Depression

Depressive disorders come in different forms, just as in the case with other illnesses such as severity, and persistence.

Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

Dysthymia. A less severe type of depression, dysthymia, involves long-term, chronic symptoms that are not disabling, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Bipolar disorder.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycles or episodes of mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed episode, an individual can have any or all of the symptoms of a depressive disorder. When in the manic episode, the individual may be overactive, over talkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes. Mania, left untreated, may worsen to what is called psychosis, or the loss of touch with reality and associated hallucinations or delusions.

Depressive illness in children and adolescents includes a group of symptoms which have persisted for at least two weeks, including several of the following:

• Sadness
• Irritability
• Significant change of appetite
• Change in sleeping patterns (such as trouble falling asleep, waking up in the middle of the night, early morning awakening, or sleeping too much)
• Loss of interest in activities formerly enjoyed
• Loss of energy, fatigue, feeling slowed down for no reason, "burned out"
• Feelings of guilt and self blame for things that are not one's fault
• Inability to concentrate and indecisiveness
• Feelings of hopelessness and helplessness
• Recurring thought of death and suicide, wishing to die, or attempting suicide

Children and adolescents with depression may also have vague, non-specific physical complaints (stomachaches, headaches, etc.). There is a greater likelihood of depressive illness in the children of parents with significant depression.

In children, depressive symptoms may be less noticeable by their parents, teachers and others, since children may not be able to express their feelings in the same way as adults. So for them, symptoms may be evidenced by changes in the following:

• grades or attendance at school
• relationships with your family and friends
• alcohol, drugs, or sex

The good news is that you can get treatment and feel better soon. Approximately 4% of adolescents get seriously depressed each year. Clinical Depression is a serious illness that can affect anybody. It can affect thoughts, feelings, behavior, and overall health.

Most people with depression can be helped with treatment. But a majority of depressed children and adolescents never get the help they need. And, when depression isn't treated, it can get worse, last longer, and prevent this youngster from getting the most out of this important time in life.

Myths about depression often prevent people from doing the right thing. Some common myths are

• MYTH: It's normal for teenagers to be moody; Teens don't suffer from "real" depression.
• FACT: Depression is more than just being moody. And it can affect people at any age, including teenagers.
• MYTH: Telling an adult that a friend might be depressed is betraying a trust. If someone wants help, he or she will get it.
• FACT: Depression, which saps energy and self-esteem, interferes with a person's ability or wish to get help. It is an act of true friendship to share your concerns with an adult who can help.
• MYTH: Talking about depression only makes it worse.
• FACT: Talking through feelings with a good friend is often a helpful first step. Friendship, concern, and support can provide the encouragement to talk to a parent or other trusted adult about getting evaluated for depression.

WHAT CAUSES DEPRESSION?

Genetic. Some types of depression, such as bipolar disorder or early onset depressive disorder, run in families, suggesting that a vulnerability to developing depression can be inherited. For example, studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, not everyone with the genetic makeup that causes vulnerability to depression will develop the illness. Quite possibly, additional factors such as trauma, loss of a loved one, early perinatal difficulties, or stresses at school or home may involved in its onset.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

Physical Health. In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder.

Emotion/Personality. People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

DIAGNOSIS

Only in the past two decades has depression in children been taken very seriously. The depressed child may pretend to be sick, refuse to go to school, cling to a parent, or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, grouchy, and feel misunderstood. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary "phase" or is suffering from depression. Sometimes the parents become worried about how the child's behavior has changed, or a teacher notices a change in behavior. In such a case, a visit to the child's pediatrician is in order.

Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression, and the physician should rule out these possibilities through examination, interview, and lab tests. If a physical cause for the depression is ruled out, a psychiatric and psychological evaluation should be done, usually by a child psychiatrist, general psychiatrist or psychologist.

A good diagnostic evaluation will include a complete history of symptoms, i.e., when they started, how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and what treatment was given. The doctor should ask about alcohol and drug use, and if the patient has thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness and, if treated, what treatments they may have received and which were effective.

Last, a diagnostic evaluation should include a "mental status examination" to determine if speech or thought patterns or memory have been affected, as sometimes happens in the case of a depressive or manic-depressive illness.

If treatment is needed, the doctor may suggest that a therapist, social worker or psychologist provide therapy while the psychiatrist will oversee medication if it is needed. Parents should not be afraid to ask questions: What are the therapist's qualifications? What kind of therapy will the child have? Will the family as a whole participate in therapy? Will the child's therapy include an antidepressant? If so, what might the side effects be?

PUBLICATIONS

BOOKS FOR FURTHER READING

Cobain, Bev, When Nothing Matters Anymore: A Survival Guide for Depressed Teens. 1998, Free Spirit Publishing, Inc.

Copeland, Mary Ellen and Copans, Stuart. The Adolescent Depression Workbook1998 Peach Press. .

Fassler, M.D., David, and Dumas, Lynne S. Help Me, I'm Sad: Recognizing, treating, and preventing childhood and adolescent depression 1997, Penguin Putnam, Inc. .

Ingersoll, Barbara and Sam Goldstein. Lonely, Sad, and Angry: A Parent's Guide to Depression in Children and Adolescents. 1995, Bantam Doubleday Dell Publishing Group.

SCIENTIFIC PUBLICATIONS

Winter LB, Steer RA, Jones-Hicks L, Beck AT: "Screening for major depression disorders in adolescent medical outpatients with the Beck Depression Inventory for Primary Care." J Adolesc Health 1999 Jun;24(6):389-94 .

Emslie GJ, Walkup JT, Pliszka SR, Ernst M: "Nontricyclic antidepressants: current trends in children and adolescents." J Am Acad Child Adolesc Psychiatry 1999 May;38(5):517-28

Schatzberg AF: "Antidepressant effectiveness in severe depression and melancholia." J Clin Psychiatry 1999;60 Suppl 4:14-21; discussion 22. .

Montgomery SA, Kasper S: "Depression: a long-term illness and its treatment." Int Clin Psychopharmacol 1998 Jul;13 Suppl 6:S23-6 .

For further research: www.ncbi.nlm.nih.gov/PubMed/.

ON THE WEB

http://www.nami.org/helpline/depression-child.html

http://www.nimh.nih.gov/depression

http://www.nimh.nih.gov/publicat/depchildmenu.cfm

http://www.nimh.nih.gov/publicat/depresfact.cfm

http://www.nimh.nih.gov/publicat/depchildresfact.cfm

http://www.aacap.org

http://www.aacap.org/publications/dprchild/index.htm

http://www.drkoop.com/wellness/mental_health/depression

SUPPORT GROUPS AND ORGANIZATIONS

Child & Adolescent Bipolar Foundation
1187 Wilmette Ave.
P.M.B. #331
Wilmette, IL 6009l
Fax (847) 920-9498
Website: www.bpkids.org

NAMI The Nation's Voice on Mental Illness
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
Helpline: (800) 950-NAMI (6264)
Tel: 703-524-7600
Fax: 703-524-9094
Website: www.nami.org

National Depressive and Manic Depressive Association
730 North Franklin Street, Suite 501
Chicago, IL 60610
1-800-826-DMDA (3632)

National Foundation for Depressive Illness, Inc.
P.O. Box 2257
New York, NY 10016
1-212-268-4260; 1-800-239-1265
Website: www.depression.org

National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
1-800-969-NMHA (6942)

National Institute of Mental Health
NIMH Public Inquiries
6001 Executive Boulevard, Rm. 8184, MSC 9663
Bethesda, MD 20892-9663 U.S.A.
Voice (301) 443-4513
Fax (301) 443-4279
Website: www.nimh.nih.gov