| ntroduction
What is depression? Most people, children as well as adults, feel low or `blue’ occasionally. Feeling sad is a normal reaction to experiences that are stressful or upsetting. When these feelings go on and on, or dominate and interfere with your whole life, it can become an illness. This illness is called `depression’. Depression probably affects one in every 200 children under 12 years old and two to three in every 100 teenagers. What are the signs of depression in children • Being moody and irritable – easily upset, `ratty’ or tearful • Becoming withdrawn – avoiding friends, family and regular activities • Feeling guilty or bad, being self-critical and self-blaming – hating yourself • Feeling unhappy, miserable and lonely a lot of the time • Feeling hopeless and wanting to die • Finding it difficult to concentrate • Not looking after your personal appearance • Changes in sleep pattern: sleeping too little or too much • Tiredness and lack of energy • Changes in appetite • Frequent minor health problems, such as headaches or stomach-aches • Some people believe they are ugly, guilty and have done terrible things. If you have all or most of these signs and have had them over a long period of time, it may mean that you are depressed. You may find it very difficult to talk about how you are feeling. What causes depression in children Depression in children is usually caused by a mixture of things, rather than any one thing alone. Events or personal experiences can be a trigger. These include family breakdown, the death or loss of a loved one, neglect, abuse, bullying and physical illness. Depression can also be triggered if too many changes happen in your life too quickly. Risk factors People are more at risk of becoming depressed if they are under a lot of stress, have no one to share their worries with, and lack practical support. Biological factors Depression may run in families due to genetic factors. It is also more common in girls and women compared to boys. Depression seems to be linked with chemical changes in the part of brain that controls mood. These changes prevent normal functioning of the brain and cause many of the symptoms of depression. Where can I get help? There are a lot of things that can be done to help people who suffer from depression. Helping yourself Simply talking to someone you trust, and who you feel understands, can lighten the burden. It can also make it easier to work out practical solutions to problems. For example, if you are stressed out by exams, you should talk to your teacher or school counsellor. If you are worried about being pregnant, you should go and see your general practitioner or family planning clinic. Here are some things to remember: • talk to someone who can help • keep as active and occupied as possible, but don’t overstress yourself • you are not alone – depression is a common problem and can be overcome. How parents and teachers can help It can be very hard for young people to put their feelings into words. You can help by asking sympathetically how they are feeling, and listening to them. When specialist help is needed If the depression is dragging on and causing serious difficulties, it’s important to seek treatment. Your general practitioner will be able to advise you about what help is available and to arrange a referral to the local child and adolescent mental health service. Many young people will get better on their own with support and understanding. For those whose symptoms are severe and persistent, the most effective forms of treatment include cognitive behavioural therapy (CBT) and sometimes antidepressant medication. CBT is a type of talking treatment that helps someone understand their thoughts, feelings and behaviour (see Royal College of Psychiatrists Factsheet on CBT). Antidepressant medication may help and usually has to be taken for several months. They are not addictive, but there may be some withdrawal symptoms for a short time when you stop taking them. All medicines have side-effects, but if you are concerned about these, you should talk to your general practitioner or psychiatrist (see Royal College of Psychiatrists’ Factsheet on antidepressants; www.rcpsych.ac.uk). References • Carr, A. (ed.) (2000) ‘What Works with Children and Adolescents?’ – A Critical Review of Psychological Interventions with Children, Adolescents and their Families. London: Brunner-Routledge. • Rutter, M. & Taylor, E. (eds) (2002) ‘Child and Adolescent Psychiatry’ (4th edn). London: Blackwell. • Scott, A., Shaw, M. & Joughin, C. (eds) (2001) ‘Finding the Evidence’ – A Gateway to the Literature in Child and Adolescent Mental Health (2nd edn). London: Gaskell
|
|
Category Archives: General
Depression In Children
Self Help for Depression
THE first thing to realise when looking at self help for depression is that the very nature of depression can make self help difficult. In this case, your best option is to get help from a trained professional.
However, if you feel up to helping yourself, here is a comprehensive list of what you need to do.
- Get a good understanding of what depression is. Self help for depression is much more effective once you know what you are dealing with. Ensure you know clearly what is going on.
- Regulate your sleep patterns. Get up no later than 8am and go to bed no later than 11.30pm, even if you can’t sleep. If you have problems getting up in the morning, get someone else to rouse you, or have a friend call.
- Eat 3 meals a day, whether you are hungry or not, at the right times.
