Your kids and depression

By Drum Digital
03 May 2014

Depressive illness is showing up even in pre-schoolers. Here’s why, and what to look out for.

Imagine a child so down nothing can bring him joy: not a new toy, an exciting outing or his mom’s touch – and imagine being unable to recognise these feelings and having no words to express them. This is the world of childhood depression, a condition as chronic and real as adult depression – and it’s on the rise.

Pre-school teachers are picking up signs of depression in children as young as three and psychologists have kids of six on their books. Depressive illness in kids is not just sadness or unhappiness, Johannesburg-based psychiatrist David Benn says.

“Issues such as parental conflict and divorce will cause any child to become despondent. Depression occurs when a child with a genetic predisposition to the condition is placed under serious stress. The sadness is intense, lasts for two weeks or longer and is accompanied by other symptoms of depression.”

Although the cause of depression varies from child to child experts say the higher incidence could be due to the stresses of today’s society. With both parents often working outside the home, children spend less time with them and receive less support in general, says Frederick Goodwin, a US professor of psychiatry and former director of the American National Institute of Mental Health.

Hanita Prag, a clinical psychologist in Port Elizabeth, says any modern-day dilemmas affect children’s sense of wellbeing. “More and more families are faced with retrenchment, divorce and other issues that induce stress and children are aware of the challenges their parents are dealing with.”

Experts say early detection is vital because one in 10 children who develop major depression before puberty later commit suicide. Worldwide suicide is the third biggest killer of children after homicide and road accidents, according to the South African Depression and Anxiety Group (Sadag).

“You want to catch it before it has devastating consequences,” Benn says.

Pre-school

Possible causes Depression can be triggered by a nasty divorce, custody issues, illness, substance abuse in the family, death of a parent, close friend or sibling and physical or mental abuse and causes for depression in primary school kids can also apply.

Signs to watch

  • A sudden change in behaviour such as an active child who becomes increasingly sleepy during the day or a laidback child becoming hyperactive.
  • Frequent stomach aches and headaches.
  • Irritability.
  • Frequent sadness and crying.
  • Loss of pleasure in previously enjoyable activities.
  • Excessive clinging to parents.
  • Lack of appetite and sleep problems.

Primary school

The causes of depression in pre-schoolers also apply and include the death of a parent, close friend or sibling, divorce, family conflict, abuse, being bullied at school or major life changes such as changing schools or towns.

Signs to watch

  • Suddenly becoming anxious about going to school.
  • Changes in sleep patterns.
  • Significant weight loss/gain.
  • Frequent worrying or suddenly developing low selfesteem.
  • Unprovoked aggressive behaviour.
  • “Depressed children may lack motivation to do their schoolwork properly and so their grades drop,” Benn says. “They’ll lose interest in things they love – the keen cricketer no longer wants to go to practice. They could also become withdrawn from their friends.”
  • Frequent tummy aches and headaches. “Children are not pretending to have tummy aches – they really have them,” Benn says. “Parents often take their kids to their GP because of these aches and pains and a sensitive doctor may be able to detect depression.”

Teens

The causes in pre-schoolers and primary-schoolers can also apply and include a devastating break-up of a romance, dysfunctional family relationships such as excessive parental criticism and lack of parental support.

Signs to watch

  • Inattention to appearance.
  • Difficulty concentrating.
  • Constant fatigue.
  • Avoiding family and friends.
  • Running away from home.
  • Developing suicidal thoughts or actions.
  • Extreme sensitivity to failure.
  • Low self-esteem.
  • Loss of appetite.
  • Loss of enjoyment in previously pleasurable activities.
  • Crying often and becoming easily irritated and angry.
  • Missing school because of stomach pains and headaches.
  • Experimenting with drugs and alcohol.

Other causes of childhood depression

Genetics: “Having a depressed parent or relative increases the chances of a child developing depression although it doesn’t mean they definitely will,” Benn says.

Brain chemistry: Depression can occur when the balance of brain neurotransmitters such as serotonin and the stress hormone cortisol are disturbed due to genetic vulnerabilities and/or stressful life events.

