Depression in Children

Dr Ruwan M Jayatunge – rumj@sltnet.lk

Depression is a mood disorder which can affect adults as well as children. In general terms depression is an overwhelming feeling of hopelessness, sadness and lack of self-worth. It is more than a sad feeling. Depression is common among adults. Unlike adults childhood depression is difficult to distinguish. They often express their feelings through behavior. Depression affects child’s overall energy, mood, expressions of emotion and behavior.

According to the British experts at least two per cent of children under 12 struggle with significant depression, and by teenage years this has risen to five per cent. Following the geopolitical and economic conditions in Sri Lanka a significant number of children are affected by childhood depression. Most of these cases are undiagnosed and not receiving adequate treatment.

Depressed children have prolonged anhedonia (the inability to experience pleasure), hopelessness, and failure to experience an increase in mood in response positive events and sometimes have inattentive features similar to Attention Deficit Hyperactivity Disorder or aggressive behavior similar to Conduct Disorder. The affected children are mostly alienated and they often have learning difficulties due to difficulty in concentrating and impaired memory.

Reasons for Depression in Children

Genetic factor: the family history of depression
Adverse life events (maternal or paternal deprivation, death of a close family member)
Childhood trauma (child abuse, witnessing traumatic events)
Excessive social demands (exam stress, academic failure)
Physical illnesses ( depressive episodes in post viral fever, thyroid hormonal imbalance)

Symptoms and Behaviors Associated with Depression in Children

Crying, feeling sad, helpless or hopeless
Feeling discouraged or worthless
Loss of interest or pleasure in others or most activities
Fatigue and loss of energy nearly every day
Bad temper, irritable, easily annoyed
Fearful, tense, anxious
Repeated rejection by other children
Drop in school performance
Inability to sit still, fidgeting or pacing
Repeated emotional outbursts, shouting or complaining
Doesn’t talk to other children
Repeated physical complaints without medical cause (headaches, stomach aches, aching arm or legs)
Significant increase or decrease in appetite
Change in sleep habits

Suicidal thoughts, feelings or self-harming behavior in Children

As a result of childhood depression serious and critical symptoms such as suicidal ideation and deliberate self harm can be seen among the affected children. According to the International Journal of Adolescent Medicine and Health ( 2008 ) the summarized report findings from 13 nations indicate that there may be a link between bullying and suicidal ideation in children and adolescents. Depressed children have a risk of committing suicide.

Risk factors for Development of Childhood Depression

There are number of risk factors associated with childhood depression.
Personality traits – characteristics that influence reactivity to stress play a major role in development of depression. Children who lack social skills, problem solving skills often shattered by life stress and easily go in to depression. Lacks of family cohesion, expressiveness, organization too negatively affect the child’s overall mental health. Parental life philosophy too plays a major role. Negative views of self, the world and one’s future, devaluation of the child’s abilities, excessive criticism can lead to depressive feelings in a child. Repeated physical, emotional or verbal abuse at home or school could be a vital risk factor.

Treatments in Childhood Depression

Medication and psychotherapy are foremost treatment modes in depression. Many Physicians use SSRIs (Selective Serotonin Reuptake Inhibitors) to treat childhood depression. Frequently medication is combined with psychotherapy. A variety of psychotherapeutic techniques have been shown to be effective in childhood depression. CBT or Cognitive Behavior Therapy helps to correct negative thought patterns and erroneous negative assumptions. CBT encourages the child to use positive coping behaviors.

Social skills training are important in childhood depression since the affected children lack social skills. The children are thought initiating conversations, responding to others and transforming in to positive communication style. Some therapists use Interpersonal Therapy which is focused on relationships, social adjustment and mastery of social roles.

The resent research in USA and Europe indicate that EMDR (Eye Movement Desensitization and Reprocessing) is effective in treating childhood depression. EMDR (Eye Movement Desensitization and Reprocessing) is a much easier and less painful process than traditional therapy for resolving depression and trauma. EMDR is an information processing psychotherapy that was developed to resolve symptoms resulting from disturbing and unresolved life experiences. It uses a structured approach to address past, present, and future aspects of disturbing memories.

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