- Ensure you get outside early to make sure you get enough bright light to help regulate your sleep patterns.
- Do things to occupy your mind. If you have nothing to do all day, you will tend to ruminate over your problems.
- If you are facing a big problem, make the decision to put off thinking about it for, say, 2 weeks, or whatever is appropriate in your case. If you cannot put it off, speak to someone else who you know to be a good practical problem solver.
- Begin a ‘depression diary’. In this rate each day from 1 to 10, where 1 is the worst kind of day, and 10 the best. This will help break down the ‘all or nothing’ thinking that depression can cause.
- Get as much exercise as you can. Make yourself walk briskly every day, at least. If you have any concerns about your health, see your doctor before beginning this. Research shows that exercise can lift depression.
- Get some kind of relaxation during the day. If you know how to do meditation, self hypnosis, tai chi or some other mind-calming technique, do it. It will help reduce the physical effects of the depression greatly.
- Start challenging your own thinking about things. If you find yourself thinking about things in a depressive way, deliberately think in a new way. A good way to do this is to write down the original thought, and then generate some alternatives.
- Understand that depression is not part of you; it is due to a set of symptoms. These symptoms cause you to feel, think and act differently to normal. Once depression goes, things will be different. And when you have the skills to beat it, it is more likely to stay away.
- Supplement your diet with pure high grade epa fish oil, this has been proven to help many people.
- seek nutritional advise to ensure that your diet is properly balanced.
Self help for depression can be difficult. Don’t be afraid to ask for help if you need it. Once you have beaten it, you can help others.
Seasonal Affective Disorder
SAD usually begins, in the Northern Hemisphere, around November reaching its worst point for sufferers in January and February. It is caused when the shorter days of winter reduce the amount of sunlight to the retina. The lack of sun causes the body’s level of serotonin to decrease while increasing the level of melatonin, which in turn causes seasonal depression. SAD symptoms disappear in spring, and many sufferers may experience a short period of hyperactivity or hypermania when the light begins to increase
Symptoms of Seasonal Affective Disorder
Appetite change – craving for sweet and starchy food (chocolate, pasta, bread)
Sleep disruption sleeping at odd times or for long periods of time
Difficulty in waking up (where this not the norm for you)
Weight gain
Fatigue all day no matter how much rest
Lack of energy and lethargy
Little or no sex drive
Mood swings
Lack of concentration
Inability to make decisions
Increased PMS in women
Withdrawal from social contact
Unfounded anxiety
Feelings of guilt or worthlessness
Thoughts of death and/or suicide
Treatment for Seasonal Affective Disorder
SAD can significantly improve with the use of light therapy, and some hospitals now have walk in clinics with light boxes for people with SAD. Light boxes have been an effective solution for as many as 80% of sufferers with improvements occurring in as little as four days of use. Light therapy should be the first treatment for SAD. If this does not work your Doctor may recommend antidepressants but do let your doctor know you want to try light therapy first (sometimes it may not be possible because of retinal disease or because your health authority does not support light therapy treatment). For people with milder versions of the SAD symptoms or a bad case of winter blues we have compiled a list of activities and treatments (costing nothing, or very little, to £100.00) that may help dispel some of the winter gloom
Ways to beat the winter blues (Seasonal Affective Disorder)
1. Increase Omega-3 essential fatty acids. Research has shown these to be effective in alleviating mild depression and symptoms of SAD. Flax seed oil and fish oil are the best sources.
2. Light up your life. Spending time outdoors during the day or arranging homes and workplaces to receive more sunlight can be really helpful. Studies have shown that an hour in the sunlight is as affective as 2 and half hours under a bright artificial light.
3. Get moving. Do something to reduce your stress and improve your endomorphic levels – walking, swimming, cycling or regular and moderate aerobic exercise.
4. Brighten Up. Keep your curtains or blinds open throughout the day and cut back any foliage that blocks light from your windows.
5. Buy a negative ioniser. Research in light therapy has also shown that SAD sufferers may benefit from negative ionisers.
6. Dawn simulation. Some people, especially those that need to wake in the morning when it is still dark may benefit from lamps that simulate a slow, gradual sunrise, in the final hours of sleep. The light levels are much lower than those used in bright light therapy and the units are much cheaper to purchase. People who have used these lamps say they are extremely effective, one user told us ‘after about a week I really felt my depression lift, and felt much more alert in the morning’.
