Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next 5 years.

  20. Major Depressive Disorder – DSM Criteria • Five or more of the following symptoms have been present during the same 2 week period AND represent a change from previous functioning; • At least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure • Symptoms should be present most of the day, nearly every day

  21. MDD - Criteria 1. Depressed (or in children irritable) mood 2. Markedly diminished interest or pleasure in all, or almost all, activities Change in participation, communication. Increased social isolation. 3. Significant weight loss or weight gain 4. Insomnia or sleeping too much 5. Motor agitation or retardation observable by others 6. Fatigue or loss of energy 7. Feelings of worthlessness, excessive or inappropriate guilt 8. Diminished ability to think, concentrate, make decisions 9. Recurrent thoughts of death, suicidal ideation with or without plan

  22. MDD – Associated Symptoms • Crying spells or tearfulness • Frequent absences from school or poor performance in school • Frequent complaints of physical illnesses such as headaches and stomachaches • Frequent bouts of physical illnesses that don't get better with treatment • Extreme sensitivity to rejection or failure

  23. More Associated Features • Emotional outbursts • Poor social relationships or change in friendships • Alcohol or Substance abuse • Reckless behavior – single person car accidents • Reluctance to meet new people or try new things • Fears of separation • Psychotic features can occur, but are more likely to be auditory hallucinations than delusions

  24. What Should a Parent Do? • Listen to your child • Accept, do not argue about his or her feelings • Help your child cope • Get your child professional assistance • Make it easy to get to therapy • Encourage compliance with treatment • Collaborate with the professionals involved in your child’s care – both at school and in treatment • Remind your child that you love him or her

  25. Treatment Options • Early diagnosis is important • Recognize that depression is a treatable illness that requires professional help • A combination of individual psychotherapy, family therapy and medications is probably best

  26. Resources • The American Academy of Child and Adolescent Psychiatry – Facts for Families (http://aacap.org) • Madison Institute of Medicine – booklets on Depression, etc http://www.miminc.org/ • Depression and Bipolar Support Alliance (DBSA) - http://www.dbsalliance.org/site/PageServer?pagename=home

  27. More Resources – books for Parents • Lonely, Sad and Angry: How to Help Your Unhappy Child (Paperback) by Barbara Ingersoll • Help Me, I'm Sad: Recognizing, Treating, and Preventing Childhood and Adolescent Depression by David Frassler and Lynne Dumas • Talking to Depression: Simple Ways to Connect When Someone in Your Life is Depressed by Claudia Strauss

  28. More Resources – books for children • Feeling Better-A Kid’s Book About Therapy by Rachel Rashkin • The Boy Who Didn’t Want to be Sad by Robert Goldblatt • Depression is the Pits, But I’m Getting Better-A guide for Adolescents by E. Jane Garland • Beyond the Blues: A Workbook to Help Teens Overcome Depression (Paperback) by Lisa Schab • When Nothing Matters Anymore: A Survival Guide for Depressed Teens (Paperback) by Bev Cobain

  29. More Books for Children • Don’t Feed the Monster on Tuesdays! The Children’s Self Esteem Book by Adolph Moser • Tales of a Fourth Grade Nothing by Judy Blume • Beezus and Ramona by Beverly Cleary

  30. Yet More Resources – online ordering • Magination Press – self help books for kids and adults by the American Psychological Association http://www.apa.org/pubs/magination/ • ChildsWork/ChildsPlay – resources for parents, teachers and professionals: http://childswork.com/ • Courage to Change – more resources available online: http://couragetochange.com/ • Creative Therapy Store - http://portal.creativetherapystore.com/

  31. Classroom Tips • School Behavior.com – All sorts of resources about all sorts of common mental health problems and learning difficulties in children

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