The notion of depression is rather widely known and not only in psychology and medicine but everyday life as well. In this paper we are going to look at the problem in general, give the definition of it, and study the issue in connection with children, its symptoms, causes, treatment, and some cases.
To define the depression, we should mention that this is a kind of mental disorder, mental illness when a person is overwhelmed with unshakable and deep sadness and has little interest in the things around him. The same term is used when we describe some temporary band mood, sadness, loneliness and so on. There are hardly people who have never experienced the depression in a hard or light way. There is another term – major depression, meaning the severe depressions not simply a common feeling of sadness, this one can cause a lot of problems at work and in conduction any social functions.
When we talk about depression we should not consider age, race or economic status of a person; the researchers prove that about 19 million Americans suffer from depression annually. Depression has little to do with the character of a person; this is a kind of medical illness. The good side is that almost all people can be treated for depression if to choose the appropriate method of treatment. Important is to understand the difference between some sadness feelings which can be experienced from time to time by all people because of different reasons from the real long periods of feeling sad and lack of interest to the world.
Depression can influence the thoughts and actions of a person. There is a classification of types of depression:
- atypical depression
- bipolar depression
- endogenous depression
- involutional depression
- reactive depression
- major depression
- primary depression and so on
(Weissman MM, Wolk S, Goldstein RB, et al. (1999)).
Depressed could be adults and children as well. Children and teenagers do experience this kind of illness sometimes. About 5 % of all children suffer from depression at a specified period. Depression also influences the behavior of children, but it can still differ from the behavior of depressed adults.
There are some signs that should make parents aware that their child is under the pressure of depression:
- When a child feels sad often and even cries when a child has little hope
- When a child has little interest in some activities or doesn’t want to return to the activities which used to be interesting for him.
- When a child has little energy and is constantly bored
- When a child is isolated from his peers and doesn’t want to communicate with them
- When the self-esteem of a child is low
- When a child easily get irritated and angry
- When a child often complains of headaches or other physical problems
- When a child can hardly concentrate upon something
- When a child doesn’t want to eat or changes his sleeping habits
- When a child talks about or even makes attempts to run away from home and some other.
Children usually like to play with their peers and their friends; this is not ok if a child refuses to do that and spends most of the time alone. Sometimes parents do not connect the problems of a child’s behavior deviations with his depressed state. Some children, when asked, can say that they are sad or unhappy, but not all of them would confess. The sooner the depression is diagnosed and the sooner the treatment of it is started the better it is for the child’s mental health. The forms of treatment would be looked upon in detail later on in this paper.
Causes of child depression could vary. There is no commonly used test for identifying the depression. Doctors still lack information about the work of the brains and about the causes that make it work not correctly. The medicines against depression were discovered accidentally in 1950 when researchers were looking for the medicine for tuberculosis.
Some children have to face the so-called risk factors that could be the causes of depression. The examples of them would be – illness or loss of parents or other close relatives, early death of parent/parents, divorce and so on. Thus the causes and often the symptoms of depression in children are unique for every child. There are three main types of depression: chemical depression, psychological and a mixed one. It is really important to concretely identify the cause of depression to concentrate on the correct, appropriate treating of it.
Most children with depression have one of the major diagnoses, anxiety disorder, substance abuse, ADHD and some others. ADHD could develop before the depression start and thus brings complications to the treatment process. It is purely individual but in most cases substance abuse stars after the first episode of depression. These conditions could also follow the depressive episodes thus making the child more vulnerable to recurrent depression. If a child suffers from depression together with ADHD or conduct disorder, he is more likely to commit a crime or suicide, than those with pure depression. Depression might result in problems at school and relations with other people. Violent thoughts, early pregnancy, and drugs could also be the results of depressive moods. The suicide attempts are also not rare among children and teenagers with depression; the researches show that since the year 1950 suicide rate increased by 12 %. The risk of suicide is higher by teenager boys, as a result of conduct disorder accompanied by alcohol or drugs. In 1997 suicide was the third cause of the death of people from 10 to 24. Among teenagers who experience depression about 7% are likely to commit suicide. Thus it becomes clear that parents and doctors should react seriously to the words or attempts of suicide. To stop the teenager from doing it is better to start the treatment as soon as possible and to restrain his access to medications, firearms and other risky things.
It often happens so that depressed children have stressed parents. It is still not quite clear whether the child’s depression leads to parents’ stresses or poor parenting results in child’s depression, as all cases are different. Some children are hyperactive, and parents experience a lot of difficulties in coping with them, some parents lack coping skills, in some cases, the irritability of parents does harm to the child’s mental health. There are even cases when a child is genetically vulnerable to depression.
To diagnose the major depression by a child is more difficult that by an adult and it takes more time. During the diagnostic process, the child and his parents are interviewed, it is also better to have both parents present at the interview. By parents it is easier to see the outward signs of depression, children are more aware of inward signs. Sometimes the doctors need school and other outside reports.
To name the main tools for screening children for possible depression, we should mention the Children’s Depression Inventory – for ages between 7 to 17, Beck Depression Inventory – for teenagers, and the Center of Epidemiologic Studies Depression.
Treatment of depression includes short-term psychotherapy, medications, targeted interventions (home and school are as well involved). In most cases, the additional research is needed.
