Depression in Children and Adolescents

There is a misconception that depression is only experienced by adults. But depression can also occur in childhood. Depression in children and adolescents can be just as challenging for children and adolescents as it is for adults today. Depression in children and adolescents is often marked by changes in behavior. Depression can be seen differently in each child and adolescent. In some children, it can be seen as restlessness in behavior, becoming more irritable, disobeying, while in others it can be seen as introversion, silence and stagnation. Depression in children and adolescents can also be associated with cognitive difficulties such as attention and concentration.

At the same time, depression in children and adolescents should not be confused with having difficulties with friends, worrying about failure, experiencing disappointment, or being exposed to temporary stressors. While these situations cause children and adolescents to feel sadness, depression is a long-lasting and serious condition. Serious suicidal thoughts and self-harm tendencies in children and adolescents with depression pose a risk. When depression in children and adolescents is thought to be present, it is important that suicide risk is assessed by specialists. Research on depression in children and adolescents reveals two important points. The first of these is that the risk of depression increases in adolescence. The second is that the first stages of depression occur at an earlier age than previously thought. Increasing the number of studies on this subject, raising awareness of the society about depression in children and adolescents, and increasing the accessibility of professionals and treatment enable the symptoms to be recognized at an earlier age.

In addition, the increase in suicide rates among young people is a warning for society. It is very important to recognize depression in children and adolescents and to evaluate early preventive treatment options. Especially high-risk groups with risky behaviors, children and adolescents exposed to sexual or physical violence should be evaluated for depression. Different prevalence rates have been reported for depression in children and adolescents. In a study conducted in the USA, depression rates were found to be %0.9 in preschool children and %1.90 in school-age children and %4.70 in adolescents. It is known that depression in children and adolescents is more common in girls in early adolescence. Some studies have also found that female adolescents show more severe depressive symptoms than males.

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What Causes Depression in Children and Adolescents?

Depression in children and adolescents can have many different causes. When addressing the source of depression in children and adolescents, it is important to make a thorough assessment and observation. Correctly addressing the child's or adolescent's difficulties is very important for the treatment process. Depression in children and adolescents can be triggered by genetics, environmental factors, biological factors, growth hormones and psychological conditions.

Also depression in children and adolescents;

Domestic violence
Neglect
Long separation from mother or father (depending on the age of the child)
Divorce of parents
Being subjected to physical, emotional or sexual abuse
Traumatic experiences
A new member joins the family
Problems with school or friendships
Disease processes
Situations such as social events can be a source of depression in children and adolescents.

What are the Symptoms of Depression in Children and Adolescents?

Symptoms of depression in children and adolescents can present with different symptoms for each age.

Symptoms of depression in childhood are as follows:

Acutely occurring eating and sleeping problems
Withdrawn, indifference to social environment
Excessive activity, irritability
Harming yourself or someone else
Finger sucking, nail biting, bed wetting
Unstoppable masturbation
It can be seen as emotionally inconsistent.

The symptoms of depression in adolescents may be different from those that may be experienced in childhood.

Depression in adolescents;

Physical complaints
Decline in school success
Loss of motivation
Attempts to escape from home
Sudden outbursts of anger
Smoking, alcohol or substance abuse
Decreased interest in friendship or socializing
Fear of death or frequent talk of death
Self-harming behaviors
It can be seen as sleep and eating problems.

How is Depression Diagnosed in Children and Adolescents?

When diagnosing depression in children and adolescents, it is important to differentiate it from other disorders. Biological conditions that mimic or cause depression need to be differentiated. Depression in children and adolescents should be differentiated from disorders such as anxiety disorders, adjustment disorders, substance abuse in adolescents and early-onset schizophrenia.

In order to diagnose depression in children and adolescents, a detailed anamnesis (history) from parents is very important. At the same time, information from the school can be a guide for the correct diagnosis. Certain psychological tests and inventories can be used to diagnose depression in children and adolescents. The important point of the evaluation is to question when and how the symptoms started, whether it is an expected situation in the age development period, and how much it affects the functionality of daily life. After these evaluations, a diagnosis is made by a child-adolescent psychiatrist and treatment methods are recommended.

How is Depression Treated in Children and Adolescents at Private Moodist Hospital?

Treatment of depression in children and adolescents requires a biopsychosocial approach. In the treatment of depression in children and adolescents, the child and the family need to be informed. Parents may often feel responsible for their child's condition and may feel excluded. They tend to question themselves about their parenting skills. Therefore, parental education is one of the most important criteria for helping the child with the problem. Collaboration with parents becomes even more important, especially during the play age. During treatment, the child should be included in the child's life, given special time and made to feel valued. It should be emphasized that the child will be supported at all times, not only because of his/her depression. In the treatment of depression in children and adolescents, the warm, protective, supportive attitude of the specialists that the child receives support from is also important and helpful.