7. Buy or rent a light box. Light boxes can be bought for as little as £100 and, in the UK, are now VAT free. It is possible to hire light boxes and the SAD association rents boxes to members. See our resources section at the end of this article for details.
8. Change your diet. Eat a diet rich in raw fruits and vegetables. with soybeans and soy products, brown rice, millet, and bens. Try to keep to a low fat diet and cut down on protein and red meat.
9. Cut out or down on caffeine and alcohol, switch to herbal teas. SAD sufferers often crave caffeine.
10. Cut down or out refined sugars
11. Try eliminating wheat from your diet
12. Watch your vitamins and minerals. Take daily magnesium and B complex vitamins. A banana smoothie every morning is a great way to ensure you are getting the magnesium you need during the winter too.
13. Take Vitamin D3. D3 is believed to enhance positive affect in patients suffering from winter blues. D3 helps in the utilisation of calcium, phosphorus and in the assimilation of Vitamin A. A dose of 400 to 800 IU per day is recommended, higher dosages should only be taken under the supervision of a professional health practitioner
Antidepressant
An antidepressant is a medication used primarily in the treatment of clinical depression. Some examples of antidepressants on the market today are:
• fluoxetine (Prozac, Sarafem, Fluctin, Fontex, Prodep, Fludep)
• sertraline (Zoloft, Lustral, Apo-Sertral, Asentra, Gladem, Serlift, Stimuloton)
• venlafaxine (Effexor)
• citalopram (Celexa, Cipramil, Talohexane)
• paroxetine (Paxil, Seroxat, Aropax)
• escitalopram (Lexapro, Cipralex)
• fluvoxamine (Luvox, Faverin)
• duloxetine (Cymbalta)
• bupropion (Wellbutrin)
Anitdepressant
Antidepressants are not thought to produce tolerance, although sudden withdrawal may produce adverse effects. Antidepressants create little if any immediate change in mood and require between several days and several weeks to take effect.
Some antidepressants, notably the tricyclics, are commonly used off-label in the treatment of neuropathic pain, whether or not the patient is depressed. Smaller doses are generally used for this purpose, and they often take effect more quickly.
Many antidepressants also are used for the treatment of anxiety disorders, and tricyclic antidepressants are used in the treatment of chronic pain disorders such as Chronic Functional Abdominal Pain (CFAP), Myofacial Pain Syndrome, and post-herpetic neuralgia.
Antidepressants do not seem to have all of the same addictive qualities as other substances such as nicotine, caffeine, cocaine, or other stimulants. There is still controversy on the definition of addiction. Some argue that antidepressants do not meet the general requirements for the commonly established view. While some antidepressants may cause dependence and withdrawal they do not seem to cause uncontrollable urges to increase the dose due to euphoria or pleasure. For example, if an SSRI medication is suddenly discontinued, it may produce both somatic and psychological withdrawal symptoms, a phenomenon known as “SSRI discontinuation syndrome” (Tamam & Ozpoyraz, 2002). When the decision is made to stop taking antidepressants it is common practice to “wean” off of them by slowly decreasing the dose over a period of several weeks.
Antidepressant
It is generally not a good idea to take antidepressants without a prescription. The selection of an antidepressant and dosage suitable for a certain case and a certain person is a lengthy and complicated process, requiring the knowledge of a professional. Certain antidepressants can initially make depression worse, can induce anxiety, or can make a patient aggressive, dysphoric or acutely suicidal. In certain cases, an antidepressant can induce a switch from depression to mania or hypomania, can accelerate and shorten a manic cycle (i.e. promote a rapid-cycling pattern), or can induce the development of psychosis (or just the re-activation of latent psychosis) in a patient with depression who wasn’t psychotic before the antidepressant.
Antidepressant History
Like many psychiatric drugs, antidepressants were discovered by accident. The first antidepressants, imipramine, a tricyclic, and iproniazid, a monoamine oxidase inhibitor, were discovered in the 1950s. These drugs were found to have the side effect of improving the patients’ mood. However, the newer SSRI antidepressants were early examples of rational drug design.
