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CHILDREN'S SERVICES
Teen Depression
| If you would like to receive a DVD or VHS on Teenage Depression, please contact Joanne King at: |
| Phone: 401-724-8400 ext. 236 |
Email: jking@gatewayhealth.org |
Click here to view the Teen Depression video.
What is depression?
Depression is a disorder characterized by persistent depressed (sad)
mood which may last months or even years. It can occur at any age
through the lifespan.
We do not yet completely understand the processes in the brain and
the mind that lead to or sustain a depression. Some people seem
to be a greater genetic risk for depression than others, just like
some people are at greater genetic risk for hypertension, obesity,
adult-onset diabetes and other "complex" genetic disorders
(disorders where the risk is associated with a number of genes each
of which somewhat increase the risk rather than diseases associated
with a single gene which "causes" the disease). Environmental
factors on average have about as much influence on who gets a depression
as do genetic factors. Again, this makes depression almost exactly
like other similar "complex" genetic disorders with strong
environmental contributions (e.g. hypertension, obesity, adult-onset
diabetes). Adverse life stresses, perhaps particularly interpersonal
"loss" events (e.g. death of a parent) increase the hazard
for a depression.
What are the different kinds of depression?
Many classification systems have been proposed for depression. However,
there is overwhelming evidence for at least two distinct type of
depression:
1. Unipolar Depression
2. Bipolar Disorder or Manic Depressive Disorder
Unipolar depression consists of one
or more episodes of moderate to severe depression with persistent
depressed mood and other symptoms of depression including suicidal
ideation, suicide attempts, inability to experience pleasure when
doing normally pleasurable activities, impaired concentration,
change in appetite, change in weight, difficulty sleeping, and/or
increased sleep. The disorder is usually recurrent - if you get
it once you are likely to get it again in the future.
Bipolar disorder is characterized by
periods of depression essentially identical to that seen in unipolar
depression and periods of euphoric (too happy) or extremely irritable
mood at the same time as the person has other symptoms of mania
including much less need for sleep, very rapid speech, dramatic
increase in activities, hypersexuality, and/or "racing"
(very rapid and confused) thoughts.
How often do children get depression?
About 2% of school-age children (i.e. children 6-12 years of age)
appear to have a major depression at any one time. With puberty,
the rate of depression increase to about 4% major depression overall.
With adolescence, girls, for the first time, have a higher rate of
depression than boys. This greater risk for depression in women persists
for the rest of life. Depression is diagnosable before school age
(e.g. ages 2-5) where it is somewhat more rare but definitely
occurs. Overall, approximately 20% of youth will have one or more
episodes of major depression by the time they become adults.
Do children with depression need treatment? Will
they just "grow out of it"?
Episodes of depression in children appear to last 6-9 months on average
but in some children they last for years at a time. When children
are in an episode they do less well at school, have impaired relationships
with their friends and family, suffer inside, and have an increased
risk for attempted and completed suicide. Because there are effective
treatments, to ignore it and hope for the best while the child suffers
is not a reasonable approach.
How can you
tell if your child is depressed?
Signs that frequently help parents or others know that a child should
be evaluated for depression include: the child talking about feeling
persistently sad or blue, the child who talks about suicide or being
better off dead, the child who is suddenly much more irritable, has
a marked deterioration in school or home functioning, or no longer
engages in previously pleasurable social interactions with friends.
Because the depressed child may not show significant behavioral disturbance,
sometimes parents "hope for the best" or fail to get a child
evaluated who shows signs of suffering internally but not disrupting
the family.
What Are the Symptoms of Depression?**
These are some symptoms that people have when they're depressed:
- depressed mood or sadness most of the time (for what may seem
like no reason)
- lack of energy and feeling tired all the time
- inability to enjoy things that used to bring pleasure
- withdrawal from friends and family
- irritability, anger, or anxiety
- inability to concentrate
- significant weight loss or gain
- significant change in sleep patterns (inability to fall asleep,
stay asleep, or get up in the morning)
- feelings of guilt or worthlessness
- aches and pains (even though nothing is physically wrong)
- pessimism and indifference (not caring about anything in the
present or future)
- thoughts of death or suicide
What are the treatments for depressed children and adolescents?