We should look upon each type of treatment in detail. Starting with psychotherapy, we should mention that some types of short-term psychotherapy, for example cognitive – behavioral therapy (CBT) to help with depression cases in children and teenagers. CBT is based on the fact that people with depression have cognitive problems concerning the views of themselves, of the surrounding world and coming future. The time for this kind of therapy is usually limited, and it pays most attention to changing of these distortions. The researchers compared different types of psychotherapy and concluded that CBT is successful in 65 % of all cases when it was used. Whereas family and supportive therapies also do play important roles in treating depressed children.
Another well-known type of psychotherapy is – interpersonal therapy. It concentrates upon the interpersonal relations that contribute to the development of depression. By the time this type was not widely used for teenagers, but some researchers brought positive results.
The special types of psychotherapy are appropriate for several months. It helps to cope with aftereffects of depression and to avoid returning to it.
Another way of treatment is medications. Antidepressant medications as an addition to psychotherapy could bring good results in treating depression in adults. Concerning the usage of medications for children and teenagers there appeared a lot of controversial opinions. Many doctors considered it normal to use medication when treating children from depression; this can be explained by the fact that till recent times there was little information about safety and efficacy of the psychotropic medications for young people. The researchers of the last years show that “some of the newer antidepressant medications, specifically the selective serotonin reuptake inhibitor, have been shown to be safe and efficacious for the short-term treatment of severe and persistent depression in young people, although large-scale studies in clinical populations are still needed” (Kovacs M. (1997)). It is important that there are not studies at the moment that support the efficacy of tricyclic antidepressants for young people.
Doctors should think of the medical treatment of children mostly in cases when there are severe symptoms when psychotherapy would probably be not effective enough when children are not able to undergo psychotherapy when they suffer from psychosis or current episodes. Treatment with medicaments could be prolonged to several months time in the case when there is a high risk or relapse and recurrence of depression.
There is no wonder that parents play a very important role in the process treating the depression in children. Parents are the closest people to a child. Parents should be first of all aware of the problems their child faces being in the depression. Physicians usually talk to parents to provide answers to their questions and concerns. They should inform parents about the ways of treating depression, about the positive results in school and communication with peers this kind of treatment is going to bring and help the parents to do their best to support their child.
To finally clarify the problem of depression in children, we are going to provide several examples of case studies:
- Case #1:
Eddie was a happy and healthy boy until his parents decided to divorce, at that moment he was about 11 years old. After the divorce parents were hostile towards each other. It was certainly a tough situation for Eddie as he wanted the good times of his family to return. Unfortunately that was not possible, and as a result, Eddie started to change as well. He wasn’t interested in his school subjects and work anymore, he looked sad most of the time and often cried. His mother paid attention to the fact that he wasn’t playing with his peers anymore and preferred to stay alone, but still didn’t seem to enjoy anything he was doing. It is clear that Eddie was in depression and needed special help to overcome it and become the same boy he used to be before the divorce.
- Case #2:
Marilyn, she was about nine years old, was always good at school subjects and did like going to school as well. The only problem for her was reading where she needed special help, but she seemed to be a success with this advice. Suddenly, she started to suffer from stomach aches and didn’t go to school often. Parents of the girl saw that she often became irritated and sad. Her mother even heard the girl called herself stupid and dumb. Marilyn was trying to struggle with her disability, but the negative comments of her peers and classmates upset her so much that she became depressed about it. What she needed severely – was her self – esteem, to solve this problem the required girl communication first of all.
- Case #3:
Tom, being at the age of 14 seemed to lose interest in the surrounding world at all. He looked sad and often talked about the feeling of hopelessness. His appetite was poor, and he had problems with sleeping, besides the level of his life energy was rather low. The mother of Tom soon understood what the problem of her son was as she experienced the same feelings when she was depressed. She asked for the professional help of a doctor. As it was already mentioned, some researchers state that there are cases of hereditary depression, maybe Tom’s case was exactly the example of it. The positive moment was that his mother identified the problem soon and the boy received the necessary help before something bad happened to him.
At the end of the work, we consider it necessary to mention some misconceptions about children and depression. It is a usual situation when an adult says: “But what does he/she have to be depressed about?” There are two misconceptions in one question. The first one shows little or lack of understanding of the matter of clinical depression. Clinical depression is far not the same as every day “down” mood or some “blues” that are common to all people from time to time. These are usually the results of unhappy family life or not satisfactory work conditions or any other factors. Clinical depression can also base upon these problems, but it is longer lasting and deeper problem, sometimes even life-threatening. For children it is not always caused by some event or troubles in life, almost all children are worried and concerned about peer acceptance or expectations of their parents. Adult people rarely think about children as having little or even no power to control their lives; this can be frightening and frustrating for them as well.
Overall, in this paper we briefly discussed the matter of depression in general, indicated its common points in comparison to simple bad mood, concentrated upon the problems of children in depression, upon the possible causes and most common symptoms of child’s depression, looked upon the major ways of treatment from depression for children and adults, tried to apply the theoretical material to some practical examples of case studies and at last tried to summarize the most commonly met misconceptions concerning the matter of children in depression.
Having studied all the points we could come to the conclusion that it is essential to pay attention to the behavior and mood of the children in order to help them to avoid or to overcome their psychological difficulties and give them the chance to became useful and appreciated members of the society, with high level of self – esteem. Children can hardly learn how to overcome problems in their life by themselves. They always need the support from adults, mostly from their parents and teachers.
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