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Key points
· Around one in 10 children are affected by depression before they reach 18.
· It is important to treat depression as early as possible.
· Half of all children with depression get better within a year.
Depression is a condition in which you or your child have a low mood, a loss of interest in everyday activities, feelings of low self-worth, a lack of energy and poor concentration, all of which last from two to six weeks.
About depression in children and young people
All children feel sad or miserable from time to time, but these feelings often pass. Depression can make your child feel sad or low for a long period of time. It can affect their social life, how they usually spend their time or other areas of their life.
The number of children affected by depression varies considerably between different countries. However, the World Health Organization estimates that two in 10 young people experience a mental health problem every year, and depression and anxiety are most common.
There are three levels of depression that are classified according to symptoms.
· Mild depression can cause your child to feel unhappy, but will not stop him or her from leading a normal life. Your child may find everyday things difficult to do and less worthwhile. If your child makes some simple lifestyle changes, it can help him or her to recover from mild depression.
· Moderate depression can have a significant impact on your child’s life and it can make him or her feel constantly miserable and low. It is important for your child to visit a doctor as changes in lifestyle alone are unlikely to help.
· Severe depression can cause your child to have constant negative thoughts and feel like he or she is not able to cope. It is important that your child visits a doctor as soon as possible as he or she may even have suicidal thoughts.
Around one in 10 children who have depression recover within three months. After a year, half of all children with depression get better. However, depression in children and young people can often come back (recur) and continue into adulthood. It is therefore important to treat the condition as early as possible.
Symptoms of depression in children and young people
The symptoms of depression can vary from person to person. Some of the most common symptoms include:
· a low mood and feeling irritable
· losing interest in everyday activities and not wanting to see friends or family
· feeling guilty or bad, being self-critical
· feeling hopeless or helpless
· feeling unhappy for most of the day
· lacking self-esteem
· problems sleeping
· tiredness and a lack of energy
· difficulty concentrating
· loss of confidence
· changes in appetite
· frequent aches and pains, such as a headache or stomach pain
· thoughts about death or suicide
These symptoms may be caused by problems other than depression. If your child has any of these symptoms, see a doctor for advice.
It can sometimes be difficult to tell if a young person has symptoms of depression or is showing signs of normal teenage development. Generally, children are said to have depression if they have symptoms for two weeks or longer.
Complications of depression in children and young people
Severe depression is associated with self-harm and suicide, so it is important to look out for changes in your child’s mood. Although this may not happen, it is important to be aware of these complications.
Causes of depression in children and young people
There is not a specific cause of depression and it can often be a combination of events that cause it. Depression tends to run in families and it also appears to be linked with chemical changes in the part of the brain that controls your child’s mood. Life events that can trigger depression include:
· family problems or parents splitting up
· the death of a relative, friend or someone close
· abuse
· bullying
· neglect
· long-term health problems or a serious illness
· problems at school, such as low grades
· a major life change, such as moving house
· relationship problems
· alcohol or drug use
If your child has had depression, their risk of having it again within five years is higher than a child who has not had depression. However, most children and young people who have depression will go on to lead a normal adult life.
Diagnosis of depression in children and young people
It is important to seek medical help early if you think your child has depression. A doctor is a good first point of contact. He or she may suggest your child goes to a child and adolescent mental health service for help.
As well as talking to your child about their symptoms, your child’s doctor may also get information from a range of people, such as you, and your child’s teachers.
There is no specific medical test to diagnose depression but your child may have a number of psychological and medical tests to see if any other medical condition is causing your child’s symptoms.
Many young people who have depression get better by themselves. However, if your child has severe depression, your doctor may refer him or her to see a specialist who can talk with your child about his or her problems. This may be a child psychiatrist (a doctor who specialises in mental health problems in children and adolescents) or a clinical psychologist.
Please note that availability and use of specific tests may vary from country to country.
Treatment of depression in children and young people
There are a number of treatments available for depression. Your doctor will advise you which type of treatment is most suitable for your child.
Self-help
If your child has mild depression, there are a number of things he or she can do to help ease their symptoms. For example, regular exercise, such as walking, running, swimming or cycling can help your child to feel better. Your child’s doctor may advise him or her to follow an exercise programme. It is also important that your child eats a healthy, well balanced diet.
It is also very important to be supportive. For example, you could try talking to your child about their problems and give some reassurance that you will help him or her to get better.
