Depression in Children
Depression in children is a mental illness that reveals a noticeably lowered mood in the child. This illness can give rise to psychological, psychosocial and physical symptoms, which can have serious consequences for the child. Depression can be a key symptom or part of a comprehensive mental illness. The first manifestation is possible from toddler age. Depression in children is a serious problem and consultation with a doctor should be early on.
The causes of depression in children are very diverse and can be seen, for example, in biochemical processes, psychological and social factors, as well as genetic predisposition. In childhood, which represents the time of need for protection, personality development, orientation and development of social life, irregularities in the child's psychosocial experience are dominant.
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The most common and most serious reasons are mentioned here, which leave further options open as causes. The numerically frequent separation / divorce of parents in industrialized countries, which deprives the child of the protective environment. Family disputes and problems can also be in the foreground here. The loss of a parent and the subsequent difficult existence of a half-orphan / orphan confront the child with great stressful situations at an early age and seek a sometimes complex problem solving. In addition, every dying process of a loved one is a potential cause.
In addition, abusive sexual assaults can place a child in an existentially threatening situation. The difference in personality at school can also lead to depression through regular rejection and bullying. Depending on the personal background, depending on the social milieu, premature pregnancy or contact with alcohol and drugs can lead to rejection and the basis for mental illness.
A low income of the parents could also be identified as a potential reason. The existence of a physical or mental illness in the parents is a serious cause of depression in children. Both a current and a previous depressive episode in one of the parents is associated with an increased risk for the child himself of developing depression.
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Typical accompanying symptoms of depression in childhood can be carried over to the age of the child. This often results in a time-lagged physical and mental development status. The relapse into behavior patterns of younger age can be observed in severe cases. The development deficit is accompanied and possibly caused by regular eating and sleeping disorders, as well as headaches and abdominal pain. This often results in being overweight or underweight. Motor and language skills stagnate or develop back again if necessary.
The ability to pay attention is usually greatly reduced. The changed developmental progress means that there are big differences to children of the same age. A low level of independence, trust and interest in new things follow the constant depression and anxiety. Social contact with peers also suffers as a result and leads to loneliness. Feelings of guilt and frequent self-criticism are very pronounced and can lead to announcement or, in very pronounced cases, even to attempted suicide.
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Aggressive behavior in the context of depression is a multifaceted symptom and can be directed against other people, against yourself or against objects. Reasons can be in high emotional, social and performance-oriented demands and create a seemingly unmanageable state. Frequent solitude and constant confrontation with oneself often lead to aggression under the mentioned circumstances. This can end in vandalism, fights or suicide attempts, for example. The latter is a common problem in children after puberty.
Difficulty sleeping and tiredness
Sleep disorders and depression can usually be observed together. A typical characteristic is waking up early in the morning, but also a restless sleep at night. Those affected can easily assess the length and quality of sleep. Changes in the psyche can be overestimated and create worries and anxieties about your own well-being, from which sleep disorders result. In addition, a persistent tense mental state contributes to such irregularities. The neurotransmitter system in the brain also comes into focus. Since an unbalanced control of certain hormones is usually the cause of depression and this dysregulation is also important for the sleep rhythm, both usually occur together.
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Nightmares and sleep disorders have been shown to be common in depression.The irritable, anxious and depressed behavior that occurs during a depressive episode often supports the emergence of nightmares. Overall, girls suffer more often from these undesirable dreams than boys of the same age. However, in the context of depression, the risk of a suicide attempt can be greatly increased if the child reports nightmares as accompanying symptoms. Therefore, frequent nightmares (more than two per week) must be clarified. Medicines the child is taking can also cause this. Therefore, the origin of the nightmares should be clearly clarified.
