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Is Your Child Depressed?

Posted Aug 24 2008 1:49pm
LISA CLARK: I'm Lisa Clark. Welcome and thanks for joining us for this Webcast. Depression is usually thought of as a grown-up problem. But studies have shown that up to 2.5% of young children, 8.3% of adolescents in the U.S. suffer from depression. Left untreated, it can lead to academic, social problems, or even violence and suicide. How do you know if your child might be suffering from depression? What does depression at a young age mean? And here to discuss these questions, we have Dr. Peter Jensen. He is a Professor of Child Psychiatry at Columbia University-eminently qualified for this topic. Children can experience depression obviously.

PETER JENSEN, MD: Absolutely. And the sad thing is we used to think that depression couldn't, by definition, occur in young children. When I trained originally, that was the general notion, that depression perhaps didn't occur in children.

LISA CLARK: So what brought about the change in thinking and the recognition that this can affect children?

DR. PETER JENSEN: Well investigators, the researchers, began to apply the approaches and the methods used to study depression in adults to children. And lo and behold, they found it wasn't just a stage. And if you had all the signs and symptoms that adults have, as a young child, you're probably at much greater risk even than when an adult has onset with depression. It has a much more difficult problematic course. And early intervention is quite critical.

LISA CLARK: Are there certain types of children who are more prone to depression?

DR. PETER JENSEN: We think that family history is important, so genetic factors probably play a role. But there are other factors that are also suspect. Prolonged medical illnesses might serve as a precipitant. Stress factors occurring throughout a substantial period of one's life. Some people have demonstrated that the loss of significant loved ones in early critical periods, in the first five years of life, might lead to later problems, and later a modest increased risk for depression. Some of the other things we don't think about, but also are linked to depression, are substance use. And so prolonged substance use probably is linked to depression as well.

LISA CLARK: For the child to have had substance use, or the mother during gestation?

DR. PETER JENSEN: Both.

LISA CLARK: Now girls are more prone to depression at certain stages in development. When is that?

DR. PETER JENSEN: Well the funny thing is, boys and girls are equal prior to puberty. And so the rates are not particularly high, as you mentioned, maybe 2% or so, in that range. But when they hit puberty, then girls really seem to, unfortunately, blossom as far as depression is concerned. And so at that point it probably doubles or triples among girls, where the rate among boys only increases modestly. We don't know if it's because of pubertal hormones or some of the new stress factors that occur to girls as they reach puberty and face other responsibilities. Or male/female differences in societal expectations.

LISA CLARK: There are certainly a lot of issues regarding weight concerns and body image, those sorts of things, that might contribute.

DR. PETER JENSEN: Absolutely.

LISA CLARK: What sorts of things can parents do to recognize depression in children? I may be wrong, I would suspect this might be a little easier with an adolescent than with a very young child. What should parents look for in those cases?

DR. PETER JENSEN: Well, that's correct. In very young children, the child may not verbalize like an adolescent would be able to describe his or her feelings. An so for younger children, the parent has to observe changes in mood that more are exhibited by the child being more tearful, crying, loss of interest in maybe the child's normal activities. But there might also be vegetative or bodily changes, like changes in weight, sleeping more or sleeping less. But predominantly in children, irritability, and pronounced and prolonged sadness, easy crying would be the major signs.

In adolescents, all of those same things might be present. But adolescents get very good at hiding depression. And so frequently we find that an adolescent can be very depressed, but has to feel like they've got to put on a show to keep up the image, either around their parents, particularly around their peers. And so the parent will have real difficulty getting kind of an inroad and talking with the adolescent and finding out what's going on because the adolescent might be basically incommunicado and might be very depressed. But again, if it looks like the child's depressed, if there's easy, frequent irritability or tearfulness, talking about death or suicide, loss of interest in normal activities, decline in grades, staying alone in one's room for long periods of time- these would all be some of the warning signs.

LISA CLARK: Suffering from delusions may also be an indicator.

DR. PETER JENSEN: That wouldn't be very common one for depression, per se, unless it was a very, very severe case of depression that we sometimes call a psychotic level of depression. That would be uncommon. But it can occur.

LISA CLARK: How long does a depressive episode last for a child? Is this a lifelong thing? Is it measurable in terms of months, years?

DR. PETER JENSEN: Well if a child, prior to puberty, has a depression, we know he or she is at much greater risk for subsequent depressions. And so some studies have shown, for example, among pre-pubertal- prior to puberty- children, their risk was about 80% for developing a second depression again in the next five years. And not only depression, but other difficulties as well. Sometimes other conditions, like bipolar disorder or anxiety problems. And so it's a very severe problem when it occurs in childhood.

When it occurs in adolescence, while it still can be life threatening, it doesn't convey the same degree of the likelihood that it will be persistent. And so it's somewhat less likely to be persistent. Although once you've had a depression, you're more likely than somebody who's never had one to have a subsequent depression.

LISA CLARK: If your child is diagnosed with depression, what sorts of treatment options are available?

DR. PETER JENSEN: Well there are two forms, major forms of treatment. In medication, some of the newer medications are called SSRIs. It's a fancy term, but it's medications like Prozac or Zoloft. These are special, new medications that work on a different chemical in the brain than some of the older style ones. They're quite safe. They're highly effective in adults. And we're now getting the evidence that they appear to work now as well in adolescents.

The other form of treatment that we think works well is something called cognitive behavior therapy. CBT we call it. And it's not your garden variety therapy. It's a special therapy. And so the parent really- and the adolescent- needs to be savvy about this because if you walk in and see any old doctor or therapist, you may get any old therapy. And those aren't necessarily the therapies that work. It's the special form of cognitive behavior therapy.

Education of the parent; education of the youth. And turning to Web sites, they have- and there's many good ones out there that have information on the treatments and how to seek help, is a good strategy.

LISA CLARK: Any final advice for a parent who suspects their child might have depression, but is not sure who to turn to for an accurate diagnosis?

DR. PETER JENSEN: First thing I would do as a parent is educate yourself. And speak with a primary care provider, the child's pediatrician or adolescent medicine specialist. And you get their advice as well. And frequently they'll know resources within the community. So you need to be armed with good information as a parent to what works and what doesn't because it's a let the buyer beware game out there.

And then turn to your doctor and, with that information, get the best advice you can from your own doctor.

LISA CLARK: But the bottom line is, seek treatment because it can help immeasurably.

DR. PETER JENSEN: Absolutely.

LISA CLARK: Thanks so much, Dr. Jensen. We appreciate you being here. And thanks to you for joining us in our Web audience. I'm Lisa Clark.

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