Posted: March 30th, 2022

Depression in Children and Adolescents

Depression in Children and Adolescents

 

Depression is a severe sickness, which is capable of affecting almost all parts of a young individual’s life and considerably affects his or her family as well. It can interfere with relationships amidst friends and family members, damage performance at school and limit other academic opportunities. It can result to other health issues because of the impacts it has on eating, physical activity, as well as sleeping. Given that it has several repercussions, it is very vital that the illness is realized and successfully treated. When this is done, the majority of kids can resume with their normal daily lives. Depression is not easily noticeable in kids. The symptoms of depression are frequently hidden in kids by other physical and behavioral complaints. The majority of young individuals that are depressed shall at the same time also have a second psychiatric condition, which complicates diagnosis (APA & AACAP, n.d.).

 

Not more than three years ago, depression was regarded as a mainly adult disorder: kids were regarded to be too immature in terms of development to be able to experience depressive disorders, and low moods in adolescents were viewed as being part of ‘ordinary’ teenage mood swings. Developmental researches have, however, been central in changing that perspective. A few would now question the reality of child and adolescent depressive disorders, or even that adolescent depression is linked to a variety of negative outcomes with the inclusion of academic and social impairments together with both mental and physical health concerns, later in their life. Additionally, however, not only has studies on the course and depression correlation recognized significant similarities across development, but has also emphasized age-associated variations; as an outcome, researchers continue to assess the degree to which childhood, youth and adult onset depressions display the same basic conditions (Maughan, Collishaw, & Stringaris, 2013).

 

Diagnostic Criteria

 

Diagnostic criteria for unipolar depression concentrate on the main symptoms of continual and pervasive grief, together with lack of enjoyment or interest in activities; related symptoms include excess guilt, low self-esteem, suicidal behaviors or thoughts, psychomotor retardation or agitation, and appetite and sleep interruptions. Majorly, these particular criteria are implemented notwithstanding age (with the inclusion of age-suitable changes, in the latest researches of pre-schoolers) (Maughan, Collishaw, & Stringaris, 2013).

 

All through the course of life, depression is co-morbid with other psychiatric disorders. For adulthood, the most important associations are actually with anxiety. As for the school-aged samples, about two-thirds of young individuals suffering from depression display at least one co-morbid disorder, and more than ten percent display two or more; overlaps with disruptive disorders such as Oppositional Defiant Disorder [ODD], Conduct Disorder [CD], and Attention Deficit Hyperactivity Disorder [ADHD] are just as common like other emotional diagnoses at this particular stage (Maughan, Collishaw, & Stringaris, 2013).

 

In the pre-school samples, co-morbidity rates are even greater, having three out of every four depressed preschoolers reported as displaying further vulnerabilities (Egger & Angold, 2006; Wichstrom, Berg-Nielsen, Angold, Egger, Solheim, & Sveen, 2012). In case several disorders co-occur in this manner, some two-way relations might basically reflect overlaps related disorders. Such an example is ADHD-depression co-morbidity disorder that is mediated by the strong connections of both disorders with ODD/CD. Additionally, ODD seems to be playing a major role in pre-school samples; it is actually the commonest depression concomitant in all young kids, and mediates connections with anxiety and ADHD at this phase. According to Egger and Angold (2006), these particular results raise questions regarding the degree to which depressive disorders, particularly among preschoolers are comparable to those in later development, or if they might instead index a more universal syndrome of behavioral and emotional dysregulation (Maughan, Collishaw, & Stringaris, 2013).

 

Risk Processes and Mechanisms

 

Examples of psychosocial risks are family grief, disagreement and separation, child neglect and maltreatment, and peer clashes and bullying. Chronic stressors impacting relationships seem to bear more influence compared to isolated acute occurrences, particularly in females (Thapar et al., 2012). Additionally, there are various pointers to aetiological disparities amid adult-, adolescent-, and child-onset depression. Firstly, the balance of environmental and inherited risks seem to differ across development, with two identical studies constantly reporting lower heritability estimations for childhood depression than in adolescence depression (Maughan, Collishaw, & Stringaris, 2013).

 

Childhood difficulties, such as sexual abuse, psychopathology, and poverty, might also put forward distal threats for depression, later on in life, through more nerve-racking and disadvantaged life conditions (Maughan, Collishaw, & Stringaris, 2013).

 

From a developmental point-of-view, a major issue deals with factors, which contribute to the post-pubertal increase and surfacing of sex disparity in depression among adolescent children. Several methods have been suggested here, with the inclusion of gender differences in the cognitive processing of nerve-racking occurrence and coping methods: increased sensitivity or exposure to psychosocial stress among the teenage girls; hormonal variations related with pubertal maturation; as well as variations in the basic development of the brain (Maughan, Collishaw, & Stringaris, 2013). Unraveling certain causal mechanisms is quite challenging, provided the degree of psychosocial, biological, and cognitive changes taking place during puberty, and the possibility of intricate interactions amid varying mechanisms and factors. Additional proof is also required on how far the aetiological mechanisms talked of here are limited to depression or instead play a part in the extensive risk for psychopathology, and might therefore assist in explaining co-morbidity (Maughan, Collishaw, & Stringaris, 2013).

