CASA of Arizona

Childhood Depression - pg. 3

Other Syndromes



Depression in children often co-occurs with other mental disorders, most commonly anxiety, disruptive behavior, or substance abuse disorders, and with physical illnesses, such as diabetes. Children can also suffer Attention Deficit Disorder, and, especially in teenage girls, eating disorders and self-injury. Studies have shown a cyclical effect between eating disorders and depression. Clinical depression can lead to eating disorders and eating disorders can lead to clinical depression.

Here is a list of several of the illnesses that can effect depressed children. If you would like more specific information on any of these illnesses and how they relate to depression, click here.

  • Addiction
  • Anxiety and Panic
  • Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder
  • Borderline Personality Disorder
  • Eating Disorders
  • Obsessive-Compulsive Disorder
  • Seasonal Affective Disorder
  • Self-Injury

Almost one-third of 6- to 12-year-old children diagnosed with major depression will develop bipolar disorder within a few years. Children diagnosed with one of the above syndromes may also have depression as an underlying illness. In any case, when there are multiple disorders effecting a child, all of the disorders need to be treated at the same time for treatment to be effective.

Treatment



Depression and other patterns of manic-depressive disease are chemical disorders of the brain. They can occur spontaneously or be promoted or induced by other medical illnesses, drugs and medications, and environmental events.

A large number of strategies have been developed for the treatment of depression. Many of these approaches can be implemented individually, in groups, or family therapy environment. The management of children, adolescents, and young adults with affective illness should be multimodal. Patients must be informed about the nature, course, and treatment of this disease. There is considerable evidence to suggest that interventions which emphasize treatment of the family, and not just the "identified patient," are critical to positive treatment outcomes. Peer group approaches have been found to be effective for children. Play therapy is sometimes appropriate with younger children.

Here is a list of different treatment methods that are used for depression.

  • Cognitive - Cognitive approaches utilize specific strategies designed to alter negatively-based cognitions. Depressed patients are trained to recognize the connections between their thoughts, feelings, and behavior; to monitor their negative thoughts; to challenge their negative thoughts with evidence; to substitute more reality-based interpretations for their usual interpretations; and to focus on new behaviors outside treatment.
  • Behavioral - Behavioral approaches designed to increase pleasant activities include several components such as self-monitoring of activities and mood; identifying positively reinforcing activities that are associated with positive feelings; increasing positive activities; and decreasing negative activities.
  • Social Skills - Social skills training consists of teaching children how to engage in several concrete behaviors with others. Initiating conversations, responding to others, refusing requests, making requests, etc. Children are provided with instructions, modeling by an individual or peer group, opportunities for role playing, and feedback. The object of this approach is to provide children with an ability to obtain reinforcement from others.
  • Self-Control - Self-control approaches are designed to provide the self-control strategies including self-monitoring, self-evaluation, and self-reinforcement. Depressive symptoms are considered to be the result of deficits from one or more areas and are reflected in attending to negative events, setting unreasonable self-evaluation criteria for performance, setting unrealistic expectations, providing insufficient reinforcement, and excessive self-punishment.
  • Interpersonal - Interpersonal approaches focus on relationships, social adjustment, and mastery of social roles. Treatment usually includes non-judgmental exploration of feelings, elicitation and active questioning on the part of the therapist, reflective listening, development of insight, exploration and discussion of emotionally laden issues, and direct advice.
  • Medications - Several classes of medications are used with adult populations. Major types include monoamine oxidase inhibitors (e.g., phenelzine), tricyclics (e.g., imipramine and amitriptyline) and SSRIs (e.g., Prozac, Paxil, Zoloft, Serazone, Luvox), but other classes have emerged as well. While these drugs are not without side effects, they have been shown to be 50-70% more effective with adults than placebos and no other treatment. Very little is know about the safe use of antidepressants with children. The risks and side effects of medications, and the findings that competent therapy and counseling interventions may be more effective restrict, the use of medications with children.

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