The involuntary weight loss is a very unspecific accompanying symptom of many diseases. Without an intentionally strict dietary lifestyle, this process always makes a doctor sit up and take notice. Weight loss is the result of a certain quality and manifestation of an illness. The change in body weight in the context of mental illnesses can often result from a disturbed appetite. Childhood depression is often accompanied by abdominal pain, constipation (constipation) or diarrhea and insomnia and, in addition to the depressed mood, can result in altered eating behavior. The accompanying symptoms often prevent a regular daily routine and thus prevent, among other things, a healthy and distributed food intake throughout the day.
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Deterioration in academic performance
Children who suffer from depression at a young age often feel that they are not prepared for the emotional and social expectations placed on them. In this situation, dealing constructively with classmates often does not seem realistic. The child falls into isolation. Without involving other people of the same age to cope with one's own stress at school, this quickly leads to a loss of motivation.
In addition, enthusiasm for topics that were previously interesting is increasingly difficult and can present itself to the outside world as a memory disorder. The affected student's reduced ability to concentrate often results in a decline in performance at school. Usually parents and teachers only notice this deterioration. Therefore, regularly questioning the child's mood at school with regard to depression can help prevent depression.
Loss of drive is seen as a reduced or lack of human drive. The drive is the basis of all action and can be seen as a will or as an ability. It is used to carry out activities to achieve necessary and voluntary goals. The depression is due, among other things, to the lack of drive and is thus defined by it. A distinction must be made between an occasional and permanent lack of drive. If it occurs over a longer period of time, it can lead to neglect for yourself and social contacts. In pronounced symptoms, it leads to the omission of necessary everyday activities in life, such as self-care. This includes, among many other activities, maintaining social contacts, personal hygiene, nutrition or working. Thus, the lack of drive in the context of depression can have far-reaching consequences for an individual.
A typical characteristic of depression is also pronounced concentration disorders. At first, however, these appear very unspecific and the question of the origin of the child's lack of concentration is often not put into a disease context. A concentration disorder manifests itself, for example, in the fact that what has just been experienced or just read content can no longer be reproduced. If these persist for days and weeks, the affected child gets into situations that are perceived as very uncomfortable. In the context of depression, these quickly lead to self-doubt and questioning of one's own intelligence. The daytime weakness that occurs sporadically in every person differs from an illness-related concentration disorder, which is very much dependent on other factors, such as sleep, diet and stress. It is therefore very important to take a closer look at the current accompanying circumstances in which the child is in the current life situation.
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The treatment of depression can take place in an outpatient or inpatient setting, i.e. in a clinic. It is important to consider how much the child will benefit from the respective therapeutic framework. The decision should take into account the severity of the disease and whether, for example, the child was at risk of suicide. The severity of the symptoms as well as the personal and family environment are also taken into account. Considerations as to whether and to what extent parents, teachers, grandparents and other confidants can be included also influences the form of therapy. The treatment depends crucially on the age, the level of development of the child and the ability to talk. The modern treatment of depression in children usually takes place in the context of non-drug therapy forms with the help of various psychotherapeutic methods. In addition to the child's therapy, both parents are included, if possible. Thus, the attempt is made to establish a more stable environment for the child in the long term. Behavioral therapy, as part of psychotherapy, deals, for example, with learning mechanisms for stress competence after understanding the causes of one's illness. The methods of light therapy and electroconvulsive therapy are also used to a limited extent. The complementary methods of play therapy complete the treatment using the playful nature of the child. Theater therapy is sometimes used in a similar way to this procedure. Further novel approaches to behavioral therapies are currently being discussed. In addition to the non-drug therapies, antidepressants and mood stabilizers are used as part of drug therapy.
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Which drugs can be used?
In children, as in adults, the use of medication must be carefully considered and checked. In principle, the use of antidepressants is possible, with a few exceptions. Drugs from the group of selective serotonin reuptake inhibitors (SSRI) have, according to the latest findings, been described as having few side effects and effective. One representative of this group as an oral antidepressant is fluoxetine, which alone or in combination with cognitive behavioral therapy showed good results. However, it should mainly be used for difficult courses. In mild to moderate depression, an improvement could only be shown with psychotherapy.
