Sunday, September 1, 2002
Tackling Childhood Depression Wed Aug 28, 7:06 PM ET By Amanda Gardner HealthScoutNews Reporter
WEDNESDAY, Aug. 28 (HealthScoutNews) -- Depression shouldn't be part of anyone's childhood, but too often it is.
Some 5 percent of teens and 1 percent of children suffer from depression, according to an article in tomorrow's issue of The New England Journal of Medicine ( news - web sites).
Before puberty, boys and girls are at equal risk for falling victim to the disease. After the onset of puberty, however, girls face a rate twice that of boys. The annual rate of suicide attempts requiring medical attention among adolescents is 2.6 percent.
How do you recognize and treat this insidious condition?
Adolescent depression isn't that different from adult depression. An estimated 40 percent of adults probably had their first depressive episode when they were in their teens, says study author Dr. David Brent.
Brent is professor of psychiatry and academic chief of child and adolescent psychiatry at Western Psychiatric Institute and Clinic, which is part of the University of Pittsburgh Medical Center.
Depression in adults or teens doesn't always manifest itself as sadness. "Not everybody is sad," Brent says. "The things you look for are either a depressed mood, sad mood, boredom, inability to have fun or irritability." Talk of suicide should always be taken seriously, he adds.
Parents -- and physicians -- should also look for changes in how children are functioning. Are they able to function well in school and with their peers and family? Changes in sleep patterns, weight gain or weight loss, difficulty making decisions, difficulty concentrating and low motivation can also be danger signs, Brent says.
Depression often doesn't show up as a sudden change.
"Kids have a gradual descent into depression, in which case often the change isn't something you notice," Brent says. "Often depression starts as a dysthymic disorder [a mild or moderate depression, which is longer-lasting]. It's hard to notice. It's there one day, and not another. We often see patterns of three or four years of this, and then a more full-blown depression."
Diagnosis needs to first rule out other health problems, such as anemia, hypothyroidism or hyperthyroidism, and inflammatory bowel disease.
Unfortunately, there's no simple test for depression, but a number of factors need to be taken into account, including the patient's personal and family histories. If a parent has a history of depression, the child's risk of a depressive episode increases by a factor of two to four, Brent says.
Two basic treatment approaches have been shown to be effective, either separately or in combination, for teens, Brent says. One approach consists of specific psychotherapies (cognitive behavioral and interpersonal). The other consists of administering the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).
"The standard in primary care is to treat with SSRIs, and there the most important thing is an adequate dose," Brent says. "Adolescents may need more, and sometimes people aren't aggressive enough in raising the dose."
Eight to 16 sessions of cognitive behavioral therapy over a period of three to four months have been shown to be effective in treating depression. This type of psychotherapy emphasizes acquiring interpersonal skills and modifying self-defeating thought patterns that can lead to depression, among other things.
Interpersonal therapy has also had some success. Here the focus is on coping mechanisms for such things as the loss of relationships.
"[Psychotherapy and medication] have never been directly compared, although if you look at studies they look about equally efficacious. So either approach is a reasonable one to begin with," Brent says.
According to Brent, about 60 percent of teens treated with cognitive behavioral therapy and about 60 percent who are treated with SSRIs will show signs of improvement in fairly short order. Some will be able to stop the treatment after six months or a year, but this is highly variable.
Experienced family physicians can often treat simple depression. However, chronic depression or depression compounded by other conditions such as attention-deficit hyperactivity disorder should be managed by a specialist, such as an adolescent psychiatrist.
Dr. Eugenio M. Rothe, associate professor of psychiatry at the University of Miami School of Medicine, says, "Adolescent depression is different from adult depression in that it is more characterized by irritability and boredom. Of course, that's part of the difficulty in diagnosing, because irritability and mood swings are part of the adolescent process."