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Depression: Not Just for Adults

Children can often be miserable, tearful and down in the dumps; mood swings and mini traumas are all part of growing up. But is your child just sad… or depressed?

Ellen Beardmore tackles the argument that modern life is making our kid’s lives a misery

As much as every parent tries to protect their child, a rise in academic testing, building pressure to succeed from a young age and the disintegration of traditional family life means many think today’s youths are the most stressed out and sad generation yet.

Recent media reports, medical authorities and concerned parents suggest that today’s society is making the children of today depressed. Alarmingly, theses suggestions have been backed up by several disturbing study results. These statistics reveal that depressive illness occurs in two to four per cent of children, although less so in those under eight years of age.

David Cottrell, professor of child and adolescent psychiatry at Leeds University, co-wrote the guidelines on depression in children for special health authority NICE in September 2005. He believes that childhood depression is not on the increase, but that the illness is simply being recognised more as people become aware of its actual existence.

He says: “Depression has always affected children, but what is happening is we’re getting better at thinking about depression and training people to recognize, diagnose and treat it as a genuine illness.” 

Causes.
As is the case with adult sufferers, diagnosis of depression in children is not as straightforward as with other ailments and it can be difficult to pinpoint a specific cause. Every child’s depression is different, and will have an individual reason behind it. But children do have certain risk factors in their lives which typically trigger mental health problems.  
These include traumatic changes such as the bereavement, or loss of a loved one, moving home, divorce or splitting up of a family, as well as bullying, social exclusion, pressure at school, neglect or dealing with new siblings and lifestyles.  
There can also be a genetic link, meaning that depression is thought to be passed on throughout families and if a parent suffers with the illness, there is a chance their child could too. Sometimes - although more so in adults - depression can also develop with no clear reason, and experts have argued that depression may be wholly chemical in some people.  

Signs
  • Becoming sad, easily upset or withdrawn and irritable.
  • Avoiding friends, family as well as normal or regular activities and hobbies.
  • Being self-critical, feeling guilty and miserable for most of the time.
  • Feeling tired and having concentration difficulties.
  • Ignoring appearance and hygiene.
  • Feeling helpless and hopeless.
  • Being uninterested in life, attempting to run away or self harm.
  • Thinking and speaking about death often, especially in younger children.
 Sufferers identifying with two or more of the above symptoms would be classed as having mild depression. For those recognising five symptoms, that level rises to moderate and for seven or more the illness would be rated as severe.  But some of them are also associated with other conditions such as glandular fever, sleep apnoea and thyroid gland conditions which make the afflicted feel low or miserable. Health professionals will be able to help diagnose what the symptoms are a result of. 

Effects
The knock-on effects depression can have are far reaching, but they also go hand in hand with growing up, which means that they often go uncommented on and unnoticed. Child sufferers typically stop to care about their performance at school, or at other activities and change their personal hygiene and appearance routines.
Their behaviour could become defiant or destructive while they may start having hallucinations or voicing peculiar beliefs. In severe cases, sufferers may run away, start to self harm, abuse alcohol or drugs and attempt to, or commit suicide. 

Getting help
It is important to listen to what children say about how they feel and provide caring support. Trying to get the child involved in regular activities will also help them feel more confident and happy, especially those which involve team games, sports or exercise. If depressive symptoms last longer than a few days, make an appointment with your GP.
They will be able to talk to your child, run tests and make a diagnosis before outlining the different kinds of help available or refer them for treatment. Increasing numbers of teachers, special needs coordinators and school counsellors are also trained to help children with mental health difficulties, and can be an excellent support outside the home. 
Once diagnosed, sufferers are usually referred to child and adolescent mental health services (CAMHS) in hospitals. Waiting lists for these can be lengthy, but many GPs now have practice counsellors who can help young people address some of the issues worrying them. 

Treatment
Treatment for depression in children and young people may involve short-term psychotherapy, medication or a combination of the two.
For mild to moderate cases, certain types of short-term psychotherapy, particularly cognitive behaviour therapy (CBT) can alleviate depression in children and teenagers. CBT and other psychotherapies are often called “talking treatments” because they aim to help sufferers understand and change negative attitudes they hold, as well as think positively again by working through any issues.

