Dr. Ruwan M. Jayatunge M.D. PhD
Depression is a mood disorder that can affect adults as well as children. In general terms, depression is an overwhelming feeling of hopelessness, sadness, and lack of self-worth. It is more than a sad feeling. Depression is common among adults. Unlike adults, childhood depression is difficult to distinguish. They often express their feelings through behavior. Depression affects a child's overall energy, mood, expressions of emotion, and behavior.
According to the British experts, at least two percent of children under 12 struggle with significant depression, and by teenage years this has risen to five percent. Following the geopolitical and economic conditions in Sri Lanka a significant number of children are affected by childhood depression. Most of these cases are undiagnosed and not receiving adequate treatment.
Depressed children have prolonged anhedonia (the inability to experience pleasure), hopelessness, and failure to experience an increase in mood in response to positive events and sometimes have inattentive features similar to Attention Deficit Hyperactivity Disorder or aggressive behavior similar to Conduct Disorder. The affected children are mostly alienated and they often have learning difficulties due to difficulty in concentrating and impaired memory.
Reasons for Depression in Children
- Genetic factor: the family history of depression
- Adverse life events (maternal or paternal deprivation, death of a close family member)
- Childhood trauma (child abuse, witnessing traumatic events)
- Excessive social demands (exam stress, academic failure)
- Physical illnesses (depressive episodes in post-viral fever, thyroid hormonal imbalance)
Symptoms and Behaviors Associated with Depression in Children
- Crying, feeling sad, helpless, or hopeless
- Feeling discouraged or worthless
- Loss of interest or pleasure in others or most activities
- Fatigue and loss of energy nearly every day
- Bad temper, irritable, easily annoyed
- Fearful, tense, anxious
- Repeated rejection by other children
- Drop in school performance
- Inability to sit still, fidgeting, or pacing
- Repeated emotional outbursts, shouting, or complaining
- Doesn't talk to other children
- Repeated physical complaints without medical cause (headaches, stomachaches, aching arms or legs)
- Significant increase or decrease in appetite
- Change in sleep habits
- Suicidal thoughts, feelings, or self-harming behavior in children
As a result of childhood depression, serious and critical symptoms such as suicidal ideation and deliberate self-harm can be seen among the affected children. According to the International Journal of Adolescent Medicine and Health (2008), the summarized report findings from 13 nations indicate that there may be a link between bullying and suicidal ideation in children and adolescents. Depressed children have a risk of committing suicide.
Risk Factors for Development of Childhood Depression
There are a number of risk factors associated with childhood depression.
Personality traits—characteristics that influence reactivity to stress—play a major role in the development of depression. Children who lack social skills, problem solving skills are often shattered by life stress and easily go into depression. Lack of family cohesion, expressiveness, and organization too negatively affect the child's overall mental health. Parental life philosophy, too, plays a major role. Negative views of self, the world, and one's future; devaluation of the child's abilities; and excessive criticism can lead to depressive feelings in a child. Repeated physical, emotional, or verbal abuse at home or school could be a vital risk factor.
Treatments for Childhood Depression
Medication and psychotherapy are foremost treatment modes in depression. Many physicians use SSRIs (selective serotonin reuptake inhibitors) to treat childhood depression. Frequently medication is combined with psychotherapy. A variety of psychotherapeutic techniques have been shown to be effective in childhood depression. CBT, or cognitive behavior therapy, helps to correct negative thought patterns and erroneous negative assumptions. CBT encourages the child to use positive coping behaviors.
Social skills training is important in childhood depression since the affected children lack social skills. The children are thought initiating conversations, responding to others, and transforming into a positive communication style. Some therapists use Interpersonal Therapy which is focused on relationships, social adjustment, and mastery of social roles.
The recent research in the USA and Europe indicates that EMDR (Eye Movement Desensitization and Reprocessing) is effective in treating childhood depression. EMDR (Eye Movement Desensitization and Reprocessing) is a much easier and less painful process than traditional therapy for resolving depression and trauma. EMDR is an information processing psychotherapy that was developed to resolve symptoms resulting from disturbing and unresolved life experiences. It uses a structured approach to address past, present, and future aspects of disturbing memories.
