Depression in children and adolescents

Depression in children and adolescents: description

Tired, no desire to play, sad for no apparent reason … all these can be signs of depression in children. Nevertheless, the disease is often not recognized, it has long been even doubted that there is depression in children at all. Instead, the children get vitamins and iron supplements for their tiredness, and the rest, it is believed, will grow. But the fact is: severe depressive disorders are protracted in children and adolescents, relapses are common. The earlier a depression sets in, the worse the prognosis.

How widespread are depression in children and adolescents?

Depression in children may in rare cases occur at an early age. About one to two percent of children in primary and primary school age suffer from depression. More often, depression does not occur until puberty. About three to ten percent of the adolescents are affected by depression. Before puberty, more boys suffer from depression than girls. After puberty, however, the relationship is reversed. Girls are then much more likely to get into a morbid mood depression than boys. Since childhood and adolescent depression is often not recognized, it is unclear how many children and adolescents actually suffer from depression.

Depression in children and adolescents: symptoms

Young children express their feelings through behavior rather than words. Instead of the classic symptoms of depression or listlessness, children sometimes experience depression in the form of temper tantrums, heavy crying, or constant attachment to parents. To make matters worse, that especially the youngest describe a depression as “stomachache” or “headache”, because they still lack the ability to name dejection. Parents and doctors are thus on a completely wrong track.

The older the children are, the more their symptoms match those of adults. But even among young people it is important to differentiate well. For in puberty, sadness and desperation can be part of a normal development that disappears after some time. Nevertheless, they have to be taken seriously.

For children with depression, the same diagnostic criteria apply as for adults, but the symptoms in children are often different. Below is an overview of possible symptoms that may indicate depression in children or adolescents:

Toddler (1 – 3 years)

• Feels sad, the face is expressionless
• Is scared and shy
• Is very affectionate
• Cries fast or gets angry quickly
• Does not feel like playing
• Sleeps badly
• Sucks a lot on the thumb or plays with the genitals
• Weighs back and forth
• Shows changed eating behavior

Preschooler (3-6 years)

• Looks sad or apathetic
• Shows little or diminished gestures and facial expressions
• Retracts or reacts aggressively
• Suffers from nightmares, often wakes up at night
• Does not enjoy playing, otherwise can not be happy
• Loses weight or increases and moves reluctantly

Schoolchild (6-12 years)

• Told that it is sad
• Speaks about suicidal thoughts
• Has worse academic performance
• The eating habits change without any explainable reason
• Feels neglected by the parents
• Has strong fears
• Has unfounded feelings of guilt
• suffers from a feeling of hopelessness
• Worries a lot, has concentration problems

Teenager (13-18 years)

• Has little self-confidence
• Is apathetic or timid
• Retires from social life
• Can not concentrate
• The educational achievements suddenly collapse
• Has an appetite, eating or sleeping disorder
• Adds injury
• Has suicidal thoughts
• The emotional state fluctuates throughout the day
• Is no drive

Not all symptoms necessarily indicate a depressive illness. To be on the safe side, or if you suspect that your child is suffering from depression, seek professional help. Contact a family or youth counseling center or find a child and adolescent psychiatrist.

Special case of anaclitic depression in infancy

A particularly severe and tragic form of depression is called anaclitic depression. Developmental researcher René Spitz observed this type of depression in infants in homes and hospitals in the last century. If children are separated from their caregiver, usually the mother, for three to five months or more during their first year of life, they show severe physical and mental impairments. Binding plays a decisive role in the first years of development. Even with medically good care, children atrophy when they receive no love and security.

In the first part of the separation the babies cry a lot, later they refuse contact with other persons. If the separation lasts longer, the depression worsens. The children no longer cry and behave apathetically. They barely show facial expression and do not interact with other people. Infants with anaclitic depression are more susceptible to disease and physical development slows down. If children have no caregiver for more than five months, they are in danger of dying.

