Transcript 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.
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.
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.
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.
Why?
 The etiology of
depression is
unknown
 These factors play a role in
depression:
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Biological rhythms
Biogenic amines (neurotransmitters)
Physical illness
Genetics
Psychosocial factors
Other: Depressed parents, child
abuse, gender, hormonal changes,
poverty, alcoholism and substance
abuse
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
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
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
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.
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
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
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
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
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.
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
Associated Symptoms
 Physical Symptoms such as headaches or
stomachaches
 Change in interests
 Change in friendships
 Change in school performance
What Should a Parent Do?
 Learn the symptoms of depression - it often
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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
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
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.
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
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
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
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
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
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
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?page
name=home
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
More Resources – books for children
 Feeling Better-A Kid’s Book About Therapy by Rachel
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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
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
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/
Classroom Tips
 School Behavior.com – All sorts of resources about all
sorts of common mental health problems and learning
difficulties in children