In the treatment of depression in children and adolescents, it is important to help and encourage the child to name and describe their feelings and to overcome negative emotions. In addition to all these attitudes, medication can be added to the treatment under the supervision of a physician. Psychotherapy has a very important role in the treatment of depression in children and adolescents. Psychotherapy can be applied in coordination with medication, or it can be applied alone, depending on the decision of the treatment team.

Listening to the child, trying to understand him/her, providing explanatory information, helping him/her to realize his/her characteristics and guiding him/her when necessary are among the main goals of psychotherapy. Both the child and the family should be told that adolescents with suicidal thoughts should be referred to a physician. Careful supervision and family-school cooperation are important for adolescents with suicidal thoughts or self-harm. In the treatment of depression in children and adolescents, the family is expected to contribute to the process. Schema therapy, child-centered play therapy, cognitive behavioral therapy, EMDR therapy, solution-focused therapy and family therapy techniques are used in treatment.

What happens if depression in children and adolescents is not treated?

Treatment of depression in children and adolescents can have risky consequences if not taken seriously. Depression can lead to suicidal thoughts, especially in adolescents. It may pose a risk for smoking, alcohol or substance abuse. If depression in children and adolescents is left untreated, it can lead to impaired functioning, reluctance and restlessness, which can reduce the quality of daily life.

Again, untreated child and adolescent depression can lead to withdrawal and lack of relationships, certain ideas about how to commit suicide, feelings of failure and worthlessness.

In children and adolescents with depression, a restless family environment increases suicidal thoughts. It is known that family structure and family support are associated with suicidal thoughts. Children and adolescents with depression describe their families as more strict, exclusionary and unsupportive. This may lead to more strained relationships between adolescents and their parents.

What can be done to cope with depression in children and adolescents?

In order to cope with depression in children and adolescents, it is very important to accept the situation and get expert support. In addition to expert support, it is necessary to teach the child and adolescent functional coping methods. It is important to enable them to connect with others. To cope with depression in children and adolescents, it is important to structure the daily routine of the child or adolescent. Providing alternative occupations and enabling them to socialize will reduce depressive symptoms. It is known that physical health affects mental health. When dealing with depression in children and adolescents, attention should be paid to sleep and eating routines.

Advice for Parents of Depressed Children

Parents should observe behavioral and psychological symptoms in children and adolescents. A specialist should be consulted when at least four of the symptoms of depression persist for several weeks in both children and adolescents. Early diagnosis and treatment are very important. It is important that parents have knowledge about depression. It is very important to approach the child or adolescent with understanding, to be patient, sensitive and consistent. From time to time, parents may think that the child is being spoiled and using these ways to attract attention. This can lead to a feeling of not being understood and can make the child feel guilty and incomplete. When the family accepts that depression is a treatable illness, it will be a relief for the child or adolescent. Depression in children and adolescents can be caused by problems in family relationships. It is very important for parents to be consistent and sensitive in family relationships.

What are the Wrong Approaches that Prevent Treatment of Depression in Children and Adolescents?

“I will solve his problem, he doesn't need support”

Depression in Children and Adolescents is often a periodic state of sadness that is not taken seriously by families. This can lead to a delay in the treatment process and is a false idea that hinders treatment. Families often believe that they can solve the symptoms of depression in children and adolescents on their own. Collaborating with the family in the treatment not only makes the process healthier, but also makes the child or adolescent feel more supported. One of the important points is that early diagnosis and initiation of treatment will prevent the disease from becoming resistant. For this reason, it is extremely important to get expert support in the treatment of depression in children and adolescents.

“I don't want him to take medication”

For the treatment of depression in children and adolescents, it is important to consider all treatment options. This includes medication. Unfortunately, parents think that the medication will harm the child due to misinformation in the digital or print media and social media. For example, while there is no concern about the medications used in the treatment of a child with influenza, the same sensitivity is not shown in the use of medications that provide psychological treatment. Depression is a condition related to chemical deterioration in the brain, which is why medication is often invaluable in the treatment of depression. It is known that treatments in which medication and psychotherapy go hand in hand are more functional.

“There is no reason for him to be depressed”

From time to time, even when parents recognize the symptoms of their child or adolescent and seek help from a specialist, they still look for the source of the problem in the child. According to families, everything is very normal and there is nothing wrong for the child to be depressed. However, it is known that all events in the family affect the mental health of the child. The well-being of the parents, a peaceful home environment, democratic attitudes are important for the child's well-being. Children are in a way a reflection of their parents. For this reason, it is normal for a mother with depressive symptoms to have depressive symptoms in her child.

Today's children wake up early in the morning, spend time in traffic to get to school, attend classes and follow rules at school, fulfill their responsibilities at home and run around until the end of the day. At this pace, the child may not have time for emotional release. It is like a miniature adult.

It is a fact that today's parents have much more mental distress, not only because of their influence but also because of their living conditions. For this reason, children and adolescents may have mental difficulties and may need treatment. Involving the family in the treatment is extremely valuable.

The information on this page has been prepared by the Medical Team of Private Moodist Hospital.