Talking treatments are provided by professionals such as clinical psychologists, psychiatrists, nurses, counsellors or social workers who have been specially trained in this kind of approach. The therapist will assess your child’s suitability before treatment takes place. Usually, the sufferer will identify goals they wish to achieve, such as smiling more, or enjoying football, before working out a strategy to reach it in a set amount of time. Homework assignments may be set, such as keeping a diary of feelings and the child will be expected to monitor and evaluate their own progress. Treatment is generally offered on a one-to-one basis, although it can be supplied in groups and may be needed for several months. 

Medication
Antidepressant medications have been shown to be effective in adults, but there has been less research done on their effect on children. Only in urgent cases will they be considered as a treatment for depressed young children, and if so they will initially be fluoxetine, also known as Prozac.

Professor Cottrell says: “Severe depression may require medication as well as talking therapy to be treated fully. Although medication for children is seen as controversial, it will only be prescribed in severe circumstances when it is really needed.
”Medication should be used alongside – not instead of – talking treatments.”

Antidepressants may take some time to work, but if after several weeks there has been no improvement then different medications or treatment can be suggested. These include family therapy, if problems at home seem to be behind a child’s depression, and individual psychotherapy sessions as well as stronger antidepressants for deeply depressed or suicidal sufferers.   Professor Cottrell adds: “Childhood depression is serious, but it can be treated successfully, safely and relatively quickly. It is good to be on the alert for signs of any changes in your child, especially symptoms of depression, but there is no need to panic about an epidemic.” 

Information
There are many useful websites and books available which can help the sufferers of childhood depression and their families. 
  • Government guidelines on depression in children and adolescents can be downloaded free from www.nice.org.uk.
  • Young Minds is a national charity dedicated to improving the mental health of all children and young people. It provides information to those concerned about the mental health or emotional well-being of young people.
    Parents information service: 0800 018 2138 Open Monday and Friday     10am to 1pm and Tuesday and Thursday 1pm to 4pm.
    Website at www.youngminds.org.uk.
  • Mental health charity SANE runs a confidential helpline; open from 1pm to 11pm every day. SANELINE volunteers can provide, help, advice and links to resources as well as professional clinics and services. Calls to 0845 767 8000 are charged at normal local rates.
  • “Growing Up Sad: Childhood Depression and its Treatment” by Leon Cytryn and Donald H McKnew examines the diagnosis and treatment of depressed children. It is available from Amazon.com.
  • Fact sheets on mental health problems - including depression - in children are available from the Royal College of Psychiatrists at www.rcpsych.ac.uk.
 Case Study
*Ian Bland can’t remember a life before it was consumed by the desperate lows and helplessness of depression. Now 21, he has battled with the illness – undiagnosed and untreated until five years ago – since he was just seven.  The Manchester-born factory worker says his earliest memories are of constantly been told to “cheer up” and act ‘normal’ by frustrated relatives, teachers and peers. He says: “Before I even went to secondary school, it felt like there was a thick, black, cloud hanging over my head and no matter what I did, I could not fight my way through it. The feelings of worthlessness and pointlessness just didn’t go away.”  Depression is often thought to be triggered by a traumatic personal experience, or a series of changes that occur during childhood.
Ian believes that his parent’s separation was the catalyst for his depression problem. He says: “Obviously we were all upset when my parents decided their relationship was over but I remember been absolutely devastated – and thinking it was somehow my fault.  As his concentration levels continued to drop, school work declined and he was still completely uninterested in life, teachers, family and friends began to think his depression was simply an attention-seeking exercise. Ian adds: “I would hide myself away from people and just sit, in silence. Mum would beg me to tell her what the matter was, tell me to cheer up and try to make me happy, but I refused to talk, play with others, take part in or allow myself to enjoy anything.” 
As Ian got older, he started to play truant from school to avoid awkward questions and comments. He sank further into despair, beginning to think about death, and committing suicide, constantly. He says: “I just felt this overwhelming sadness all of the time. I began to think that I might as well die because I was never going to be happy and everyone would be better off without me.” 
After leaving school with no qualifications, Ian and his mum fought often until one night he confessed he wanted to kill himself. He adds: “My mum was devastated, and begged me not to. I finally managed to tell her how I felt about everything and the next day I was at my doctors explaining it to him.” Ian spent two years in intensive therapy before being prescribed anti-depressant medication. He still has regular counselling, but says he can now see light at the end of the tunnel. He says: “There are still very bad days, but they come less often and I am better equipped to deal with them. Life is a lot better than I ever imagined it could be, but I do think if I had been diagnosed earlier things could have been a lot different.”  

*Name changed to protect identity.