Q. What is depression ?
The mind of an individual is a complex function of different faculties which includes the way an individual thinks, feels and perceives self and the surroundings. Disorder of one may lead to disorder of the other. Essentially, depression is disorder of mood where the person is sad, gloomy, does not enjoy habitually pleasurable activities or may complain of a flat mood. The person may have diminished interest in all activities. Associated with this, the person will have early morning awakening, increase or decrease in appetite, some body dysfunctions and difficulty in thinking clearly. His mind & body will move slowly. Children and adolescents like adults are prone to suicide.
Q. What are the causes of depression ?
Both psychosocial factors (it acts as a seed) and genetic vulnerability (it acts as the soil in which the seed germinates) are responsible for the occurrence of depression. Any negative life event would be depressing. Depending upon the inherent strength (i.e. the ability to get over depression), an individual gets depressed or recovers.
Q. How is depression different in a younger child and in a teenager ?
Teens present with a change in mood, which they may express. They may become irritable and aggressive. Teens are vulnerable to alcohol and sleeping pill use as self-devised antidepressant therapy.
Younger children present with problems in relationships. They may tend to cling to the parents, may have change in sleep & food habits, may show falling school grades. They may be excessively submissive or aggressive in behavior and suffer from non-specific body aches and pains.
Other symptoms seen in a patient of depression are :-
- Sense of worthlessness Sense of worthlessness
- Sense of guilt/self reproach Sense of guilt/self reproach
- Easy fatigability
- Inability to concentrate Inability to concentrate
Q. My 9 years old child has recently started eating and sleeping excessively. My doctor says that he is suffering from depression. However, I have never seen him depressed, sad or crying. How is it possible that he is suffering from depression ?
Depression can be a symptom, a disorder by itself or part of a disorder. Manifestation of depression in a child depends on the age of the child.
In children, abnormal behavior, abnormal sleep rhythms, abnormal food habits, irritability, destructive behavior, poor attention or multiple vague illness (like recurrent chest infection, not gaining weight, and crankiness) may denote depression.
Precise manifestation depends on the age, pattern of family behavior and other contributory factors. The child may adopt symptoms of an illness that some person in the neighborhood may have suffered .
Q. Is depression common in children? I thought only adult suffered from depression?
Depression is seen at all ages. In fact, the first peak is seen in adolescents. There is a frightful rise in adolescent suicides. Suffering from depression may be an important cause. Second peak is seen in midlife. After the age of sixty years, the incidence of depression increases per every decade.
Q. How does depression occur?
Depression is a biochemical disorder. Changes in body biochemistry essentially affect particular chemicals in the brain called the serotonin and norepinephrine. Hence, antidepressants (drugs which modify serotonin and norepinephrine levels in the brain) are the treatment of choice.
Psychosocial factors may trigger the imbalance, exacerbate the disorder or perpetuate the illness.
Q. Is depression recurrent ?
Yes, depression is known to be a recurrent illness.
Q. Is it possible that a child who has suffered from depression may also suffer from depression as an adult ?
It is quite likely that such a child may suffer from depression in adulthood.
Q. What is the treatment of depression?
Treatment of depression depends on 3 major factors :-
- Treatment of acute episode
- Prevention of recurrence.
It can also be divided into drug therapy and non-drug therapy.
Drug therapy: They are known as antidepressants. There are several groups of antidepressants available. Their side effects vary. The older drugs cause dryness of mouth, constipation, blurring of vision and cause an adverse effect on the heart. The newer drugs have lesser side effects but may cause acidity, restlessness and loss of sleep. [The older drugs are imipramine, amitriptyline, dothiepin, doxepin, mianserin, clomipramine. The newer ones are fluoxetine, fluvoxamine, tianeptine, venlafaxine, paroxetine].
Caution: Benzodiazepines should not be used as antidepressants. They can be dangerous. They may lead to addiction, memory difficulties and may facilitate suicidal behavior.
Non-drug treatment: It consists of cognitive therapy where the patient's mind frame is changed so that the patients does not respond to stress or any other negative influence with depression. In children, family therapy may be an essential part of depression. A functionally broken home breeds mental dysfunction in children. The child may feel in secure, misunderstood and not taken cared for. This might prompt the child to become rebellious.
Advice to parents:
- Child sees the parents as one unit. Any breakup may lead to insecurity. The parents should not have any dispute in presence of children and it should be settled before it percolates down to the children.
- Avoid conflicting instructions.
- "PRACTICE WHAT YOU PREACH AND PREACH WHAT YOU PRACTICE".
- Don't do what you would not accept your child doing like smoking, drinking, quarreling.
- Set an example to children through personal behavior.
Q. What are the complications of depression?
Suicide is one of the major problem of depression. Anxiety, alcohol & substance abuse and difficulty in interpersonal relationships and sexual life are other problems of depression. Elderly depressed and chemically depressed are known to experience memory difficulties
PREVENTION OF RECURRENCE
To prevent recurrence of depression, mood stabilizer drugs like lithium, Carbamazepine, Na Valproate, Lamotrigine and other newer antiepileptics may be given for a long time. They should always be given under a doctor's guidance. Thyroid hormones may also be used in treatment of resistant depression.
Always follow the policy of start low & go-slow. The patients should engage in neutral, non-stressing environments, sports. The patient should not be a loner and should not bottle emotions. Guilt and negative emotions should be resolved.
DEPRESSION IN ADOLESCENTSDepressed children may behave differently as compared to depressed adults. Help should be seeked if following signs persist-
- Frequent sadness and crying
- Feeling of hopelessness
- Disinterested in surrounding with persistent boredom
- Low energy and easy fatigability
- Avoids friends and social contact
- Poor self esteem
- Frequent complaints of aches in the body
- Falling grades and poor performance in school
- Inability to concentrate
- Increased / Decreased appetite
- Increased / Decreased sleep.
- Runs away from home
- Thoughts of suicide
- May abuse alcohol or drugs to feel better.
Children under stress and those having ADHD, conduct disorders and learning disabilities are more prove to depression. Depression may also run in families. Troublesome behavior is a sign of depression and parents may not realize it as the teenager may not appear sad.
SuicideSuicide among younger generation is increasing in recent years. Teens who are thrown towards suicide are under lot of stress, confusion, low self-esteem, pressure to avoid failure (especially in children appearing for exams) and others fears while growing up. Sometimes infatuation and violence may provoke a teen into committing suicide and violence to others.
Warning signs of a child who may try to commit suicide:
- Teen having a low self esteem and self doubts
- Teen making statements like "I won't be here to trouble you much longer"
- Puts all his work in order for e.g. cleans his room, gives away precious
- Sudden cheerfulness after a period of depression
- Teen having bizarre thoughts.
Teenagers prone to suicide are:
- Teens on drugs and alcohol abuse
- Rebellious teens (running away from home, violent behavior)
- Teens having marked depression
- Teens with high family pressure to succeed.
Always take the statement made by the child of killing oneself seriously and seek evaluation from a doctor. With strong family support and professional treatment, teenagers who are suicidal can be turned to a more healthy way of development.