For some children, childhood is not a time of carefree, fun-filled days, spent playing and laughing with friends, eating pizza and ice-cream, oblivious to the harsh realities of the outside world. Instead for some, it is a dark and confusing time, filled with tears, frustrations and self-doubt. Paul, a recently recovered major depressive, was diagnosed at thirteen. He says he felt as if he were in a glass box. He could see other children around him having a good time while he felt so unhappy. He felt as if he was trapped. He didn't understand what was happening and just couldn't get out of the box to reach anyone.
Depression is striking more children and adolescents than ever. The American Academy of Child and Adolescent Psychiatry estimates there to be approximately 3,4 million significantly depressed youngsters in America, which is about 5 % of the youth population, which is a percentage that is most likely higher in South Africa. Depression is a life-threatening illness that children and teens are not likely to be able to shrug off that easily. Youngsters who develop depression are three to four times more likely than their peers to abuse drugs and alcohol, and suicide rates for children and teens have tripled in the last four decades. Nearly one out of ten children, who develop major depression before puberty, go on to commit suicide.
Mental health experts have implicated rapidly changing social conditions as one of the reasons for this increase in depression amongst children. "Children today have fewer emotional anchors", states Frederick Goodwin, a psychiatry professor at George Washington University and a past director of the American National Institute of Mental Health. He also states that over the past thirty years, there has been a decline in the amount of time parents spend with their children, and as a result children are receiving less support from home. In the past, grandparents either lived nearby or with the family, and the average time a family lived in a neighbourhood was 21 years, so naturally there was also a lot more support from extended family and neighbourhood friends.
Divorce has also been on the rise in recent years, and it has become a well-known fact that children with divorced parents or parents in conflict are more likely to suffer from depression. Children are also far less protected than they used to be. Thanks to increased violence on t.v., international news coverage of conflicts all over the world, and the internet, children are exposed at an earlier age to the grim realities of war and suffering. For some this can lead to increased anxiety and depression, which leaves them feeling helpless and hopeless.
This leads us to the question - So what do I do if my child is depressed? Recently medication seems to have become the popular choice. In the United States alone, at least half a million children and adolescents are estimated to be taking prescription antidepressants. The problem is that these drugs have not been approved for use in children by the FDA (Food and Drug Administration). Even so, it is legal for children to get the antidepressants because they have been approved for adults and can be prescribed "off label" for children.
So far, only one major study has been published on the effectiveness of the newer antidepressants, the SSRIs, in the treatment of childhood depression. It was found that some children did indeed benefit, but that they are no miracle cure. After eight weeks, 56 % of the children on Prozac improved and 31 % got total symptom relief.
At the moment, a debate rages between professionals as to the pros and cons of medicating children. Some doctors firmly believe that antidepressants can vault children out of crises, especially those who have a significant family history of depression or those with physical symptoms. But other professionals are a little more skeptical. They feel that too many doctors with no psychiatric experience are prescribing antidepressants for children, despite insufficient knowledge and training about childhood depression and certain drug interactions. They feel it should be remembered that children are not miniature adults. They are going through a lot more physiological changes that probably make them more vulnerable to the effects of drugs. Thomas Laughren, the director of the FDA team that approves drugs, states: "The most popular drugs alter the brain chemistry, and the long-term effects of doing so are unknown. We just don't have enough information to draw the conclusion that they're safe and effective for children."
Other professionals feel that merely prescribing a drug is a superficial or cosmetic approach to dealing with childhood depression. They feel that this does not get at the underlying cause or teach children different ways of approaching the world to prevent depression in the future. Others worry that rushing in too soon with drugs may artificially "short-circuit" the grieving process, which may be important for a child to work through, for example, after something like a divorce.
The solution to this problem seems to require the use of common sense and the consideration of alternative treatments, to be used either in conjunction with medication, or in place of it. Obviously if a child is so overwhelmed that they can't function, or the cause of the depression is undoubtedly a physical problem, like a thyroid disorder, they need medication, but there are also other treatments like therapy that need to be looked at. Studies have shown cognitive-behavioural therapy to be an effective option. This therapy works on changing the way the child views, thinks about and interacts with the world. Therapies that involve the family have also been found to be very beneficial. Support groups can also help combat the feelings of isolation and helplessness that these children and their families experience. It is recommended that sufferers and their families find out all they can about the disorder, to ensure the most effective treatment, which seems in most cases to be a combination of therapy and medication.
There are a number of signs that can be used to identify whether your child or teen is depressed:*
INFANTS AND TODDLERS
§ Failure to grow and thrive
§ Decreased pleasure in activities that should interest a child of this age
§ Lack of social interest
§ Little motor activity
§ Excessive whining or crying, or too little crying
§ Sad or deadpan facial expression, voicing sadness
§ Frequent, unexplained stomachaches, headaches and fatigue
§ Overactivity, excessive restlessness
§ Irritability or low tolerance for frustration
§ Frequent sadness
§ Loss of pleasure in previously enjoyable activities
§ Frequent, unexplained physical complaints
§ Expressions of sadness, or morbid and suicidal thought
§ Changes in sleep patterns or significant weight loss or gain
§ Tearfulness, frequent worrying or low self-esteem
§ Unprovoked hostility or aggressive behaviour
§ Drop in Marks, or refusal or reluctance to attend school
§ Little interest in playing with peers
§ Drop in marks or behaviour problems at school
§ Fatigue, or sleep pattern changes
§ Social isolation, anti-social or delinquent behaviour
§ Feelings of sadness, suicidal thoughts or actions
§ Inattention to appearance
§ Extreme sensitivity to rejection or failure, low self-esteem
§ Eating-related problems
§ Loss of enjoyment in previously pleasurable activities
*Taken from "Help me, I'm Sad: Recognizing, Treating and Preventing Childhood and Adolescent Depression" by David G. Fassler M.D. and Lynne S. Dumas