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What caregivers might notice in their child?Children and adolescents with depression may experience some or all of these symptoms below everyday, or most of the day: Feeling or appearing sad, tearful or irritable Not being able to have fun doing things that were fun before Eating a lot more or a lot less than usual Moving around very quickly or very slowly Sleeping much more or much less than usual Having a lot less energy than usual Feeling like they are “no good” or guilty Having a hard time thinking, concentrating, or remembering Having thoughts about hurting or killing themselves Something to note, younger children may have a harder time expressing their sad thoughts than older children. Be on the lookout for signs of increased irritability, boredom, and physical complaints as signs of depression for younger children.
Who is affected by depression?Depression is a mental health condition that can affect people of all ages, even children. Depression is more common in adolescence, with more than half of adolescents reporting feeling depressed at some point. However, depression can also affect younger children, even preschoolers. Children and adolescents may not know how to talk about feeling down or worried and may become withdrawn or less cooperative or irritable
What causes depression?Research suggests that depression has a genetic component. Depression is more common among kids who have a family history of the condition, and it is believed that certain genes may make some people more vulnerable than others. While the presence of these genes does not guarantee that a person will develop depression, it does increase the risk. Additionally, stress can also play a role in both the onset and severity of depression. Stress can come in all different forms and might include: Difficulties with peers Family relationship challenges School changes Loss of a loved one Developmental factors (such as learning and language disabilities) Puberty can also be an additional time of stress for an adolescent. During this time, it's normal for children to experience some ups and downs during. After all, they're going through a lot of changes both physically and emotionally. However, for some children, these changes can be overwhelming and can lead to depression and anxiety. Adolescents are likely to react more emotionally due to their stage of brain development and the fact that they don't yet have effective problem-solving skills. With the support of family and friends, most children will eventually adjust to the changes they are experiencing and emerge from puberty unscathed. However, if you are concerned about your child’s emotional well-being, don’t hesitate to seek professional help.
Treatments that work for depressionCognitive Behavioral Therapy (CBT) CBT is a widely researched form of psychotherapy that has been shown to be an effective form of treatment for youth with depression. CBT focuses on how a child’s thoughts, feelings, and behaviors are interconnected. A CBT therapist will collaboratively work with your child to help them learn new skills, tools, and knowledge needed to help them improve their mood. A CBT therapist may also work with a child’s caregivers to provide them with [PM1] resources and skills to continue to help their child after therapy ends. CBT therapy sessions that include the caregivers may be together or individual (parent alone, child alone). CBT will likely also incorporate hands on techniques that you and your child can practice in-between treatment sessions. These in-between practices help your child generalize the lessons learned in treatment to outside of the therapy office. Pediatric guidelines recommend CBT as a first-line treatment for those with mild depression. However, for those adolescents with more severe depression and those that have treatment-resistant depression, CBT combined with antidepressant medication may be the most effective form of treatment. CBT alone treatment typically incorporates six to 16 weekly sessions. Click here for more information. Interpersonal Psychotherapy-For Adolescents (IPT-A) Although CBT is the most widely studied psychotherapeutic intervention for adolescents, IPT is a well-established treatment that has been shown to be effective for a variety of mental health conditions. IPT-A is a type of therapy that can help teens improve their relationships with others. The goal of IPT-A is to learn how to effectively communicate emotions and needs, problem-solve within a significant relationship, and understand the biopsychosocial explanation of depression. A biopsychosocial model emphasizes that negative or distressing events people experience can exacerbate feelings of sadness and worthlessness, both common symptoms of depression. As relationships with others improve, the depressive symptoms may subside, and the person will hopefully experience improved functioning in multiple areas of his/her life. Teens who undergo IPT-A therapy may find that they are better able to manage their depression and have more positive relationships with others. An IPT-A therapist will focus on improving your adolescent’s communication and problem-solving skills through incorporating techniques such as psychoeducation, affect labeling, and social skills training. IPT-A will also include techniques that your child can practice in-between treatment sessions. These in-between practices help your child generalize the lessons learned in treatment to outside of the therapy office. The therapist will work with the adolescent in individual sessions as well as help their caregivers learn additional ways to support their child and monitor their symptoms. IPT-A treatment typically incorporates 12 to 16 weekly sessions. Dialectical Behavioral Therapy (DBT) DBT, is a type of cognitive behavioral therapy that was originally developed for adults. In recent years, however, it has been adapted for use with adolescents. DBT has been proven to be an effective treatment for moderate to severe depression, as well as co-occurring disorders such as anxiety and substance abuse. It is also effective in treating self-harm and suicidal behaviors. DBT is based on CBT, but it also includes strategies for controlling emotions and handling stressful situations. As a result, DBT is a highly effective treatment for adolescents struggling with mental health issues. DBT is particularly useful for adolescents who have difficulty managing their feelings of intense emotions and mood swings. A DBT therapist will help your child learn skills related to emotion regulation, managing relationships appropriately, distress tolerance, mindfulness, and finding a balance within their emotional reactions. DBT incorporates individual therapy sessions for your teen, group sessions with peers, and one-on-one coaching during emotional crises. DBT treatment typically incorporates 1-2 sessions per week for approximately six months. Medications Antidepressant medication can be an effective form of treatment for children and adolescents struggling with depression. In fact, the American Academy of Child and Adolescent Psychiatry indicates that about 55-65% of children and adolescents will respond to initial antidepressant medication treatment. Also, for those that do not respond to antidepressant medication alone, research seems to suggest many youth respond well to medications combined with therapy. Medications called selective serotonin reuptake inhibitors (SSRIs) are the primary treatment for youth with depression.Currently there are only two SSRIs that are approved by the FDA for treatment of depression for youth. Fluoxetine (also known as Prozac) has been approved for children 8 years and older. Escitalopram (also known as Lexapro) has been approved for adolescents 12 years and older. Important to note, the American Academy of Child and Adolescent Psychiatry indicates that “your doctor may prescribe other antidepressant medications that are not FDA approved based on available data. You should know that prescribing an antidepressant that has not been approved by the FDA for use in children and adolescents (referred to as off-label use or prescribing) is common and is consistent with accepted clinical practice.” Before your child starts antidepressant medication, it will be important to have your child get a thorough evaluation from a mental health professional. This can be done by a psychiatrist – or a pediatrician or family physician who is experienced in treating children and adolescents with mood disorders. A medication evaluation should include: An assessment of your child’s current emotional and behavioral concerns, particularly related to if your child potentially has multiple problem areas/diagnoses. An evaluation of your child’s family history of mental health and suicide concerns. A detailed review of any risk factors that may affect your child and increase their risk of self-harm behaviors. For more information related to medication management for youth with depression see the American Academy of Child and Adolescent Psychiatry’s Depression: Parents’ Medication Guide.
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