Depression in children: causes and risk factors

Whether child or adult – the mechanisms of depression are still not fully understood. However, it is a complex interplay of genetic, other biological and environmental influences.

Genetic influences

The genes certainly play a role in the development of depression. In children whose parents suffer from depression, the risk of becoming ill is significantly increased.

environmental factors

However, it is now believed that ultimately it is environmental factors that contribute significantly to break out of depression in children. In children, the family plays a crucial role. A good relationship with parents who provide support and love can protect children from depression. Achievement pressure, divorce or death of the parents, but also teasing at school, poverty and sexual abuse are considered as possible triggers of depressive illnesses. It is not only the strength of the stress that counts, but also how well the child has learned to process crises, solve problems or seek help.

Risk phase puberty

More often than in children are depression in adolescents. Puberty carries a special risk. This time is associated with many changes and big challenges and thus with an increased stress level. Young people are looking for their own identity, they are more separated from their parents and seek affiliation with their peers. Also the body and the external appearance change strongly in this time. The hormonal turbulences in this phase of life probably also play a major role. The great insecurity that comes with the upheaval can contribute to the onset of depression in adolescents. However, good social relationships with parents or friends can counteract this and strengthen young people.

Depression in children: examinations and diagnosis

Recognizing depression is not easy even in adults. This is even more difficult for young people, as it is often difficult to distinguish from age-typical “normal” problems.

Basically, the study and diagnosis of depression in children and adolescents follow the same pattern as the diagnosis in adults. The diagnosis is based on ICD 10, the International Statistical Classification of Diseases and Related Health Problems, which presents three main symptoms – depressed mood, loss of interest, listlessness and fatigue – as well as seven secondary symptoms, including guilt, sleep disorders and changes in appetite.

These are recorded by the doctor or therapist using standardized questionnaires. There are also physical examinations that are supposed to rule out a physiological cause of the abnormalities.

Depression in children: treatment

Once the depression is recognized in a child, it can also be treated accordingly. Especially antidepressants can get small patients with severe depression out of the “black hole”. However, they are used only with the utmost care and in addition to other therapeutic measures. Do not depend on antidepressants.

Hardly studied drug effect

The problem is, however, that many remedies for depression that help adults are not yet sufficiently studied for the treatment of children. Especially with young children, the influence of medicines and therapies has been under-researched. Then, especially at the beginning of the treatment, attention must be paid to the behavior of the children. Because sometimes antidepressants in younger patients can cause aggression and suicidal thoughts or attempts.

Helpful psychotherapy

Therefore, in children with mild to moderate depression, preference should be given to psychotherapy. Psychotherapists are important companions on the way out of depression. It is usually advisable to involve family members as part of family therapy. Play therapy can help younger children: safety and self-confidence are strengthened by playing in a protected environment and new behavioral possibilities are playfully tested.

In older children and adolescents, the combination of cognitive-behavioral therapy and medication is also suitable for severe depression. In the context of behavioral therapy, adolescents are encouraged to break the vicious circle of depression, develop new ways of thinking, and discover techniques for solving problems. In the future, they will be better equipped to deal with crises.

Depression in childhood and adolescence: disease progression and prognosis

It is important that parents, kindergarten teachers and teachers are alert and learn to correctly interpret the confusingly diverse signs of depression in children. Anyone who suspects that their child is depressed should not wait, but seek competent help as quickly as possible. Because depression is a serious mental illness. If left untreated, they can be fatal: Even children are suicidal in the event of a major depression.

Will the Depression in children and adolescents not treated, there is a high risk that the disease is chronic. Especially with young people, the relapse rate is very high at around 70 to 80 percent. This and the danger of chronicity are probably responsible for changes in the brain. On the other hand, depression in children and adolescents is accompanied by difficulties in concentration and learning, which are reflected in school performance. This contributes to increasing stress and makes it difficult to break out of negative thoughts. With timely treatment, about 30 percent of children and adolescents become permanently healthy again after a depressive phase.