Depression is a common illness affecting about 15 million people, including children.

Dr. Stuart Brown, a Board Certified Family Physician with Trinity Medical Group, explains that depression is a serious health condition that must be recognized and understood.

DEPRESSION

The Webster dictionary defines depression as a condition of low spirits. Medically, Dr. Brown notes it is diagnosed when someone has a depressed mood or loss of interest plus other symptoms such as a change in appetite or weight, sleeping a lot or very little, fatigue or loss of energy, feelings of worthlessness and/or recurrent thoughts of death. And typically, the first episode begins in young adulthood, although it can occur at any age.

The CDC notes that while occasionally being sad or feeling hopeless is a part of every child’s life, when children feel persistently this way they may be diagnosed with depression.

• Feeling sad, hopeless, or irritable a lot of the time
• Not wanting to do or enjoy doing fun things
• Changes in eating patterns – eating a lot more or a lot less than usual
• Changes in sleep patterns – sleeping a lot more or a lot less than normal
• Changes in energy – being tired and sluggish or tense and restless a lot of the time
• Having a hard time paying attention
• Feeling worthless, useless, or guilty
• Self-injury and self-destructive behavior

The CDC also indicates that extreme depression can lead a child to think about or plan for suicide. In youths ages 10-24 years old, suicide remains the leading cause of death. (Read about youth suicide prevention.)

Dr. Brown explains that an episode doesn’t mean an hour or even a day or a week. “Untreated, the first episode will usually last a few months to a year,” he says. “However, 90% will have recurrence after a third episode. Therefore, many people need to continue lifelong treatment to prevent recurrent bouts of depression.”

Depression not only affects a person’s mental health but their physical health as well. “It increase the risk of developing heart disease, osteoporosis, diabetes, and cerebrovascular disease,” Dr. Brown explains. “Depression occurs in cancer and cardiac patients and also in people with other medical conditions such as thyroid conditions, hepatitis and fibromyalgia.”

ANXIETY

Dr. Brown notes that about 60% of people with depression also have anxiety. And according to the CDC, this is when children do not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include

• Being very afraid when away from parents (separation anxiety)
• Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)
• Being very afraid of school and other places where there are people (social anxiety)
• Being very worried about the future and about bad things happening (general anxiety)
• Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Anxiety may present as fear or worry but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed.

Related conditions include Obsessive-Compulsive Disorder and Post Traumatic Stress Disorder.

(Learn more about anxiety in children)

TREATMENT

Dr. Brown notes that while stressors in life may trigger events, genetics also appears to play a role, “Those people with family members who have psychiatric problems are at higher risk of depression. And, treatment does not necessarily mean medication.”

According to Dr. Brown, Psychological treatment can be just as effective and may actually have a lower risk of recurrence because patients learn to cope with the stressors that can trigger depression.

The CDC encourages parents and guardians to first talk with a healthcare provider to get an evaluation.

The American Academy of Child and Adolescent Psychiatry (AACAP) recommends that healthcare providers routinely screen children for behavioral and mental health concerns. The explain that it is important to get a careful evaluation to get the best diagnosis and treatment.

Consultation with a health provider can help determine if medication should be part of the treatment. A mental health professional can develop a therapy plan that works best for the child and family. They note several kinds of therapy including behavior therapy, and cognitive-behavioral therapy. Behavior therapy includes child therapy, family therapy, or a combination of both. The school can also be included in the treatment plan. For very young children, involving parents in treatment is key. Cognitive-behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. It helps the child change negative thoughts into more positive, effective ways of thinking, leading to more effective behavior. Behavior therapy for anxiety may involve helping children cope with and manage anxiety symptoms while gradually exposing them to their fears so as to help them learn that bad things do not occur.

Treatments can also include a variety of ways to help the child feel less stressed and be healthier like nutritious food, physical activity, sufficient sleep, predictable routines, and social support.

Get help finding treatment

Here are tools to find a healthcare provider familiar with treatment options:

• Psychologist Locator, a service of the American Psychological Association (APA) Practice Organization.
• Child and Adolescent Psychiatrist Finder, a research tool by the American Academy of Child and Adolescent Psychiatry (AACAP).
• Find a Cognitive Behavioral Therapist, a search tool by the Association for Behavioral and Cognitive Therapies.
• If you need help finding treatment facilities, visit MentalHealth.gov.

When considering medication, Dr. Brown notes depression medications differ in terms of side effects. “Some older medications called Tricyclics were more sedating than the newer medications called SSRIs. SSRIs have less side effects but can cause stomach upset and fatigue. Therefore, medication choices are based on effectiveness, side effects and sometimes possible drug interactions. It is not a one size fits all approach, but an approach based on individual needs.”

MANAGING SYMPTOMS: STAYING HEALTHY

“It is important to maintain a healthy diet, as nutritional deficiencies can aggravate depression,” adds Dr. Brown. “Exercise is also extremely important as it helps the body restore its natural hormone levels and can also help with self-esteem.”

The CDC also indicates being healthy as an important approach for all children, especially those struggling with depression or anxiety.

• Eating a healthful dietcentered on fruits, vegetables, whole grains, legumes (for example, beans, peas, and lentils), lean protein sources, and nuts and seeds
• Participating in physical activityfor at least 60 minutes each day
• Getting the recommended amount of sleepeach night based on age
• Practicing mindfulness or relaxation techniques

PREVENTION

It is not known exactly why some children develop anxiety or depression. Many factors may play a role, including biology and temperament. But it is also known that some children are more likely to develop anxiety or depression when they experience trauma or stress, when they are maltreated, when they are bullied or rejected by other children, or when their own parents have anxiety or depression.

CDC officials add that although these factors appear to increase the risk for anxiety or depression, there are ways to decrease the chance that children experience them. Learn about public health approaches to prevent these risks:

• Bullying prevention 
• Child maltreatment prevention
• Youth violence prevention
• Depression after birth
• Caring for children in a disaster

“It’s important not to overlook or ignore depression,” adds Dr. Brown. “It can be treated and medication may not be required. If someone you know is suffering, try to get them to seek help. You can also help by including them in fun activities, helping them eat healthy, and inviting them to exercise with you. It will do you both good.”

Healthy Tip Tuesday is a Newsymom.com exclusive informational series brought to you by Trinity Hospital Twin City.