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Kelly E. Miller
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Depression-Understanding It


Your daughter spends more time in her room than usual, with the door closed and the shades drawn. She sleeps a lot, and even the family dog can't make her smile anymore. She has stopped hanging out with her friends, and when you ask what's going on, she just mumbles.

Normal teen behavior? Not really. There's more here than meets the eye, something that's telling you things are not right.

It's possible that your child is depressed. In the United States, depression is the most common mental health disorder, affecting 17 million people of all age groups, races, and economic backgrounds each year. As many as one in every 33 children may have depression; in adolescents, that number may be as high as one in eight. If you suspect that your child is depressed, you'll want to learn more about what depression is, what causes it, and what you can do if your child is depressed.

What Is Depression?
Depression isn't just bad moods and occasional melancholy. It's not just feeling down or sad, either. These feelings are normal in children, especially during adolescence. Even when major disappointments and setbacks make people feel sad and angry, the negative feelings usually lessen with time. But when a depressive state, or mood, lingers for a long time - weeks, months, or even longer - and it limits a child's ability to function normally, it can be diagnosed as depression.

Two types of depression, major depression and dysthymia, can affect children. Major depression is characterized by a persistent sad mood and the inability to feel pleasure or happiness. A child with major depression feels depressed for most of the day, almost every day.

If the sadness is not as severe but continues for a year or longer, the condition may be dysthymia.

Bipolar disorder is another type of mood disturbance and is characterized by episodes of low-energy depression (sadness and hopelessness) and high-energy mania (irritability and explosive temper).

What Causes Depression?
Depression usually isn't caused by one event or thing; it's the result of one or more factors, and its causes vary from child to child. Depression can be caused by lowered levels of neurotransmitters (chemicals that carry signals through the nervous system) in the brain, which limits a person's ability to feel good. Depression can run in families, so a child who has a close relative with depression may be more likely to experience it herself.

Significant life events such as the death of a loved one, a divorce, a move to a new area, and even a breakup with a girlfriend or boyfriend can bring on symptoms of depression. Stress also can be a factor, and because the adolescent years can be a time of emotional and social turmoil, things that are difficult for anyone to handle can be devastating to a teen.

Also, chronic illness can lead to depression, as can the side effects of certain medicines or infections.

Diagnosing Depression
Depressed children have described themselves as feeling hopeless about everything or feeling that nothing is worth the effort. They honestly believe that they are "no good" and that they're helpless to do anything about it.

But for an accurate diagnosis of major depression to be made, a more detailed clinical evaluation must be done. A medical or mental health professional (such as a psychologist or psychiatrist) must be sure that your child has had five or more of the following symptoms for more than 2 weeks:

  • a feeling of being down in the dumps or really sad for no reason
  • a lack of energy, feeling unable to do the simplest task
  • an inability to enjoy the things that used to bring pleasure
  • a lack of desire to be with friends or family members
  • feelings of irritability, anger, or anxiety
  • an inability to concentrate
  • a marked weight gain or loss (or failure to gain weight as expected), and little or too much interest in eating
  • a significant change in sleep habits, such as trouble falling asleep or getting up
  • feelings of guilt or worthlessness
  • aches and pains even though nothing is physically wrong
  • a lack of caring about what happens in the future
  • frequent thoughts about death or suicide

A child who has dysthymia must experience two or more of the following symptoms almost all the time for at least 1 year:

  • feelings of hopelessness
  • low self-esteem
  • sleeping too much or being unable to sleep
  • extreme fatigue
  • difficulty concentrating
  • lack of appetite or overeating

Depressed children and teens are more likely to use alcohol and drugs than those who aren't depressed. Because these substances can momentarily allow a child to forget about her depression, they seem like perfect "fixes." But they don't fix anything; in fact, they can make the depressed child feel even worse.

Recognizing Depression in Your Child
If you've discovered that more than a few of the symptoms of major depression or dysthymia apply to your child, you may have reason for concern.

Don't dismiss your concerns or think that the symptoms will go away by themselves - they probably won't, and they may get worse. And don't think that you're responsible for your child's depression - even if something you did (such as a divorce) triggered it, it's not your fault. It's nobody's fault.

