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Monday, July 13, 2015

Coping with Childhood Depression

From U.S. News & World Report Health

By Kirstin Fawcett
July 8, 2015

Early diagnosis, intervention and treatment are key. 

About 5 to 8 percent of kids suffer from depression at any given time,
with some cases in children as young as 2 years old.

Ian Anderson was only 5 years old when he began to lose interest in activities he once loved. He experienced mood dips and withdrew from his peers. His school performance suffered. And his mind was plagued with thoughts of suicide.

Anderson's mother took him to a family therapy session, and he was diagnosed with depression. Soon after, Anderson started regularly going to therapy. At age 10, he was prescribed antidepressants.

"It's hard to say whether [my depression was spurred] by genetics and a chemical imbalance in the brain, or whether it was because my parents had just divorced," says Anderson, a 29-year-old retail manager who lives in the District of Columbia. "But it was clear that that I was showing very classic symptoms" of the illness.

Many people mistakenly believe depression is only diagnosed and treated in adolescents and adults. After all, kids don't fully understand major life stressors or have the self-awareness and maturity to feel anything more than a shallow sense of sadness. Right?

Wrong. In recent years, experts say, the medical community has started to focus more on the diagnosis and treatment of pediatric depression – spurred by increased awareness of mental health conditions, as well as a growing body of research in the discipline.

According to pediatric psychiatrists, approximately 5 to 8 percent of children and adolescents suffer from depression at any given time. But while the numbers peak in adolescence – teens ages 13 to 16 are more likely to receive a diagnosis – physicians do report cases of depression in children as young as 2 years old.

Parents might want to wait for their kid to "snap out of" or "outgrow" their depression, mental health professionals say. But according to studies, early onset depression often persists into adulthood, and can signal that the child will experience more frequent and severe episodes in adolescence or adulthood.

"A child who experiences a major depressive episode probably has at least a 50 percent chance of having another episode in the next five years," says Dr. John Huxsahl, a psychiatrist who specializes in child and adolescent psychiatry at the Mayo Clinic in Rochester, Minnesota.

Early diagnosis, intervention and treatment are key, experts say. Childhood depression is just as serious as adult mental illness – and should be treated as such.

Identifying Depression in Kids

Say your child isn't sleeping well, or he is complaining of stomach aches, irritable bowel or migraines. He used to love going to the playground, but now barely leaves the couch. Kids who can talk will start expressing negative thoughts or sentiments; those who can't will exhibit temperamental or reactive behavior. You take your child to a primary care or family physician for a screening. You're looking for something, anything – a thyroid condition, low blood sugar – that might explain your once active, happy child's mysterious symptoms.

Your kid might lack the vocabulary or emotional savvy to explain what's going on in his head. Adding to your confusion? A depressed child might act – and feel – slightly differently than his older counterparts with the same condition, Huxsahl says. Sure, they'll share some symptoms – a loss of appetite, sleeping too much or too little, withdrawing from the world – but there are subtle distinctions.

For instance, kids with depression might not appear "sad" to others, nor will they be able to tell you they feel down. They might, however, act more irritable and angry than normal, or be prone to more arguments and temper tantrums.

Ahedonia – the inability to experience pleasure or joy – is another tell-tale symptom that your child might be depressed, Huxsahl notes.

"Children are generally happier than adults, and more spontaneous with their happiness," Huxsahl says. "When young children are clinically depressed, you notice it's like someone grabbed a thermostat that regulates their ability to regulate pleasure and dialed it down 20 degrees."

Another common feeling associated with pediatric depression is guilt, says Dr. Timothy Wilens, chief of the division of child and adolescent psychiatry at Massachusetts General Hospital in Boston. "Some adults report guilt as part of their depression, some don't. But a lot of kids [with depression] will feel guilty about everything," Wilens says. "They'll feel guilty they're not having fun, or that they're holding their family back. They'll feel guilty that they're not doing anything. There's guilt for a whole lot of reasons. You'll see that more often with kids than you do adults."

Psychosomatic complaints – a stomach ache, a headache – can be common among children with depression. And while adults with the illness often suffer in work performance, a kid with depression might start under-performing in school – not completing homework or assignments, doing poorly on tests and not paying attention in class.

Also, keep in mind that life circumstances often play a role in the development of depression in children, says Dr. Abby Schlesinger, an assistant professor at the University of Pittsburgh School of Medicine who specializes in child and adolescent psychiatry. One of the most significant risk factors is a family history of mental illness.

Kids with histories of abuse or neglect – physical and/or emotional – are also at a greater risk for developing depression, as are kids who experience traumas ranging from bullying or a major life change, such as a move, death or divorce.

"Negative, stressful life events in general can be triggers – particularly for children that are biologically sensitive because of their genetics," Schlesinger says. Keep a close eye on whether the child also has any chronic illnesses, an anxiety disorder, attention deficit hyperactivity disorder or other conditions.

Reluctant to attribute your child's recent behavior to depression? Think it might just be growing pains or a "phase?" Consider the duration and severity of the symptoms before writing them off, says Dr. Leslie Miller, an assistant professor of child and adolescent psychiatry at Johns Hopkins University School of Medicine in Baltimore, Maryland.