There are two main groups of treatments for the depressed child
with demonstrated evidence of efficacy:
1. Psychotherapy
2. Pharmacotherapy
Because the course of major depression is fluctuating and because
there is a general positive effect on the child (or adult) with
depression just from the process of seeing and talking with another
caring individual about their depression, to say that a treatment
is effective we require that it work better than non-specific
psychotherapy (e.g. talking to a nice and empathic person) in
the case of psychotherapies or placebo medication pills given
by a warm and friendly person in the case of pharmacotherapies.
Thus, the treatments described below have an additional specific
effect as well as all the benefit of the human contact and non-specific
discussion of the depression. These are the best we know how to
do at present.
The two different specific psychotherapies which show efficacy
in children and/or adolescents are cognitive behavioral therapy
(CBT) and interpersonal therapy (IPT). CBT concentrates on changing
the negative attributional bias (seeing every cup as half-empty)
associated with major depression.
Despite a number of studies, there is essentially no evidence
to suggest that older-generation tricyclic antidepressants (e.g.
Tofranil, Elavil) work for depression in children or adolescents.
There are published studies finding efficacy for two SSRIs, fluoxetine
(Prozac) and sertraline (Zoloft), in child and adolescent depression.
There are ongoing studies and studies which are completed and
have been presented at national meetings but not yet published
for other antidepressants in child and adolescent major depression.
Some of these studies are positive and others have failed to show
efficacy (though individual studies frequently fail to find evidence
of efficacy even for known effective treatments because of simple
bad luck-studies are mathematically much more informative if positive
than if negative).
In the middle of 2003 there were FDA (for paroxetine) and pharmaceutical
company (for venlafaxine) reports of low but increased rates of
impulsive/suicidal behaviors in depressed youth randomized to
those active compounds when compared to depressed youth randomized
to placebo in the same studies. While there were no completed
suicides in these studies in any group, these findings are worrisome
and demand increased attention to the question of whether or not
some antidepressants may increase the hazard of suicide. At present,
the data necessary to understand these studies has not been published
or released to the field.
OK, what is the right treatment for my depressed child?
Given that both psychotherapeutic and pharmacological approaches have
demonstrated efficacy, what is the right treatment for a particular
child? Ultimately, we don't have the answer to that question yet though
there are two large ongoing multi-site studies which will help us.
When considering monotherapy with either talking or pharmacological
approaches we do know that all of these approaches have something
like a 60% good to excellent clinical response rate which means that
many youth do not respond or do not respond adequately to the first
treatment and will require augmentation or change of treatment.
Therefore, the youth, family, and clinician should together choose
a first treatment that seems best for that individual and give that
treatment an adequate trial (e.g. 8-12 weeks). At the end of that
time if the treatment isn't working, it should be changed -- try the
treatment for at least two to three months but no longer before evaluating
it and modifying or completely scrapping as indicated by the progress.
How long should my child stay on treatment?
Medications are typically continued at least 6 months after response
before tapering off. Many therapists will decrease the frequency of
session but continue some maintenance therapy longer than the initial
8 to 12 weeks of treatment. Treatment for a first episode of depression
is likely to last at least 6 to 12 months with either treatment.
For recurring depression, many clinicians will maintain prophylactic
treatment for considerably longer periods (e.g. years).
| If you would like to receive a DVD or VHS on Teenage Depression, please contact Joanne King at: |
| Phone: 401-724-8400 ext. 236 |
Email: jking@gatewayhealth.org |
*Source: NAMI
(www.nami.org)
**Source: www.kidshealth.org
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