Depression in Children and Adolescents

Are our children depressed?  About 11 percent of adolescents have a depressive disorder by age 18 according to the National Comorbidity Survey. Girls are more likely than boys to experience depression. The risk for depression increases as a child gets older. According to the World Health Organization, major depressive disorder is the leading cause of disability among Americans age 15 to 44. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child who shows changes in behavior is just going through a temporary “phase” or is suffering from depression.

Yesterday

  • People believed that children could not get depression. Teens with depression were often dismissed as being moody or difficult.
  • It wasn’t known that having depression can increase a person’s risk for heart disease, diabetes, and other diseases.
  • Today’s most commonly used type of antidepressant medications did not exist. Selective serotonin reuptake inhibitors (SSRIs) resulted from the work of the late researcher Julius Axelrod, who defined the action of brain chemicals (neurotransmitters) in mood disorders.

Today

  • We now know that youth who have depression may show signs that are slightly different from the typical adult symptoms of depression. Children who are depressed may complain of feeling sick, refuse to go to school, cling to a parent or caregiver, or worry excessively that a parent may die. Older children and teens may sulk, get into trouble at school, be negative or grouchy, or feel misunderstood.
  • Findings from large-scale trials are helping doctors and their patients make better individual treatment decisions. For example, the Treatment for Adolescents with Depression Study found that combination treatment of medication and psychotherapy works best for most teens with depression.
  • The Treatment of SSRI-resistant Depression in Adolescents study found that teens who did not respond to a first antidepressant medication are more likely to get better if they switch to a treatment that includes both medication and psychotherapy.
  • The Treatment of Adolescent Suicide Attempters study found that a new treatment approach that includes medication plus a specialized psychotherapy designed specifically to reduce suicidal thinking and behavior may reduce suicide attempts in severely depressed teens.
  • Depressed teens with coexisting disorders such as substance abuse problems are less likely to respond to treatment for depression. Studies focusing on conditions that frequently co-occur and how they affect one another may lead to more targeted screening tools and interventions
  • Although antidepressants are generally safe, the U.S. Food and Drug Administration has placed a warning label on all antidepressant medications. The warning says there is an increased risk of suicidal thinking or attempts in youth taking antidepressants. Youth and young adults should be closely monitored especially during initial weeks of treatment.
  • Studies focusing on depression in teens and children are pinpointing factors that appear to influence risk, treatment response, and recovery. Given the chronic nature of depression, effective intervention early in life may help reduce future burden and disability.
  • Multi-generational studies have revealed a link between depression that runs in families and changes in brain structure and function. This research is helping to identify early indicators that may lead to better treatment or prevention.

Keep in Mind

With medication, psychotherapy, or combined treatment, most youth with depression can be effectively treated. Youth are more likely to respond to treatment if they receive it early in the course of their illness.

 

Source: National Institute of Mental Health http://www.nimh.nih.gov

 

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