Talking therapies
Your child’s doctor may advise your child to have a talking therapy. However, the type of talking therapy your child has will depend on its availability, their preferences and what is most suitable.
Counselling will involve your child talking to a therapist about their problems. In these sessions, the counsellor will not offer advice or treatment, but will ask your child questions to help resolve his or her worries. Counsellors can sometimes help by working with you and your child’s school.
Cognitive behavioural therapy (CBT) can help your child to change their behaviour and negative thoughts and feelings. Your child may be able to have cognitive behavioural therapy individually or in a group with others the same age. Your child’s doctor will advise you on what is most suitable.
Interpersonal therapy involves your child talking with a therapist about any relationship problems he or she may have with friends, family or people at school. The therapist may be able to help your child to solve or manage their problems.
Family therapy is a type of treatment that involves you and your child working together. You meet with a therapist and your child will talk about any problems he or she is having. It is important that you and any other family members who are involved with your child go to the sessions together.
Medicines
Your child’s psychiatrist will only prescribe antidepressant medicines if your child has severe depression, or if their symptoms do not go away. Your child’s psychiatrist may advise that he or she takes an antidepressant called fluoxetine as well as have a talking therapy.
Your child will need to see their psychiatrist weekly for the first four weeks of their treatment and then regularly afterwards. Your child’s psychiatrist will give you and your child information about any possible side-effects of the medicine and how long the treatment should last.
If your child does not feel better after taking fluoxetine, he or she may be prescribed a different antidepressant such as sertraline or citalopram. However, this is rare as there are concerns about harmful side-effects. Always ask a doctor for advice and read the patient information leaflet that comes with the medicine.
Your child will need to continue to take antidepressant medicines for six to nine months after he or she feels better.
Hospital treatment
Most children and young people who have depression get better without needing hospital treatment. However, if your child has suicidal thoughts or their psychiatrist is concerned about self-harm, your child may need to go into hospital.
Complementary therapies
St John’s wort is often used by adults as an alternative to antidepressant medicines. However, do not give it to your child as the safety of the herbal remedy is unknown in children.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.
Produced by Rachael Mayfield-Blake, Bupa Health Information Team, July 2013.
Further information
· International Mental Health Research Organisation
www.imhro.org
· International Society for Affective Disorders
www.isad.org.uk
Sources
· Adolescent mental health. World Health Organization, 2012. www.who.int
· Personal communication, Dr S Narayan, Consultant Child and Adolescent Psychiatrist, 18th July 2013
· FAQS on child and adolescent depression. American Academy of Child and Adolescent Psychiatry. www.aacap.org, published 9 May 2013
· Depression in children and adolescents. National Institute of Mental Health. www.nimh.nih.gov, published 9 May 2013
· Pediatric depression. eMedicine. www.emedicine.medscape.com, published 25 October 2012
· Depression in children and young people: information for young people. Royal College of Psychiatrists. www.rcpsych.ac.uk, published March 2012
· Depression: a global public health concern. World Health Organization. www.who.int, published 9 May 2013
· Depression in children. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published January 2009
· Depression in children and young people. National Institute for Health and Care Excellence. www.nice.org.uk, published 25 October 2005
· Cox GR, Callahan P, Churchill R, et al. Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. Cochrane Database of Systematic Reviews 2012, Issue 11. doi: 10.1002/14651858.CD008324.pub2
· The use of medication in treating childhood and adolescent depression: information for patients and families. Parentsmedguide.Org. www.parentsmedguide.org, published 9 May 2013
· Depression. Mind. www.mind.org.uk, published 9 May 2013
· Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 13 May 2013
· Pediatric depression treatment and management. eMedicine. www.emedicine.medscape.com, published 25 October 2012
· Mental health in children and young people. Royal College of Nursing. www.rcn.org.uk, published 2009
· Merry SN, Hetrick SE, Cox GR, et al. Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database of Systematic Reviews, 2011, Issue 12. doi: 10.1002/14651858.CD003380.pub3
· Public assessment report: fluoxetine 20mg hard capsules. Medicines and Healthcare Products Regulatory Agency. www.mhra.gov.uk, published 24 May 2012
· How to cope with exam stress. Mind. www.mind.org.uk, published 9 May 2013
Krabi Nakharin International Hospital
1 Pisanpob Rd., Paknam Sub-district, Muang Krabi District, Krabi 81000
www.krabinakharin.co.th
075 626 555
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