Antidepressant – How they are believed to work
The therapeutic effects of antidepressants are believed to be related to an effect on neurotransmitters, particularly by inhibiting the monoamine transporter proteins of serotonin and norepinephrine. Selective serotonin reuptake inhibitors (SSRIs) specifically prevent the reuptake of serotonin (thereby increasing the level of serotonin in synapses of the brain), whereas earlier monoamine oxidase inhibitors (MAOIs) blocked the destruction of neurotransmitters by enzymes which normally break them down. Tricyclic antidepressants (TCAs) prevent the reuptake of various neurotransmitters, including serotonin, norepinephrine, and dopamine. Although these drugs are clearly effective in treating depression, the current theory still leaves unanswered questions. For example, concentrations in the blood build to therapeutic levels in only a few days and begin affecting neurotransmitter activity immediately. Changes in mood, however, often take four weeks or more to appear. One explanation holds that the “down-regulation” of neurotransmitter receptors—an apparent consequence of excess signaling and a process that takes several weeks—is actually the mechanism responsible for the alleviation of depressive symptoms. Another theory, based on recent research published by the National Institutes of Health in the United States, suggests that antidepressants may derive their effects by promoting neurogenesis in the hippocampus.
Antidepressant Side effects
Antidepressants can often cause side effects, and an inability to tolerate these is the most common cause of discontinuing the medication. Sexual dysfunction is a very common side effect, especially with the SSRI’s. Occasionally the sexual side effects of SSRIs can persistent long after the medications have been discontinued, sometimes indefinitely. One exception to this is Wellbutrin (bupropion), which in many cases results in a moderately increased libido. Some clinicians have found that adding Wellbutrin to a regimen of SSRI medications can sometimes alleviate some degree of sexual dysfunction. However, the mechanism of action for Wellbutrin appears to be unique and quite different from other mood elevators, among these being a stimulant-like effect and concurrent insomnia, especially in the first few weeks of use. Moreover, some patients, as seen with most psycho-active drugs, cannot tolerate it all.
Although recent drugs may have fewer side effects, patients sometimes report severe side effects associated with their discontinuation, particularly with Paroxetine. Additionally, a certain percentage of patients do not respond to antidepressant drugs. Another advantage of some newer antidepressants is they can show effects within as few as five days, whereas most take four to six weeks to show a change in mood. However, some studies show that these medication might be even more likely to result in moderate to severe sexual dysfunction. However, there are medications in trials that appear to show an improved profile in regards to sexual dysfunction and other key side effects.
MAO inhibitors can produce a lethal hypertensive reaction if taken with foods that contain the amino acid tyramine, such as cheese and wine. Likewise, lethal reactions to both prescription and over the counter medications have occurred. Any patient currently undergoing therapy with an MAO inhibiting medication should be monitored closely by the prescribing physician and always consulted before taking an over the counter or prescribed medication. Such patients should also inform emergency room personnel and information should be kept with one’s identification indicating the fact that the holder is on MAO inhibiting medications. Some doctors even suggest the use of a medical alert ID bracelet.
Antidepressants often make the mania component of bipolar disorder worse, and should be used with great care in the treatment of that disorder, usually in conjunction with mood stabilisers. Their use should be monitored by a psychiatrist, but in countries such as Britain, New Zealand, and the United States, primary care physicians are able to prescribe antidepressants without consulting a psychiatrist.
In particular, it has been noted that the most dangerous period for suicide in a patient with depression is immediately after treatment has commenced, as antidepressants may reduce the symptoms of depression such as psychomotor retardation or lack of motivation before mood starts to improve. Although this appears to be a paradox, studies indicate the suicidal ideation is a relatively common component of the initial phases of antidepressant therapy, and it may be even more prevalent in younger patients such as pre-adolescents and teenagers. It is strongly recommended that other family members and loved ones monitor the young patient’s behavior, especially in the first eight weeks of therapy, for any signs of suicidal ideation or behaviors.
Depression Treatment
Beyond Prozac:
New Treatments, New Hope
Welcome to the 21st-century lab, where hormones, brain pacemakers and magnetic coils can be a depression treatment
We’ve come a long way. Some psychiatrists used to think you could cure depression by removing a patient’s colon or teeth. In the late 1800s, there was a doctor who observed his anxious patient become calm on a bumpy train; thereafter treatment consisted of shaking the poor man for greater and greater lengths of time.
In an attempt to cure the ancient malady of melancholia, we have resorted to scads of strategies, some of them plainly stupid or cruel, others, like Prozac, that work. But an estimated 30 percent of depressed patients are what’s called treatment resistant; they don’t respond to pills or talkor even shock. The good news is that there are new treatments making their way into the 21st-century world—treatments that offer hope for the newly diagnosed or for someone who has been suffering without, so far, a cure in sight.