Let your child know that you are there for her, whenever she needs you and wherever you may be. Remind your child of this over and over again - she may need to hear it a lot because she feels unworthy of love and attention. If your child shuts you out, don't walk away - remain there for her. Once your child begins to talk, let her talk about whatever she wants to talk about and don't criticize. The important thing is that she's talking and communicating her feelings. This will help your child begin to realize that her feelings and thoughts really do matter, that you truly care about her, and that you never stopped caring even when she became depressed.

If You Suspect a Problem
The good news is that there are professionals who can help your child. Depression can be successfully treated in more than 80% of the people who have it. But if it goes untreated, depression can be deadly. Depression is the number-one cause of suicide.

Depression is commonly treated with a combination of therapy and medicine. A psychiatrist can prescribe medicine, and although it may take a few tries to find the right one for your child, most children who follow the regimen eventually begin to feel better. Therapy focuses on the causes of the depression and works to help change negative thoughts and find ways to allow your child to feel better. Feeling is healing, and talking about feelings can be a powerful antidote for depression. A good therapist will communicate this to your child.

With proper treatment and your help, your child can lead a normal, happy, and fulfilling life.

Reviewed by: Paul Robins, PhD
Date reviewed: May 2001

Source:  KidsHealth www.KidsHealth.com is a project of The Nemours Foundation which is dedicated to improving the health and spirit of children. Today, as part of its continuing mission, the Foundation supports the operation of a number of renowned children's health facilities throughout the nation, including the Alfred I. duPont Hospital for Children in Wilmington, Delaware, and the Nemours Children's Clinics throughout Florida. Visit The Nemours Foundation to find out more about them and its health facilities for children http://www.nemours.org/no/ 

Dysthymic Disorder

Background: The current consensus is that major depressive disorder, dysthymia, double depression (alternating dysthymia and depression), and some apparently transient dysphorias all are manifestations of the same disease process. Thus, all of these varieties of depression respond to similar psychological and physical treatments, and they share polysomnographic abnormalities.

Because transitions between dysthymia and major depression are common, dysthymia is highly predictive of a major depression. For this reason, considerable redundancy will occur between a discussion of major depression and a discussion of dysthymia. However, the goal of this chapter is to emphasize issues that apply particularly to dysthymia.

By definition, dysthymia is a chronic mood disorder, with a duration of at least 2 years in adults and 1 year in adolescents and children. It is manifested as depression for most of the day, occurring more days than not, and accompanied by some of the following symptoms:

  • poor appetite or overeating
  • insomnia or hypersomnia
  • low energy or fatigue
  • low self-esteem
  • poor concentration
  • difficulty making decisions, and
  • feelings of hopelessness.

For cases of dysthymia, manic episodes must not have occurred, and major depressive episodes must not have occurred in the first 2 years of the illness (1 year in children).

By contrast, major depression is diagnosed if 5 or more of the following symptoms have been present most of the day, every day, for the past 2 weeks and if depressed mood (the first symptom) or loss of interest or pleasure in usual activities (the second symptom), or both, is present.

  • Depressed mood

  • Loss of interest or pleasure in usual activities

  • Significant weight loss or gain

  • Insomnia or hypersomnia

  • Psychomotor agitation or retardation

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive or inappropriate guilt

  • Diminished ability to think or concentrate

  • Recurrent thoughts of death or suicide

Chronic depression can be separated into the following 3 subtypes:

  • Chronic major depression with a duration of more than 2 years

  • Milder dysthymia

  • Double depression, where episodes of major depression are superimposed on more enduring dysthymia

A potential point of confusion is the term dysphoria, which is defined as a mood of general dissatisfaction, restlessness, depression, and anxietya feeling of unpleasantness or discomfort. Thus, dysphoria refers to a transient state that fails to meet the criteria for dysthymia or major depressive disorder either in severity or in duration. The term dysphoria also may be used for more specific disorders such as gender-specific dysphoria, dysphoric mania, premenstrual (late luteal phase) dysphoria, and hysteroid dysphoria.

While dysthymia is by definition less severe than a major depression, the consequences of dysthymia without major depression are grave and include severely impaired functioning, increased morbidity from physical disease, and increased risk of suicide. 

See EMedicine's full article on this subject, including Authors, Description, Treatment, Medication, and Care: http://www.emedicine.com/med/topic3120.htm