"You want to look at how long [the symptoms] have been going on for, and you want to look at impairment," Miller says. "Is this a kid who used to have a lot of peer interaction and now they're withdrawing? Is this a kid who pretty much followed rules for the most part but is now having a tantrum every day? Are they barely passing their classes, or not able to get their homework in? Every kid has tantrums, and that's normal and fine. But you have to look at patterns" to determine whether there's something more serious going on."

One clear – and serious – indicator of pediatric depression is suicidal thoughts or behavior, Schlesinger says. Kids are more emotion-driven than adults, and don't necessarily understand the finality of suicide. They're less likely to plan it, and more likely to end their lives in an unpredictable manner. Although suicide in young children is rare – and a child isn't necessarily going to end his life if it crosses his mind – it does happen.

According to the American Foundation for the Prevention of Suicide, suicide is the third leading cause of death in adolescents ages 15 to 24, as well as the sixth leading cause of death in children ages 5 to 14. Experts say a good psychiatric evaluation should include questions about suicidal thoughts or behaviors.

And, if a child has expressed suicidal thoughts to a parent, or shown warning signs – for instance, saying things like "I wish I were dead" – it's important for the family to have a plan on how to handle worst-case scenarios.

"Children are impulsive by nature," Schlesinger says. "If they have a strong negative emotion [and] they don't have a plan how to manage it, then they're at risk." If your child has expressed suicidal thoughts, she advises parents to stay calm and supportive. Instead of freaking out, let the child know he or she can talk to you if he or she needs help. Plan coping strategies you child can utilize to make himself or herself feel better in the event of suicidal thoughts.

Treating Pediatric Depression

If you think your child has depression, should you take him straight to a mental health professional? Not necessarily, Wilens says. A pediatrician or family medical practitioner's office is a good first stepping stone to receiving proper treatment. Not only do parents usually feel more comfortable consulting these doctors first, they can also weed out any psychological or physical problems that might either be masquerading as a depressive episode or complicate treatment. They're also familiar with the child's medical and personal history, which means they'll have a good sense of whether anything's abnormal.

However, the doctor will most likely not diagnose or treat a child for depression. Instead, he or she she will refer your son or daughter to a pediatric psychiatrist or psychologist.

If your child's been diagnosed with depression, what's next? Experts recommend evidence-based therapies such as cognitive behavioral therapy or interpersonal therapy as a first-line method of treatment for mild or moderate depression. However, if symptoms persist with no sign of relief, medication might be necessary.

The jury's still out on how antidepressants affect the developing brain. And experts are quick to mention the black-box warning on selective serotonin re-uptake inhibitor antidepressants. Issued by the Food and Drug Administration in 2004, the warnings inform patients that these medicines are associated with an increased risk of suicidal thinking and behavior in some young people.

However, certain medicines are approved for the treatment of pediatric depression. Each patient's treatment is highly individualized, although studies indicate that a combination of medication and therapy tends to be more effective than therapy or medication alone.

No matter which method of treatment you choose, Miller says, it's important parents are involved every step of the way. Their role is paramount – and not just because they're the ones schlepping the child to doctor's appointments and therapy.

"You really want the parent to be part of treatment, and to buy into what the treatment plan is," Miller says. "If you're deciding to go the medication route, you want everyone to be the same page" in terms of dosage and compliance. "With therapy, you want the parent to reinforce the skills [the child is learning]."

A typical depressive episode lasts about nine months, Schlesinger says. And there's a chance kids can get better without any intervention. "But nine months is a long time for a kid," Schlesinger points out – and you don't want him or her to miss developmental milestones or lose out on any possible benefits of treatment.

Living with Pediatric Depression

How does a parent broach the subject of clinical depression – or even try to describe what it is – to a child? Schlesinger likens it to any other treatable medical illness, such as diabetes or asthma.

"Kids don't have any stigma associated with the word depression. Adults do," Schlesinger says. "I use the word 'depression' [with] them because I want them to know what it is. And I want them to know you can use the word 'illness' [for depression] because they know what illnesses are. They know what a cold is. Even young kids know there are things they can do to stay healthy or get better when they're feeling bad. So I try to use parallels to other things they've experienced and say, 'This is just another illness like that. If you do the right things, you can feel better.'"

Medicines and or/therapy often take a while to work, so tell your child it could take time before he starts to feel better. He might also experience side effects from medication, need to change medications or, in rare instances, stop taking them altogether.

Work in tandem with experts to make sure your child's improving. Doctors recommend adhering to treatments such as medication and therapy until a full remission of symptoms is achieved. Not completing a course of treatment heightens the risk of relapse, and might also contribute to future depressive episodes.

And don't neglect the importance of education, Miller says. "Learn the warning signs and red flags so both you and your children can be aware of what a future depressive episode might look like. This can help you catch it earlier," she advises.

By catching depression early, Wilens says, you can help your child enjoy being a kid. "You have one journey through childhood," he says. "You want that child to enjoy their life.

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