 

Medication

 

Antidepressant medications could be quite effectual in alleviating depression symptoms for various kids and teenagers. One antidepressant- fluoxetine or Prozac- a drug in the group of selective serotonin reuptake inhibitors (SSRI’s) has been endorsed by the FDA for the treatment of depression in children above the age of 8. Lexapro or Escitalopram has also been endorsed by the FDA for the treatment of adolescents above the age of 12. Doctors might also prescribe other antidepressant drugs. One should realize that the prescription of an antidepressant, which has not been endorsed by the FDA for use on adolescent and child patients (called off-label use or prescribing) is quite common and consistent with the general clinical practice (APA & AACAP, n.d.). However, unusual antipsychotics are not endorsed by the FDA for treating depression among adolescents and kids and are not regarded as suitable for first-line treatment. Tricyclic antidepressants that are generally being used such as amitriptyline and imipramine have not been proven to be effectual for pediatric depression and thus should not be utilized as the first treatment. Approximately 60% of adolescents and kids respond to initial treatment with medicine. Out of those that do not, a considerable number responds to a different medicine and/or to the addition of a kind of psychotherapy known as cognitive behavioral therapy (CBT) (APA & AACAP, n.d.).

 

Prevention of Depression in Children and Adolescents

 

Majority of the treatments for youth depression were initially developed for adult treatment, and later utilized on the young individuals. Contrary to the Developmental Center for most of neurobiologic and epidemiologic studies on depression, treatment analyses have rarely been directly studied to determine if developmental factors bear moderating or predictive impacts on the treatment results. This might partially indicate the practical challenges of carrying out therapeutic studies with sufficiently large sample sizes to permit robust evaluation across developmental times (Maughan, Collishaw, & Stringaris, 2013).

 

Presently, treatments for preschools suffering from depression are being studied (Luby, 2010). Here, the studies concentrate on three major evidence-based depression treatments in older kids as well as adolescents: cognitive and behavioural therapy (CBT); interpersonal therapy (IPT); and pharmacotherapy with fluoxetine or another serotonin reuptake inhibitor (SRI). The latest proof involves the temporary impacts of these particular treatments as determined by Randomized Control Trials (RCTs); there is minimal research at this phase, regarding their impact on permanent outcomes (Maughan, Collishaw, & Stringaris, 2013).

 

The prevention of depression utilizing psychological methods appears to be practical, though it is most probably effective in adolescents and kids at great risk by virtue of sub-threshold symptoms, family history, or a past diagnosis of depression. One of the methodologically most thorough researches in this particular field compared a group-centered behavioral and cognitive prevention program to ordinary care only in teenagers at high risk as an outcome of present sub-threshold symptoms or past depression. The degree of incident depression and of self-reported depressive symptoms was considerably lower among those randomized to the prevention arm (Maughan, Collishaw, & Stringaris, 2013).

 

Cognitive Behaviour Therapy

 

Certain kinds of psychotherapy like interpersonal therapy (IPT) and cognitive behavioral therapy (CBT) are useful in the treatment of moderate to mild kinds of depression. CBT attempts to assist the patient realize and modify adverse thinking and behavioral patterns, which might lead to depression. IPT directs the patient to problem solving advances to destroyed interpersonal relationships, which could both lead to and be a result of depression (APA & AACAP, n.d.).

 

CBT has been investigated more in the depressed adolescents than in depressed kids. Most of these researches have displayed that CBT is superior to other kinds of psychotherapy in alleviating depression. A particular study, which contrasted treatment with CBT and treatment with medicine revealed that while medicine actually worked faster, by sixteen weeks, those patients treated with cognitive behavioral therapy were doing just as good as those treated with medicine. Majority of studies have discovered that for most acute or constant depression, the coupling of medicine and CBT is the most effective as well as fastest approach (APA & AACAP, n.d.).

 

CBT had been utilized with younger kids, but majorly in the prevention of depression or in treating kids with milder symptoms. Given that CBT is useful for kids having anxiety disorders, it might also assist younger kids with depression. CBT needs specific training. In case a therapist portrays him/herself as a CBT therapist, parents need to go ahead and ask the kind of CBT training the therapist has received (APA & AACAP, n.d.).

 

Conclusion

 

According to this brief overview, developmental studies have made major contributions to the comprehension of adolescent and child depression, as well as the intricate interactions amid inherited, social, and psychological factors, which impact long- and short-term risks. A developmental point-of-view has been very important in understanding how proximal and distal risks interact with ordinary developmental procedures to influence vulnerability in childhood, adolescent and adulthood depression (Maughan, Collishaw, & Stringaris, 2013). The society needs to somehow conclude that protecting kids from danger and educating them, means that they should not be robbed of the very activities which makes them the happiest (Gray, 2011).

 

Studies on childhood depression have come a very long way since the 1980s. There is no longer doubt whether kids can encounter clinically significant depression episodes or not; trustworthy estimations of its prevalence in kids and a more clear understanding of its course and presentation now exist. Considerable steps have also been made in understanding the physiological and neural foundations of depression in kids, together with genetic, environmental, and cognitive environmental risk factors (Gibb, 2014).

 

Bibliography

 

APA, & AACAP. (n.d.). The Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families. Parents Medical Guide Workgroup, 1-6.

 

Egger HL, Angold A. (2006).Common emotional and behavioral disorders in preschool children: Presentation, nosology, and epidemiology. Journal of Child Psychology and Psychiatry;47:313-337.

 

Gibb, B. (2014). Depression in Children. 383.

 

Gray, P. (2011). The Decline of Play and the Rise of Psychopathology in Children and Adolescents. American Journal of Play, 459.

 

Luby JL.(2010). Preschool depression: The importance of identification of depression early in development. Current Directions in Psychological Science;19:91-95

 

Maughan, B., Collishaw, S., & Stringaris, A. (2013). Depression in Childhood and Adolescence. NCBI, 35-40.

 

Thapar A, Collishaw S, Pine DS, Thapar AK.(2012). Depression in adolescence.Lancet;379:1056-1067

 

Wichstrom L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH.(2012). Prevalence of psychiatric disorders in preschoolers.Journal of Child Psychology and Psychiatry; 53:695-705

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