What is Depression in Children?
The term “depression” refers to a symptom or combination thereof, as well as a disorder.
Depression as a disorder is symptoms such as fearfulness, anxiety, obsessiveness, lasting at least 2 weeks for most of the day and for most of these 14 days. Symptoms should lead to the suffering and social inability of the child.
Some children do not fully meet the diagnostic criteria for a depressive disorder, but they have symptoms of depression that are part of a relatively undifferentiated emotional disorder. If besides symptoms of schizophrenia are shown, then depressive disorders are not diagnosed.
Epidemiology
In a study on the Isle of Wight, depression was found in 0.2% of 10-year-olds and 2% of 14-year-olds. Recent studies have reported greater prevalence: severe depressive episodes have ever had up to 1% of children under puberty, and about 1-5% of adolescents. Chronological age, presumably, does not affect depression, it is associated with puberty. Studies that take parent and teacher data as the basis indicate a lower incidence of depression than studies that rely on reports from teens and younger children.
It is not known exactly how important internal sadness is, which is invisible to teachers and parents. From middle or late adolescence, depressions are more prone to women than men. Before puberty, the percentage of girls and boys with depression is approximately equal, sometimes male gender predominates.
The relationship of depression with social distress is not exactly established. In recent decades, the number of children affected by depression has increased, and the average age at onset of the disorder in children has decreased.
Causes of Depression in Children
Depression spreads in families. Most often, in children with a depressive disorder, parents are affected by the same disorder. There is also a tendency: parents with depressive disorder are more likely to have children with depression. The importance of genetic and environmental transmission is not known. Twin studies revealed a moderate level of heritability, but this trend has not been confirmed in studies of adopted children.
There is little evidence that genetic heritability can affect a child’s perception of negative events in life, which affects depressive disorders.
Symptoms of Depression in Children
Signs of Depression at Different Ages
Children under the age of 5, who are separated from their parents or other people to whom they have been attached, often fall into despair. But it is not known for sure whether it is tantamount to depression. From around the age of 8, some children actually experience depressive disorders, which are reminiscent of those in adults. Therefore, depression in children is diagnosed by the same criteria as in adults, or by slightly altered ones. In children, appetite and sleep disorders are less common, in adults they are more common.
Feelings of guilt and hopelessness in depressed children are presumably more rare than in adults and adolescents with depression. Plans to commit suicide usually end in realization more in depressed teenagers than in children. Also, in children, implementation is often done through methods that are unlikely to lead to death. Depressive symptoms in childhood can be manifested in a refusal or unwillingness to go to an educational institution, abdominal pain and headaches, and irritability.
Somatic symptoms are almost always present, and are not just the result of concomitant anxiety.
Depressive equivalents
Presumably, many childhood mental disorders ranging from enuresis to behavioral disorders are the childhood equivalents of adult depression, even when the child does not look miserable. But there is not enough evidence for this.
Classification
It is important to understand how many depressive episodes were, and whether the children also had any manic, hypomanic, or mixed episodes. Severe recurrent depressive disorder is diagnosed in children with 2 or more severe depressive episodes, but without manic, hypomanic, or mixed episodes, according to DSM-IV.
If there are fewer symptoms, children can be diagnosed with dysthymia of an adaptation disorder with a depressed mood. Dysthymia is characterized by mild chronic symptoms lasting at least 1 year (for adults, the condition is a duration of 2 years or more).
There is also an adaptation disorder – when they occur for 1 month (as ICD-10 says) or 3 months (as DSM-IV says) after an identifiable stressor, and last after less than 6 months after the stressor.
Associated symptoms
– comorbidity
Comorbidity means the presence of additional symptoms of mental disorders in addition to the symptoms of depression.
– difficulties in friendships
Such difficulties often occur as long as the depressive episode lasts, may precede it or be the cause of such episodes.
– biological signs
There are cases, for example, when cortisol levels are elevated at night.
Diagnosis of Depression in Children
When diagnosing, depression in children is distinguished from normal sadness, which can be a reaction to bereavement. Sadness can also be a symptom of another mental disorder, without the additional affective, cognitive, and behavioral symptoms that must be present to diagnose a true depressive disorder.
Treatment for Depression in Children
To change the factors that are (supposedly) causing a high level of stress, family therapy is used that supports individual therapy and interaction with the school.
The effects of cognitive-behavioral and interpersonal therapy on depressed children are also investigated. The first changes negative consciousness, improves self-esteem and strengthens coping skills, increases the participation of a child or teenager in normal activities. Correctional assistance for specific learning problems and social skills training can also be applied.
The role of drug treatment has not yet been clarified. Tricyclic antidepressants are sometimes used. Limited clinical trial data support the use of serotonin reuptake inhibitors such as fluoxetine for the treatment of depression in children. The effectiveness of lithium in bipolar disorders in children and adolescents is considered high. Treatment of resistant depression in some cases is carried out by combinations of various drugs or electroconvulsive therapy. Such methods are used in specialized centers.
Psychological treatment for mild depression in a child is carried out by supporting and reducing stress. With moderate depression, in addition to these methods, you should try CBT or MLT, the last thing they try is fluoxetine.
Treatment of severe depression in children is carried out by a combination of stress reduction, CBT (or MLT), fluoxetine. If there is serious suicidality, psychotic symptoms or a refusal to eat and drink, the child should be hospitalized.
With the exception of very mild depression, it may be advisable to continue successful treatment (psychological or pharmacological) for about six months after symptomatic remission in order to prevent early relapse.
Forecast
An adaptation disorder with a depressed mood lasts, as a rule, for 2-3 months, without recurrence. Severe depressive episodes in frequent cases lasts 6–9 months and tend to recur.
The duration of dysthymia is several years; children with dysthymia are at high risk of severe depressive episodes. If a child has severe depressive episodes superimposed on dysthymia (what is called “double depression”), there is a chance of recurring severe episodes.
Depression in adolescents threatens to continue in adulthood, predicts a 6-fold increase in the frequency of suicide in adults. If depression arose before the puberty, its transition to adulthood is unlikely. Although “pure” depression does not increase the risk of an antisocial outcome in adults, a mixture of depression and behavior disorder is accompanied by an increased frequency of subsequent crime.