Childhood Depression

Characteristics A prolonged unhappy or irritable mood Change of attitude toward family, friends, life Marked change in eating and sleeping habits Develops slowly unless reactive Lasts from a few weeks to years or permanent Is associated with suicide.

Mood Mood disturbance: cannot ‘snap out of it’ unhappy, tearful pessimistic, negative self destructive hypersensitive, irritable may look ill, lack ‘bounce’ writes poetry with morbid themes may claim being ‘bored’

Cause unknown in most cases Physical / Genetic Change in the concentration of neurotransmitters. Reduced serotonin, Increased 5-hydroxytryptamine 2 (5- HT2), abnormal noradrenergic activity Linked to a family history, illness occurs earlier when family history, highest where an identical twin commits suicide   Psychological factors: learning difficulties excessive sense of responsibility for others excessive sensitivity, ego vulnerability low self esteem, poor body image internal locus of control for -ve outcomes external locus for +ve outcomes Environmental factors (reactive) war and social instability death of a loved one rape, injury, chronic illness family problems (violence, drug abuse, divorce), dysfunctional family poor school experience (bullying)

Diagnosis May be under-diagnosed in UK Children sometimes unable to express how they feel Misdiagnosed as conduct disorder May be masked by co-existing mental illness

Signs Low self esteem worthless, useless, stupid, ugly, running away, hate themsleves Doesn’t care what happens to him / her No interest in doing well Sleep problems (usually sleeping less) all night TV watching difficulty in getting up in the morning Food problems anorexia bulimia

School poor concentration dropped performance lost interest truancy disruptive suicide threats Problems with friends Losing friends Lonely Lack of interest in usual activities.

Suicide Serious risk in children and adolescents Management Naïve methods should be taken seriously He may do better next time Serious risk in children and adolescents 2000 annually in US, increasing Most in adolescence and young adults Peak incidence 15 years Boys > Girls [3:1] (but <girls have depression and suicide attempts [9:1])   Commonest methods: Females: Overdose, Wrist cutting Males: Gunshot (US), Hanging

Risk factors (suicide) drug and alcohol misuse availability of guns (US) homosexuality child abuse family history personal crisis family conflict life change mental illness serious chronic illness

Treatment Selective serotonin re-uptake inhibitors (SSRIs, Prozac) Psychotherapy Active listening Advice and encouragement Family therapy Treatment of co-existing conditions

Treatment Poorly organised in this country (? better in US) Stigma of treatment Effective?? No fast cure Cause and pathology not understood Some drugs may be useful (also dangerous) Range of treatments indicate lack of effectiveness Society lacks ‘someone to talk to’ Stressors that may not seem important to an adult may be significant to a young person

Further reading Brown, H., N. Pearson, et al. (2013). "Physical Activity Interventions and Depression in Children and Adolescents." Sports Medicine 43(3): 195-206. Davis, N. M. (2005). "Depression in children and adolescents." Journal of School Nursing (Allen Press Publishing Services Inc.) 21(6): 311-317. Greenberg, B. R. (2009). "How to recognize depressive disorders in children and adolescents." JAAPA: Journal of the American Academy of Physician Assistants (Haymarket Media, Inc.) 22(3): 38- 42. Murphy, K. (2004). "Recognizing depression in children." Nurse Practitioner 29(9): 18. PaixÃO, M. J. G. (2013). "Systematic review summary - Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents." Singapore Nursing Journal 40(3): 50-52. Pilcher, E. (2008). "Childhood depression in contemporary Australian society." Nuritinga(9): 1-9. Thomas, S. P. (2012). "Preventing Childhood Depression." Issues in Mental Health Nursing 33(5): 271-271. van der Veek, S. M. C., R. A. Nobel, et al. (2012). "The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression." Psychology & Health 27(11): 1359-1374.