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Depression In Children And Adolescents

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What is depression?

Depression is the most common mental disorder, not only for adults, but for children and teenagers as well. The DSM-IV classifies depression as a mood disorder. It states that an individual has suffered a major depressive episode if certain symptoms persist for at least two weeks, including a loss of Depression in Children and Adolescents enjoyment in previously pleasurable activities, a sad or irritable mood, a significant change in weight or appetite, problems sleeping or concentrating, and feelings of worthlessness. These symptoms of depression fall into four categories: mood, cognitive, behavioral, and physical. People with depression may experience symptoms in any or all of the categories, depending on personal characteristics and the severity of the depression (Ainsworth 2000).

Victims of depression often describe feelings of emptiness, hopelessness, unreasonable guilt, and profound apathy. Their self-esteem is usually low, and they may feel overwhelmed, restless, and irritable. The changes occurring with depression understandably result in alterations in behavior. Most individuals with moderate-to-severe depression will experience decreased activity levels and appear withdrawn and less talkative, although some severely depressed individuals show agitation and restless behavior, such as pacing the floor. Depression is more than a mental illness. It is a total body illness (Curtis, p. 132)

Major depressive disorder, also know as clinical depression, is the serious and often disabling for of depression that can occur as a single episode or as a series of depressive episodes over a lifetime. A single episode may last as little as two weeks or as long as months to years (Mondimore, 1990). Some people will have only one episode with full recovery. Others recover from the initial episode only to experience another episode months to years later.

Depression in Children

How do we determine whether children are depressed? All children feel unhappy from time to time. Sadness is a normal, natural response to many life events, from losing a soccer game or moving away from old friends to a death in the family. Although when that sadness runs too deep, lasts too long, or occurs too often, it may be a sign of clinical depression (Egger, 2002). For many years, childhood depression went unrecognized. Many mental health professionals believed that children were not emotionally mature enough to experience true depression. It was not until the early 1980s that clinicians and researchers began to realize that childhood depression was a distinct, recognizable disorder. The National Institute of Mental Health (NIMH) estimates that over 1.5 million children and adolescents are seriously depressed (Wingert, 2002).

Which Children are Most at Risk?

Children typically go through some very trying stages as they grow up. Sometimes, however, an abrupt change in a child's behavior or manner is more than a passing stage; instead in can be a symptom of a serious emotional problem like depression. Depression is not easy to identify in children. In fact, until the early eighties when it was recognized as a true disorder, even professionals often missed it. One reason was that it was shaped by the knowledge of depression in adults. So, unless the same intense sadness and tearfulness was seen in the child, or unless it was known that the child experienced feelings of worthlessness and hopelessness, depression was not suspected. Now it is realized that children, who are just learning how to express the many emotions they feel,

may communicate their distress very differently from adults.

Research confirms the many variations in the symptoms of childhood depression (McKnew, 1996). In one 1987 study, researchers at the University of Pittsburgh and New York State Psychiatric Institute found that younger kids who were depressed complained of physical problems such as stomachaches and restlessness, experienced great anxiety when separated from their parents, and developed fears of places and situations. Depression is a recurrent disease, if a child has had it once; he is more likely to have recurrence when he is a teenager or even when he is an adult (Empfield 2001).

Teenage Depression (Adolescent Depression)

Depression may also be difficult to diagnose in adolescents. Every teenager experiences a series of challenges in life, from dealing with the physical pain and hormonal changes of adolescence to separating from parents and finding their own distinct identity (Empfield 2001). These challenging tasks often cause a great deal of confusion and anxiety; consequently brief bouts of sadness, marked by tearfulness, moping, pessimism, and occasional hostility, are entirely normal during the teenage years. Teenagers can be moody, as everyone knows; but every moody teenager is not suffering from depression. Most teenagers, even the ones who are really acting out, do not have clinical depression.

The average age of onset of depression in adolescents is about fifteen, but it is not uncommon in children from ages ten to fourteen (Fassler 1997). After age fifteen, girls are about twice as likely as boys to be depressed. Gender doesn't seem to affect the duration of depressed episodes, however, as both girls and boys suffer for more or less the same period of time. An episode will last six to eight months and then end. So, why not just tell the teenager to try to tough it out and let the depression go away on its own? Several problems with this approach make it very dangerous.

First, depression can be extremely painful, comparable in severity to the worst kinds of physical pain. No one would ask a teenager to tough out even one hour of pain, for example, from having their bones crushed or even just filling a cavity in a tooth (Empfield 2001). Next, not all depression goes away so conveniently. In some cases, symptoms may last for years; while in other cases the patient recovers between episodes, but never enough to be feeling really well. Perhaps most important of all, untreated depression is a major cause of suicide.

There are certain ways in which the diagnosing depression in a teenager can be confusing. For example, adolescents sleep a lot. That is normal, and not in itself a sign of depression. Similarly, weight gain and weight loss, provided they are not extreme and do not involve binging and purging, can be ordinary events in a teenagers life, and not a sign of illness. In general, the vegetative signs, the physical symptoms, which often accompany depression, are less useful in diagnosing depression in adolescents than in adults.

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