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Adolescent Depression


After Lenas (not her real name) father passed away when she was twelve, the now 17-year-old student fell into depression. Her mother, 49-year-old clerical staff Sonia (not her real name), recalls that Lena did not shed a single tear at her father's funeral even though she was very sad. At first, nothing seemed wrong.

"It was only a year later that she started to miss him badly. This was compounded by being bullied in school and stressed by schoolswork. Always a quiet child, Lena became even more withdraw,. She had trouble sleeping, would cry for no reason, refused to eat, and talked about hurting herself." A 2004 article published by the American Academy Psychiatry defines childhood depression as an illness "when the feelings of depression persist and interfere with a child or adolescent's ability to function."

Sonia brought Lena to a polyclinic for evaluation. They were referred to a psychiatrist at a hospital. Lena was given antidepressants and started regular therapy sessions with psychiatrists and counsellors. She tried to follow their advice to riot think negatively, to focus on developing her interests and to make a timetable for each day. Everyday was a struggle.

Symptoms Of Childhood Depression

Feelings of depression are represented in the forms of mood, physical, mental and behavioral changes in a child. Many of the symptoms listed are actually applicable to both adults and children but there are telling differences. "We don't tend to categorise (childhood depression) in terms of age groups," says Dr Chan, a psychiatrist "but we can generally say that adolescent depression tends to look more like adult type depression, whereas, childhood depression can be more 'atypical', perhaps manifesting in bodily pains and behavior changes."

Numbers Of The Depressed

The American Academy of Child and Adolescent Psychiatry estimates that five per cent of children and adolescents in the general population suffer from depression at any given point in time.

No Stereotyping

There is no clear categorisation of childhood depression. Says Dr Chan, "Typing depression is notoriously difficult and fashions come and go. We now type it according to severity ie. mild, moderate and severe. Sometimes we use the teen 'reactive' depression to denote the type that is due to a reaction to some stress (such as the sudden passing of a loved one). Although very rare in children, 'psychotic' depression refers to the presence of psychotic symptoms, which are symptoms that show that the person has lost touch with reality ie. hearing voices, believing irrational, bizarre or incredible thoughts."

Stages Of Childhood Depression

According to a Harvard Medical School, "The picture changes with age. Up to age three, the signs (of childhood depression) may include feeding problems, tantrums, and lack of playfulness and emotional expressiveness. At ages three to five, depressed children may be accident-prone and subject to phobias. Even before age five, they may show signs of self-reproach by apologising unnecessarily for minor mistakes and transgressions like spilling food or forgetting to put clothes away.

"Children of early school age (six to eight) sometimes show depression with vague physical complaints and aggressive behavior. They may cling to their parents and avoid new people and challenges. At ages nine to 12, some common symptoms are morbid thoughts and lying awake worrying about schoolwork. By then, children have enough intellectual capacity and social understanding to think about reasons for their depression, and they may blame themselves  for disappointing their parents."

"I think that this is good guide by and large," says Dr Chan. Nevertheless, he cautions that it is merely a guide and should not be taken as set in stone. "For example," he adds, 'A 12-year-old boy may show signs of depression through aggressive behavior and physical complaints. Depression before the age of six is very, very rare. In a young child the common emotional condition is anxiety, not so much depression. From six years onwards, I would agree with the given description."

Treatment

Recent studies have not been able to prove that antidepressants work for children. "This could be because children are not mini adults and what works for adults may not work for kids," explains Dr Chan. There is also little research on how antidepressants  work on children, and prescription drugs could increase the risk of self-harm. However, says Dr Chan, "The increase of antidepressants prescriptions is small, probable around 2 per cent in affected children given inactive medications (placebos) to about -1 per cent of those on active medication."

Counselling, it seems, plays a key role in helping children recover from depression. "A good counsellor will try to get information from parents, child and school and co-ordinate the counselling to incorporate all these parties. Cognitive-behavioral therapy is one of the commonest forms of counselling techniques used nowadays. It seeks to change the negative thoughts of the child to more realistic and positive ones and also to help the child make action/behavioral changes that will help lift the mood," adds the psychiatrist

Counselling has certainly helped Lena. "She said she liked the sessions because she could talk to someone about her feelings and problems," says mum Sonia. "Slowly, she got better to the point that she was more cheerful and could laugh and giggle like a normal young girl. She even enrolled in yoga classes that helped her gain fitness, and to relax."

Understanding Is The Key

However, Lena stopped taking her medication for six months and took her 'N' levels examinations. She then decided to go for further studies. Within a few months, she started to feel the stress of sehoolswork again. "The course required a lot of communication skills that I don't have. It was also too fast and too intense for me," she describes. Her mental and physical health took a nosedive, and she dropped out.

Now, says Lena, "I'm very confused. I don't know «hat I call do. I only have 'N' levels and I worry about how I'm going to get a better education." "Sometimes, depressed children are mistakenly labelled as lazy stubborn or difficult," comments Dr Chan. This is largely due to a lack of knowledge and understanding of the adults' part. 

Children, unlike adults, are dependent on their families and guardians to identify their troubles and seek help. Children under stress, who experienced loss, or who have attention, learning, conduct or anxiety disorders are also at a higher risk for depression. Adds Dr Chan, "One common misconception is that the child is mad. This is totally not so.

Another is that the child is 'weak'. Some famous people who are strong of character and have suffered depression include Abraham Lincoln. Another misconception is that it is incurable or that the child is 'bad'. Depression is a very treatable condition and the change of bchavior from depression should not be mistaken for 'badness'.

For Sonia, being supportive of Lena through the down times and being sensitive to her needs are priorities. "I told her that her health is more important than studies. We can always find another course for her in the future, perhaps something oil a part-time basis and less stressful. When I'm at work, 1 try to call her and talk to her whenever I can.

She willl tell me things like, "Mummy I'm useless and I don't know what to do, and I will try to encourage her to look oil the bright side, not to think too much. I try to give her lots of love, my  full support and attention."

Signs Of Childhood Depression

Any combination of these changes that lasts for more than two weeks could mean that the child is falling into depression.

  • Persistent irritability or loss of interest
  • Loss of appetite and weight
  • Poor sleep
  • Lethargy
  • Headache
  • Stomach pain
  • Loss of concentration
  • Preoccupation with self-harm or suicide
  • Refusal to go to school
  • Increased temper tantrums
  • Anti-social behaviors such as smoking or drinking
  • Running away from home
 

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