Monday, September 12, 2011

Depression in Children and Adolescents written by our Guest Psychologist Dr Nicole Arthur Jindalee Brisbane

Childhood and adolescence are not stress-free. There are many occasions when children and adolescents will experience difficulties in their lives. These times may lead them to feel sad, stressed, irritable, or particularly sensitive. However, when such responses to life experiences become persistent and interfere with normal daily activities and function for at least 2 weeks, further assessment for Child and Adolescent Depression should be considered.

Child and Adolescent Depression
Similar to depression in adulthood, Child and Adolescent Depression leads to a host of aversive outcomes: marked psychological, physical, thinking, and behavioural symptoms. The presentation of these symptoms might differ from those experienced by adults, due to each child’s developmental level as outlined below:
Psychological symptoms:
            Low flattened mood (e.g., feeling sad or empty) (presented more as stress, irritability, hypersensitivity, or anxiety in younger children), loss of interests in previously engaging enjoyed activities (e.g., no longer playing sports or going out with friends); lack of motivation, feeling of worthlessness, inappropriate guilt, orientation toward negativity (e.g., becoming preoccupied with music with negative lyrics); persistent boredom or hopelessness
Physical symptoms:
            Lack of energy, sleep or appetite disturbance (e.g., sleeping or eating too much or too little; more likely in adolescents), changes in behaviour (e.g., inability to stay still, drastic increase or decrease of speech rate or body movement), feeling sick or having aches and pains (more likely in younger children)
Thinking symptoms:
            Reduced concentration, compromised memory, indecisiveness, suicidal thoughts (more likely in adolescents)
Behavioural symptoms:
            Withdrawal, insolating oneself from others, lack of engagement in previously worthwhile activities, suicidal action/attempts (more likely in adolescents)
Possible Associated Symptoms
Anxiety or worries
Behavioural problems
Strange or obsessive thoughts
Conflicts in interpersonal relationship
Poor school performance
Substance use

The prevalence of depression is relatively low in children and adolescents. It has been reported in 2% of children and 4-8% of adolescents. Females and males are similarly vulnerable to depression during their childhood but the vulnerability changes to 2:1 during adolescence, with females more likely to experience depression.
Causes of Child and Adolescent Depression
As with many mental health conditions, the exact cause of Child and Adolescent Depression is not fully understood. Different children develop depression for different reasons. It is unlikely that one factor can fully explain the cause of Child and Adolescent Depression and often a combinations of factors should be considered.
Biological factors
An imbalance of naturally occurring chemicals in the brain (i.e., particularly serotonin and noradrenalin) may be a factor for Child and Adolescent Depression. Additionally, depression seems to run in families, so it may be inherited. This is perhaps why some children are more vulnerable to depression. In addition, children with a more fragile temperament also seem to be more vulnerable to developing depression.
Psychological factors
Life experiences such as stressful or traumatic events may trigger depression in children with fragile temperament.
Also, depressive children tend to lack skills that help maintain their resilience in light of challenging life circumstances. These include problem-solving, assertiveness, and social skills. Additionally, they may have a tendency to view their circumstance in a less optimistic depressive-prone manner. Finally, other than hyper-sensitivity to threat and insufficiently optimistic worldview, children and adolescents with depression may not experience sufficient positivity in their environment (e.g., their withdrawal might reduce the opportunities that they can cultivate social relationship, establish social support, and/or involve in engaging activities).
Treatments for Child and Adolescent Depression
Medical intervention:      
Medical intervention for Child and Adolescent Depression is normally in the forms of antidepressants (e.g., fluoxetine- Prozac; sertraline- Zoloft, and Venlafaxine- Efexor) which act by adjusting and maintaining chemical balances in the brain. Although dependency on these medications is reportedly rare, their long-term benefits remain questionable. Some children may also experience, to a varying degree, common side effects of appetite loss, dry mouth, or nausea. Findings suggest that the benefits of antidepressant are best maximized when used in conjunction with psychological intervention.
Psychological intervention:   
Psychological intervention has been shown to be effective in helping children manage and reduce symptoms associated with Child and Adolescent Depression and reduce relapse rates. When the symptoms are relatively mild, psychological intervention might be sought as a stand-alone treatment. However, with severe symptoms, psychological intervention should be sought concurrently with or after the medical intervention.
Generally, psychological intervention targets the aspects of depression that are maintaining it or increasing the likelihood of its reoccurring. This support is mainly provided to the children. However, parents of children younger than 11 are generally involved so that they can help enhance the effect of the intervention at home.
            Psychological support for children and adolescents helps them to understand and effectively manage symptoms of depression. Behaviour strategies that help them to renew interests in engaging activities are generally introduced to enhance the positivity that they can obtain during their daily function. Relaxation strategies that target their physical symptoms (e.g., abdominal breathing, muscle relaxation) are provided to ameliorate the debilitating effects of depression. Most importantly, more realistic and more positive thinking styles are introduced as a replacement for the unhelpful depressive thinking styles. To enhance their resilience for future challenges, the children will be equipped with coping skills that help them to regulate their emotion, create and maintain social support, and resolve problems and conflicts effectively.
Treatment Outcomes
With proper management of medical and psychological support, child and adolescent depression is usually manageable, provided that sufficient duration of the treatments and proper follow-ups are regularly attained.

Dr Nicole Arthur
BHMS (Ed) B Arts (Psych)(Hons) D Psych Clin MAPS
Clinical Psychologist and Director

New Directions Psychology
Allsports Shopping Village
Suite 21/19 Kooringal Drive
JindaleeQ 4074
PH: 3376 1977 Fax: 3376 9973