Learnt personality traits: Constant negative thoughts and poor problem-solving or coping mechanisms can increase a child’s risk. They often pick up this behaviour from parents who are overly critical, pessimistic or depressed.

Treatment

A combination of medication (such as antidepressants) and psychotherapy is effective in treating depressed children. There is however debate about whether antidepressants should be given to young children.

In 2004 the US Food and Drug Administration ordered drug companies to add warnings to antidepressants after some were found to increase the risk of suicidal thoughts in children and teenagers (about a four per cent increase in the first two months of taking the medication). Yet other studies hail their benefits. “A small percentage of children may develop suicidal thoughts, just as in adults, yet there’s no evidence they actually cause children to commit suicide,” Benn says.

He says in certain areas of the US and UK where antidepressants are no longer prescribed for children there has been a marked increase in the rate of successful suicides. “The big message is that antidepressants must be used with caution, patients must go for regular checkups and the medication must be prescribed by specialists.

“A few antidepressants are approved by the American Federal Drug Administration for use in children. They’re seldom used before six years old and there’s no evidence they harm  brain development,” Benn says.

Psychotherapy is often recommended as the first line of treatment. Play therapy (for ages four to 10), talk therapy (from age six), cognitive behavioural therapy and family therapy have been shown to be successful in exposing possible underlying causes of depression and helping children manage it. Your child’s doctor may suggest  psychotherapy and consider antidepressant medicine as an additional option if there’s no significant improvement.

How do you tell if your child is depressed?

Depression is made up of a cluster of symptoms. If you answer “yes” to three or more of the statements below, formulated by the South African Depression and Anxiety Group (Sadag), and if the symptoms are a drastic change from the way your child usually acts, they should be evaluated by a GP.

Does your child:

  • Often seem sad?
  • Have trouble sleepling?
  • Often feel tired?
  • Have very few friends?
  • Cry a lot?
  • Dislike playing with other kids?
  • Eat a lot less that previously?
  • Often feel lonely?
  • Often get headaches or stomach aches?
  • Not enjoy school at all?
  • Often have bad dreams?
  • Not do as well as well at school as they used to?
  • Worry a lot?
  • Not like him/herself?
  • Often hurt or talk about hurting themselves?
  • Have trouble concentrating?
  • Often act angry?
  • Get into a lot of fights?

Tips for parents

  • Take swift action to solve underlying conflict at home.
  • “Parents need to be especially supportive if there is a depressed child in the house,” Hanita Prag says. “Unconditional love and acceptance play a vital role. Children also thrive on structure and discipline in the home so set boundaries.” For example your teenage child should have a curfew and find a hobby or activity she enjoys and is committed to.
  • When your child has been diagnosed ensure he feels comfortable with the psychologist he’s seeing. If it’s not a good fit find another therapist.
  • Let your child’s teacher and guidance counsellor know the child is depressed so he can get extra support at school.
  • Encourage daily exercise to boost your child’s natural feel good hormones.
  • Make communication open, easy and non-judgmental. American research shows children who feel cared for by their parents are less likely to be depressed.
  • Be persistent. Your children need to know you’re always available and concerned about how they feel.
  • Self-help tools such as inspirational books, music and movies can accelerate recovery.
  • Ask your doctor about foods that boost neurotransmitter levels such as bananas and pumpkin seeds. Kids should avoid stimulants that increase anxiety such as caffeinated cooldrinks, coffee and too much chocolate.
  • Encourage regular sleep patterns. Teens who get eight to nine hours of sleep every night are 25 per cent less likely to become depressed or have suicidal thoughts, a US study says.

For assistance call Sadag’s toll-free helpline on 0800- 567-567 or SMS 31393. You can also visit their website sadag.co.za.

-Kim van Reizig

EXTRA SOURCES: NEWS24.COM, SADAG.CO.ZA WITH REFERENCE TO THE BOOK HELP ME, I’M SAD: RECOGNIZING, TREATING AND PREVENTING CHILDHOOD AND ADOLESCENT DEPRESSION BY DAVID G FASSLER MD AND LYNNE S DUMAS, EDICINENET.COM, AACAP.ORG, PARENT24.COM

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