DEPRESSION IN CHILDREN AND ADULTS

Depression is a medical condition that can cause a wide variety of psychological and physical symptoms. Extreme sadness is often the most pronounced symptom. Depression can be distinguished from occasional blues and grief because depression is persistent, often interfering with daily activities and relationships.

In the past, depression was poorly understood and carried an unfortunate social stigma. However, depression occurs commonly; the risk of suffering from a major depressive episode at some time during a person's life is up to 12 percent for men and 25 percent for women. The condition can affect people of all ages, including children and older adults.

Depression is a treatable condition. Psychotherapy (counseling), drug therapy, and other treatments can alleviate symptoms and help people with depression return to rich and productive lives. Treatment is most successful in people who are open to being helped and willing to participate in treatment.

DEPRESSION CAUSES

Research has helped clarify the complex biologic basis of depression, although the exact cause of depression is still uncertain. Studies suggest that depression results from an imbalance of neurochemicals in the brain, including serotonin, norepinephrine, and dopamine. These neurochemicals allow cells to communicate with each other and play an essential role in all brain functions, including movement, sensation, memory, and emotions. That depression represents an actual biologic disorder is supported by the results of genetic studies and the response of depression to drug therapy and other therapies that alter levels of brain neurochemicals.

DEPRESSION RISK FACTORS

Although anyone can develop depression, certain factors increase a person's risk for this condition, including:

• Female sex
• A history of depression in a parent, sibling, or child
• A prior episode of major depression

Other factors have been identified as secondary (weaker) risk factors for depression:

• A history of depression in a family member who is not a parent, sibling, or child
• Lack of social supports
• Significant stressful life events
• Current alcohol or substance abuse

Depression and other medical conditions — Many people with chronic medical or neurological disorders, as well as some people with short term conditions, have difficulty with depression. The number of people with depression may be particularly high in diseases of the brain (eg, stroke, traumatic brain injury, Parkinson disease), heart conditions, cancer, and conditions that affect the immune system (eg, lupus).
The risk of depression is not related to any specific disease or organ system. However, depression can worsen the outcome of many conditions, and even increases the risk of death. This may be related to the fact that some people with depression are not motivated to take their medications on schedule, attend medical appointments, and/or exercise.
Fortunately, recognizing and treating depression can improve a person's sense of health and well-being, and can also improve a person's interest in caring for him or herself.

DEPRESSION SYMPTOMS/DEFINITIONS

Extreme sadness may be the best known symptom of depression, although depression can cause other psychological and physical symptoms. The hallmark of depression is that symptoms are persistent and interfere with daily activities and relationships.
Unfortunately, there is no single sign or symptom that serves as a marker for depression, and the condition can be tricky to identify. In fact, many people do not recognize that they are depressed or that their physical symptoms (aches and pain, appetite and sleep changes) are related to depression. One study revealed that 29 percent of people visiting their doctors for a physical symptom had a depressive disorder or an anxiety disorder [1].
The symptoms of the three types of depression (major depression, dysthymia, and atypical depression) will be discussed here.
Major depression — Major depression is the medical term for depression that includes five of the symptoms listed below. A person can have mild, moderate, or severe major depression.

• Sadness most of the day, particularly in the morning
• Markedly diminished pleasure or loss of interest in almost all activities nearly every day
• Significant weight loss or weight gain
• Insomnia or excessive sleep
• Agitated movements or very slow movement
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Impaired concentration and indecisiveness
• Recurring thoughts of death or suicide

The symptoms must be present during the same time period and must persist for at least two weeks. One of the symptoms must be either depressed mood or loss of interest.
Dysthymia — Dysthymia is a low-grade depression that persists for a long period of time. Dysthymia is usually diagnosed when a person has had depressive symptoms for at least two consecutive years. The most common symptoms of dysthymia include an absence of pleasure or interest in activities, low self-esteem, and low energy.
Atypical depression — Atypical depression is a common type of depression. People with atypical depression have some of the same features of major depression listed above, but do not have five of the nine symptoms required for a diagnosis of major depression. Instead, they often have prominent physical symptoms, including weight gain and sleep disturbances, especially excessive sleep.
Seasonal affective disorder — Seasonal affective disorder (SAD) is a form of major depression that varies with the seasons. Most patients with SAD have episodes of depression that begin in the fall and continue through the winter.
SAD is characterized by several features:

• Symptoms of depression that regularly appear during a particular time of year (unrelated to stressful events associated with specific seasons)
• Full remission of depression (or a change from depression to mania) during other times of year
• Two major episodes of depression during the associated season in the last two years and an absence of depression during other times of the year

Grief — Grief is a normal reaction to many situations, following the death of a loved one, loss of a close relationship or job, or the loss of health or independence. This section discusses one of the most common types of grief that occurs after the death of a family member or friend.
Grief following death — Immediately following death, whether or not the death has been anticipated, survivors usually experience feelings of numbness, shock, and disbelief. Intense feelings of sadness, yearning for the deceased, anxiety about the future, disorganization, and emptiness commonly arise in the weeks after the death.
"Searching behaviors," including visual and auditory hallucinations of the deceased person, are common and may lead the bereaved person to fear that he or she is "going crazy." Despair and sadness are common as it becomes clear that the deceased will not return. Sleeplessness, appetite disturbances, agitation, chest tightness, sighing, and exhaustion are common.
These reactions are usually transient and resolve in over 90 percent of people by 13 months after the loss. However, losses can trigger depression in some people; as an example, 15 to 35 percent of people who lose their spouse develop depression in the following year [2].
Some patients who grieve may develop complicated grief (or traumatic grief), which is defined as persistence of at least four of the following feelings for six months or more:

• Numbness/detachment
• Bitterness
• Feelings that life is empty without the deceased
• Trouble accepting the death
• A sense that the future holds no meaning without the deceased
• Being on edge or agitated
• Difficulty trusting others since the loss

Grief versus depression — It is often difficult to know if a person who is grieving also suffers from depression. Patients who have feelings of hopelessness, helplessness, worthlessness, and guilt, as well as severe symptoms of early grief may be depressed. Patients whose grief is complicated by depression often benefit from an antidepressant medication in addition to individual or group psychotherapy. Group therapy in a bereavement group can be particularly useful for patients with grief and depression. In contrast, persons suffering only with grief are more likely to benefit from psychotherapy alone.
Bipolar depression — People with bipolar disorder (manic depression) have periods of mania (feeling excessively elated, impulsive, irritable, or irrational) or hypomania (a milder form of mania), and may also cause a person to experience periods of major depression. Bipolar II disorder involves periods of depression interspersed with periods of "hypomania," which are periods of high energy, decreased sleep, and some agitation. People with bipolar II disorder may have a poor response to antidepressant medications; consultation with a psychiatrist is recommended to assist in the treatment of people with this disorder.

DEPRESSION DIAGNOSIS

The diagnosis of depression is based upon a patient's symptoms, the duration of symptoms, and the overall effects of these symptoms on a patient's life. There is currently no medical test that identifies depression, although blood tests are often done to rule out other medical conditions that could be causing depression (such as hypothyroidism).
A diagnosis of major depression requires that symptoms are severe enough to interfere with a person's daily activities, and the ability to take care of oneself, maintain relationships, engage in work activities, and to support oneself. A diagnosis also requires that the symptoms have occurred on a daily basis for at

WHERE TO GET MORE INFORMATION

Dr. Rudominer and his staff are an excellent source of information for questions and concerns related to your depression.

DEPRESSION IN TEENS AND CHILDREN

Not only adults become depressed. Children and teenagers also may have depression, as well. The good news is that depression is a treatable illness. Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent’s ability to function.
About 5 percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families.
The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters.
If one or more of these signs of depression persist, parents should seek help:

• Frequent sadness, tearfulness, crying
• Decreased interest in activities; or inability to enjoy previously favorite activities
• Hopelessness
• Persistent boredom; low energy
• Social isolation, poor communication
• Low self esteem and guilt
• Extreme sensitivity to rejection or failure
• Increased irritability, anger, or hostility
• Difficulty with relationships
• Frequent complaints of physical illnesses such as headaches and stomachaches
• Frequent absences from school or poor performance in school
• Poor concentration
• A major change in eating and/or sleeping patterns
• Talk of or efforts to run away from home
• Thoughts or expressions of suicide or self destructive behavior

A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way of trying to feel better.
Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad.

Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and teenagers.