Miracle Meds – depression treatment
It used to be that psychiatrists would try a patient on one antidepressant medication, wait eight weeks and, if it didn’t work, switch to another one. While this is still a viable (if frustratingly slow) tactic, psychiatrists are relying more and more on secondary, and even tertiary, drugs to boost the primary player. One of those booster drugs is Cytomel, a thyroid stimulator. Even women with normal thyroid levels can, under a psychiatrist’s supervision, take Cytomel in addition to an antidepressant. About 50 percent of the time, it helps the primary drug work more effectively. Other popular booster medications are lithium and Ritalin.
Hormone Therapy – depression treatment
Scientists have spent years and years investigating chemicals like serotonin and their effects on mood, while neglecting to study brain chemicals still more common, and abundant, like estrogen and progesterone. Andrew Herzog, M.D., a neuroendocrinologist at the Beth Israel Deaconess Medical Center in Boston, treats many women who don’t respond to Prozac and its chemical cousins with sex steroids. “The future of psychiatry lies largely in the realm of using hormones to regulate brain states,” Herzog says.
He believes many women become depressed either because they have a measurable imbalance of estrogen and progesterone or because their brains are too sensitively tuned to normal fluctuations. “Hormones are psychoactive,” Herzog says, “and there’s no doubt that they can have huge effects on our feelings.” Progesterone, claims Herzog, is seven times stronger than your average barbiturate, and it exerts a strong calming, even sleepy, effect. Estrogen, the opposite, provides pep just as well, if not better, than that Prozac pill you’re taking. For women with agitated depressions that make them nervous and jumpy, Herzog might prescribe progesterone to calm with a bit of estrogen to brighten, in the form of a cream the woman rubs into her skin. For lethargic depressions, Herzog emphasizes the estrogen instead, and he’s had remarkable success treating women who were deemed “untreatable.” “These hormones gave me my life back,” says one of his patients, who became depressed in her 40s and was incapacitated by her 50s.
Hormone treatment for depression requires that you see a knowledgeable neuroendocrinologist and that you undergo a hormone profile, having your levels of progesterone and estrogen measured at the beginning and end of the month. The procedure is new but so far highly promising.
“Get Happy” Pacemakers- depression treatment
The vagal nerve connects your brain stem with your upper body, specifically your lungs, heart and stomach. The nerve is a critical conduit for relaying information to and from your central nervous system, carrying electrochemical signals up its tubing and depositing them directly into your cortex.
Some years ago researchers began implanting a small pacemaker into the vagal nerves of epileptics to see if tiny pulses might help stop the seizures. The pacemakers did indeed reduce or eliminate seizures in some epileptics, but they did something else, as well, something surprising and critical. Epileptics with vagal-nerve pacemakers got happy. Their moods improved. That’s when researchers decided to try using them in people with treatment-resistant depression.
No one quite knows how or why they work. Some doctors hypothesize that vagal-nerve stimulation (VNS) instigates changes in norepinephrine and serotonin, two neurotransmitters closely associated with mood. John Rush, M.D., at the University of Texas Southwestern Medical Center at Dallas, and colleagues did a study of 30 people with treatment-resistant depression. They implanted the pacemakers into those people and, over a two-week period, gradually increased the amount of stimulation current to levels the patients could tolerate comfortably.
Forty percent of these patients showed a substantial decrease in depression as measured by a verbal test asking them about their thoughts and feelings; 17 percent had a complete remission.
After one year of VNS, more than 90 percent of the patients who benefited from the initial treatment continued to show a decrease in depression.
Magnetic Healing
Transcranial magnetic stimulation (TMS) may someday replace electroconvulsive therapy (ECT) altogether. In TMS, an electrical current passes through a handheld wire coil that a doctor then moves over your scalp. The electrical current makes a powerful magnetic pulse, which passes straight through your scalp and stimulates nerve cells in the brain.
TMS is in part remarkable because of its specificity. Researchers now believe they can target brain structures that they know are involved in the creation and maintenance of depression and anxiety.
Many studies indicate that magnetic brain stimulation once daily for two or more weeks may relieve depression (a typical patient’s symptoms are reduced by almost 30 percent). Although TMS is still considered an experimental form of treatment, various hospitals and clinics offer it. Within five to ten years, TMS may become a common form of treatment for people with depression.
And this is just the beginning. Twenty years ago we had only the crudest psychiatric drugs; in the space of two short decades, we’ve developed an arsenal, and more important than that, we’ve shown we’re capable of ever more complex and innovative treatment strategies. The next few decades will bring as-yet-unheard-of kinds of cures, for us, for our children and so on down the line.