When hugs are not enough

A once light hearted, engaging child becomes sulky and withdrawn, or irritable and a bully on the playground. A lack of interest in schoolwork and a drop in school performance. A parent cannot seem to "get through" to a child to discuss what is wrong and tension in the family rises. These are all symptoms that may prompt a parent to ask themselves, "Does my child have a mental illness?"

This question is a very difficult and often frightening question for a parent to voice. Understandably it is easier to overlook or explain away subtle signs of illness that may occur periodically at worst and are set against the backdrop of rapid changes of childhood or the turmoil of adolescence. Many parents may think, "It's just a phase", "He'll grow out of it", "She is under a lot of stress", "All we need to do is reassure him that we love him" or "No one in our family has a mental illness".

Yet the concern that makes a parent question their child's behaviour may be justified. For one in ten youngsters, a mental illness will lead to moderate to severe impairment in one or more areas of their lives. Depression is a common and serious form of childhood mental disorder. Until as recently as the 1980s, doctors and others rarely considered that children could become depressed. But research has shown that they do, suffering many of the same symptoms that are seen in adults with major depression, but also some that are unique for their age.

Responsive to treatment
When recognised early and diagnosed accurately, depression is highly responsive to treatment. Still, each episode of this recurrent illness tends to increase the likelihood that episodes of illness will recur. Thus, depression must be treated and managed with an eye toward the long term.

A child's risk for becoming depressed may increase with stress or with a traumatic experience of loss. Behavioural problems and mental disorders - for example conduct, attention-deficit, learning anxiety, and substance abuse disorders - frequently co-occur with depression and may help explain its onset.

What can be said for sure is that in children, no less than in adults, clinical depression is not a character weakness, normal sadness, or a passing phase. It is a real medical illness that can be accurately diagnosed and effectively treated. According to Wendy Sinclair, a psychologist who works extensively with children and adolescents, the teenage years are tumultuous and difficult. “Boys tend to direct their anger outwards whereas girls tend to direct it inwards. Boys also act out and become aggressive and girls become quiet and reflective.”

A devastating consequence of untreated depression is suicide. When a teenager thinks or talks about suicide, the risk is real. Children should understand that if a brother/sister or friend talks about suicide, it should be called to that attention of an adult. Talking about or attempting suicide should not be seen as attention getting, but as an anguished cry for help. Wendy points out some of the possible causes or triggers of teenage suicide. These include abuse in the home, a break-up of an important relationship or social isolation. Warning signs include: a persistently depressed mood, eating and sleeping disorders, social withdrawal and increased isolation, statements or comments that hint of suicide e.g. how many tablets would someone have to take to kill themselves, plan of action, or a history of previous attempts. Wendy warns, "if a teenager talks about suicide, they must always be taken seriously".

Treatments for depression are well-defined and effective for the vast majority of those with the illness. Ideally, a treatment programmed will combine psychotherapy and medications. Psychotherapy relies on age appropriate communication as a tool for bringing about changes in the patient's feelings and behaviours. Antidepressant medications target chemical imbalances in the brain associated with depression. Several antidepressants introduced in recent years have little potential risk for dangerous overdosing or adverse effects.

How to recognise depression in children and adolescents

  • Frequent sadness, tearfulness and crying
  • Increased irritability, anger or hostility
  • Hopeless - a preoccupation with depressing or nihilistic song lyrics
  • Decreased interest or enjoyment in once-favourite activities
  • Low energy - persistent boredom
  • Frequent complaints of physical illness, for example headaches and stomach-aches
  • Poor communication with family and friends - social isolation
  • Low self-esteem, feelings of guilt, oppositional behaviour, negative thinking
  • Extreme sensitivity to rejection or failure
  • Inability to concentrate - poor performance in school and frequent absences
  • Changes in sleep habits - excessive late night TV viewing or refusal to wake in the morning
  • Changes in eating habits - failure to gain weight as normally expected, bulimia or anorexia
  • Talk of running away from home or efforts to do so
  • Thoughts or expression of suicide or self-destructive behaviour

Where to go for help
Contact the Depression and Anxiety Support Group at 011 783 1474.

(Ilse Pauw, Health24)

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