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Could Your Child be Depressed?

September 16th, 2011 Carol 1 Comments

Within the last two years I have experienced a significant increase in the number of kids and tweens being admitted to a higher level of mental health treatment for increased depression and anxiety. With another school year starting and a struggling economy, more families are seeking support for the emotional well-being of their children. According to the National Institute for Mental Health (NIMH) 11% of children ages 13 to 18 are grappling with Clinical Depression. Although children may experience symptoms of depression, the risk increases as a child gets older.

More recently, parents, teachers and coaches have sent me emails with concerns for children displaying increased agitation, feelings of hopelessness and isolation from others. Some adults are not sure how to respond in taking further steps of action to assure emotional stability of youth as well as determining the severity of symptoms presented. The Center for Disease Control (CDC) reports that one of five children and adolescents aged 9 to 17 years-old experience symptoms of mental health problems that cause some level of impairment. However, fewer than 20% who need mental health services receive them for various reasons (e.g. no access to health insurance, parents and guardians are in denial, stigma attached, uneducated in mental illness). Due to economic instability insurance companies have been forced to tighten up authorizations on services for higher levels of care. For inpatient, the average length of stay is a week and in partial hospital programs if a child is not actively suicidal, insurance companies may allot four to twelve weeks based on the severity of symptoms.

In addition to limited insurance authorizations, are the social complexities associated with having a mental illness. There continues to be a stigma attached to mental illness, as well as the belief that children should not be anxious and depressed. “It’s only a phase.” However, when depressive symptoms are left untreated, there is a greater risk for negative coping patterns including substance abuse, self-injurious behavior such as cutting, eating disorders and suicidal thinking. Parents are hesitant to send their child to treatment in fear of being bullied or judged. For example, in the case of many young athletes, the pressure to succeed on both the playing field and in the classroom has resulted in feelings of anxiety and depression. Upon assessment into treatment, not only does the child show reluctance to be in therapy, the parents are worried about who will find out. Unfortunately, I see cases where it took a suicidal thought with attempt for the family to seek out a mental health professional. With a new school year, children and adolescents tend to be more vulnerable to societal pressures (e.g. workload, peer pressure, bullying, sports, etc.) within both the home and school environment.

For treating clinical depression in children, the most effective treatment is a combination of an antidepressant, most commonly a Selective Serotonin Reuptake Inhibitor (SSRI) and Cognitive Behavioral Therapy (CBT). According to the “Treatment of Adolescents with Depression Study” (TADS) 71% of patients responded well to combination treatment of CBT and Fluoxetine (Prozac), compared to 61% who received Fluoxetine alone and 43% who received CBT alone. The patients were also found to be less suicidal regardless of the treatment they received. However, there are safety concerns about taking medication and its possible side effects. The Food and Drug Association (FDA) has placed a “black box” warning label—the most serious warning label—on all antidepressant medications, which indicate an increased risk of suicidal thinking or attempts in youth.  Children should be closely monitored during initial weeks of treatment.

The idea behind CBT is to teach children how to change their thoughts about events to become more positive. A common example among middle school aged children is thinking another peer is giving them a dirty look when really he or she could just be having a bad day. This is also known as a distorted thought with a focus that “thoughts are not facts”. Children and adolescents learn and practice changing how they view a situation to produce a different feeling, which will change the result. Going back to my previous example of thinking a peer is giving a dirty look; a child may feel angry and respond in a negative way such as gossiping or getting physically aggressive. If the child altered that thought by acknowledging the peer is having a bad day, the feeling would no longer be anger. As a result he or she has now avoided a potentially harmful situation.

Another treatment modality I use on a daily basis is play therapy. Although it is not yet shown to be a best practice approach, research indicates positive impacts of play and physical activity on mood. According to Psychiatrist, Dr. John Ratey, exercise regulates all of the neurotransmitters targeted by antidepressants including norepinephrine, dopamine and serotonin, which are responsible for mood, feelings of wellness, impulse control and self-esteem. In addition serotonin helps stave off stress by counteracting cortisol. In a study conducted by James Blumenthal and colleagues known as SMILE (Standard Medical Intervention and Long-term Exercise), to determine if exercise was as effective as the SSRI Zoloft. One hundred and fifty-six patients were divided into three groups: Zoloft, exercise, or a combination of the two in a sixteen week trial. Results indicate that all three groups had a significant decrease in depressive symptoms and exercise was as effective as medication. (Ratey, 2008).  In relation to my own play therapy sessions with children including various team-building exercises, non-competitive play, jump roping etc., moods are observed to drastically change for the better with increased energy and decreased feelings of irritability.

At what point is it time to see a mental health professional? If any of the following symptoms persist for two weeks or longer, seek out help from a mental health professional immediately:

• Making comments about feeling hopeless and suicidal

• Significant drop in academic grades

• Increase or decrease in sleep and appetite

• Increased irritability and anger

• Lack of energy and pleasure in activities

• Extreme sensitivity to criticism or failure

• Difficulty concentrating

• Complaints of feeling sick (headaches and stomachaches)

• Excessive worrying

Melissa Lambert, M.Ed, LPC, YFS1 Child and Adolescent Clinician

Reference – Ratey, J. (2008). Spark: The Revolutionary New Science of Exercise and the Brain. New York, NY: Little, Brown and Company.

Posted in Children, Family, Health, Parenting, Teen