09.Major Depression
09.1.What is Major Depression?
Major depression is also known as clinical depression or unipolardepression. It is a type of mood disorder that goes beyond normal daily ups anddowns.
Depression involves the body, mood and thoughts. It can affect eating,sleeping or thinking patterns. It is not the same as being unhappy or in a“blue” mood. It is not a sign of weakness or something that can be willed orwished away.
Children with a depressive illness cannot just “pull themselves together”and get better. Treatment is often needed. Many times, treatment is crucial torecovery.
09.2.Incidence of Depression
The National Institute of Mental Health (part of the NIH) reports that:
Research shows depression is starting earlier in life than it did in thepast.
Early-onset depression often persists, recurs and lasts into adult age.Depression in youth may also predict more severe illness in adult age.
There is an increased rate of depression in children whose parents havedepression.
09.3.Risk Factors for Major Depression
The exact cause is not known. The most common risk factors include:
Family history of mental illness, including depression and suicide (evenmore so if a parent had depression as a child or teen)
A high amount of stress
Abuse (physical, sexual, emotional) or neglect
Trauma (physical, emotional, sexual)
Other psychiatric disorders
Loss of a parent, caregiver, or other loved one to divorce, death, orabandonment (even more so if at an early age)
An imbalance of neurotransmitters (natural chemicals) in the brain
Change in the body’s balance of hormones
Loss of a relationship (like moving away, loss of boyfriend or girlfriend)
Other chronic illness (like diabetes)
Other developmental, learning or conduct disorders
Low self-esteem, depends too much on others, self-critical, pessimistic
After puberty, girls are two times as likely as boys to be at risk formajor depression.
09.4.Signs and Symptoms of Major Depression
These are the most common symptoms of major depression. This may bedifferent for each child or teen. Symptoms may include:
Lasting feelings of sadness, irritability, hostility or aggression
Feeling hopeless or helpless, worthless or inadequate, or having lowself-esteem
Feeling empty inside
Having a lot of guilt
Thoughts of suicide or death that reoccur
Loss of interest in normal activities and no longer enjoying pleasurableactivities
Problems with relationships
Sleep problems (insomnia, hypersomnia)
Changes in appetite or weight
Change in activity level (increased or decreased energy)
Problems concentrating, remembering, or thinking clearly
Less able to make decisions
Frequent physical complaints (headache, stomach ache, very tired)
Running away or threats of running away from home
Very sensitive to failure or rejection
Anger and rage
Anxiety
Depression in teens may be hard to spot. Any of these signs may suggestproblems with school, behavior, or alcohol and drug use.
For a diagnosis of major depression, a teen often needs to have a“cluster” (often five or more) of the above symptoms during the same two-weektime frame. The symptoms may look like other problems or conditions. Symptomsmust be severe enough to cause problems in daily activities. Always talk toyour teen’s doctor for a diagnosis.
09.5.Diagnosis of Major Depression
Depression often co-exists with other psychiatric disorders (such asbipolar disorder, substance abuse or anxiety disorders). Seeking earlyevaluation, diagnosis and treatment are crucial to recovery.
A psychiatrist, or other mental health expert, most often diagnoses majordepression after a full evaluation. An evaluation of the teen’s family, inaddition to information provided by teachers and care providers, may also behelpful in making a diagnosis.
09.6.Treatment for Major Depression
Treatment for major depression will be advised by your child’s doctorbased on:
Your child’s age, overall health and history
Extent of symptoms
Your child’s tolerance for certain medicines, procedures or therapies
What is expected for the course of the condition
Your opinion or what you prefer
Mood disorders, like major depression, can be effectively treated.Treatment should always be based on a full evaluation of the child and family.Treatment may include one, or more, of these:
Antidepressant medicines. Research shows that, when combined withpsychotherapy, these drugs can be very effective in the treatment of depressionin children and teens. These medicines work by rebalancing the chemicals in thebrain. Anyone taking antidepressants should be watched closely for suicidalideation during the first few months after starting these.
Psychotherapy. Most often cognitive behavioral and/or interpersonaltherapy is helpful. The focus is on:
Changing distorted views of themselves and the environment around them
Working through difficult relationships
Identifying stressors in the environment and learning how to avoid them
Family therapy
Consults with the school
Parents play a vital role in any treatment process. For many reasons, manyparents of children with depression never seek the needed treatment for theirchild. But, around 80 percent of all people with major depression who do seektreatment will improve, most often within weeks. Continued treatment may helpto prevent the depressive symptoms from coming back.
Without the right treatment, symptoms of depression can last for weeks,months or years. This can cause interpersonal and psychosocial problems.Depression in teens is also linked with an increased risk for suicide. Depressionoften gets worse if left untreated.
Suicide risk rises, even more so in teen boys, when the depression occurswith other mental health disorders (conduct disorder, substance abuse). It iscrucial for parents and care providers of teens to take all depressive andsuicidal symptoms very seriously. Seek treatment right away for any symptoms.