One limitation applies to the use of tricyclic antidepressants. These can be used, but have so far not proven any clear effectiveness. (The application has been shown mainly in adolescents; there is so far a lack of knowledge from studies in children.)
As a homeopathic therapy, St. John's wort could be used as an effective herbal antidepressant for mild to moderate depression. Hops, lemon balm, lavender, and passion flower could also be considered with their mild sedative effects, as could valerian. Ginkgo baldoa and ginseng as well as rose root could be attributed to other effects. Caffeine-containing substances, which are also easily accessible, could also be classified as homeopathic options with a reduced effect. As already mentioned, the therapy applies here, mainly in the case of mild courses of depression and accompanying non-drug therapies. Severe depression in children with pronounced symptoms should always be clarified by a doctor in order to be able to prevent long-term consequences of the disease for the child in good time.
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The diagnosis of depression in childhood is based on the anamnesis (doctor-patient conversation) of the child and the parents. The age of the child and, depending on this, the mental maturity can make a decisive contribution to the diagnosis. Thus, in addition to the life situation of the child, the life situation of the parents is also taken into account, which should also be considered as the cause of the child's depression. Another fundamental criterion is the symptoms that the child presents. The main symptoms are the child's loss of interest and joylessness, a noticeably high level of fatigue, lack of drive and the depressive mood. In addition, other secondary symptoms serve to narrow down the problem. These include a reduced ability to concentrate and attention, decreased appetite and sleep disorders, as well as decreased self-esteem, feelings of guilt and worthlessness and a pessimistic mood. Information can be obtained from this as to whether depression is an underlying disease or whether it is depression in the context of another mental illness. From the course of the disease it can be read whether this is an initial diagnosis or whether it has already occurred repeatedly. In addition, the various forms of depression can be differentiated in order to be able to initiate targeted treatment.
Are there special tests to diagnose depression in children?
Access to numerous tests on the Internet to diagnose depression is currently a quick and easy-to-use tool for an initial assessment. As a rule, these are questions that briefly assess the mood of the potentially affected person using multiple choice Judge time. Similar tests are sometimes used by experts. The tests determine symptoms that are related to an existing depression. Tests for children are rare and can only be used after a certain age. A more comprehensive self-perception of the child is a basic requirement in order to be able to answer the questions in a meaningful way. Therefore, it does not make sense to use it in toddler and primary school age. In older children, the result can be seen as a guide, but never without expert advice. A self-diagnosis is to be avoided.
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Can you also diagnose depression in a child as a parent?
The diagnosis of depression is not always easy because of the many different symptoms and age-related characteristics of a child. Parents are usually familiar with their child's behavior and usually notice small things in their child's behavior and social interaction very quickly. Not every change is to be equated with a pathological phenomenon, but psychological abnormalities should be discussed and identified with an expert in good time if they are suspected. Rather, it is important to closely observe one's own relationship with the child as well as interacting with other children and is a good parameter for recognizing changes. The possibly depressive behavior of the child also influences the behavior of the parents. If you have recently felt overwhelmed as a parent, reproach yourself with regard to the upbringing or feel a greater distance or rejection of your child, this may be a reaction of you to the changed behavior of your child.
The duration of depression depends on the child's individual disease course. It cannot be compared with other children of the same age, but must always be seen as an individual case. Parameters influencing the course of the disease are age, the severity of the symptoms and the individual triggering factors of the depression, such as long-lasting family disputes. The current status of the conflict is one of the decisive factors here. If problems could be eliminated, this serves as a good basis for coping with the drop in mood. The time of the initial diagnosis has a positive effect on the severity of the course and the duration of the depressive episode. Early detection favors the course and can shorten the duration of the disease. Because once complicating factors have arisen or the symptoms have become chronic, it is all the more difficult to achieve rapid treatment successes.