It is natural to feel bad sometimes, but if that low mood persists day after day, it could indicate some kind of disorder.
Depression is an episode of sadness or apathy along with other symptoms that last at least two consecutive weeks and is severe enough to interrupt daily activities.
It is not a sign of weakness or a negative personality. It is a major public health problem and a treatable medical condition.
Depression can be mild or severe. It can be short-lived or chronic. Special circumstances, such as the birth of a baby or changing seasons, can trigger depressive symptoms.
Understanding the type of depression a person experiences helps doctors determine the treatment. And for people who are diagnosed with depression, having information about their specific disorder can be helpful.
“People seem comforted to know what’s happening to them,” says Sarah Noble, DO, a psychiatrist at Einstein Healthcare Network in Philadelphia. “At least they have an answer as to what they are experiencing.”
If you suspect that you or a loved one has some type of depression, have it evaluated by a mental health professional. They can help you discover a diagnosis and the best course of treatment.
Types of depression
Major depressive disorder:
Each year more than 16 million Americans (most of them women) experience this very common type of depression, also known as major depression or clinical depression.
According to the diagnostic criteria published by the American Psychiatric Association, people must have at least five symptoms that persist for two weeks or more to be diagnosed with major depressive disorder.
These symptoms may include feelings of sadness, emptiness, worthlessness, hopelessness, guilt, loss of energy, appetite or interest in pleasant activities, changes in sleeping habits and thoughts of death and suicide. Most cases are highly treatable.
Major depressive disorder has two subtypes: “atypical depression” and “melancholic depression”. People who fall into melancholic depression tend to sleep and eat a lot.
They are emotionally reactive and very anxious, explains Dr. Noble. “They have trouble sleeping and tend to meditate on thoughts full of guilt.”
Young adults tend to have atypical depression, and the melancholic type is seen more often in older people.
Depression resistant to treatment:
Sometimes people with major depressive disorder do not respond easily to treatment.
Even after trying an antidepressant and then another, and maybe a third or fourth, his depression is stubbornly maintained. “Maybe it’s genetic, maybe it’s environmental,” says Dr. Noble. “His depression is just tenacious.”
Helping people to overcome treatment-resistant depression begins with a thorough study to ensure an adequate diagnosis and identify other psychiatric and medical causes of their symptoms.
Patients are advised on the appropriate dose and duration of treatment. If a medication does not work, doctors will try to switch to a similar medication or one of a different kind.
Patients may benefit from adding a second antidepressant of a different class and perhaps another type of medication, such as an antipsychotic.
A person who has depressive symptoms but does not complete all the boxes for a diagnosis of major depression can be considered “subsyndromic”.
You may have three or four symptoms, not five, or you may have been depressed for a week, not two. Explains Dr. Noble.
“Instead of looking at the symptoms, I usually look at the functionality,” she says. Can the patient go to work and take charge of daily responsibilities? If the person is struggling, they can still benefit from the treatment, even with medication.
Persistent depressive disorder:
People with persistent depressive disorder (PDD) have a low, dark or sad mood on most days and at least two additional symptoms of depression that last two years or more.
In children and adolescents, PDD (also called dysthymia ) can be diagnosed if the symptoms of irritability or depression persist for a year or more.
“It can increase and decrease in intensity, but in general it is a low level of depression,” explains Dr. Noble.
To be diagnosed with this type of depression, people must also have sleep problems (too much or too little), low energy or fatigue, low self-esteem, lack of appetite or overeating, poor concentration or difficulty making decisions and feelings of depression. despair
In general, PDD requires treatment with a combination of medications and psychotherapy.
Premenstrual dysphoric disorder:
Up to 10% of women of childbearing age experience premenstrual dysphoric disorder (PMDD).
This severe form of premenstrual syndrome can trigger depression, sadness, anxiety or irritability, as well as other extreme symptoms, in the week before a woman’s period.
“It can be really uncomfortable, crippling and interfering with a woman’s daily life,” says Dorothy Sit, associate professor of psychiatry and behavioral science at the Feinberg School of Medicine at Northwestern University in Chicago.
Scientists believe that these women may have an abnormal sensitivity to hormonal changes during their menstrual cycle.
Taking antidepressants, specifically selective serotonin reuptake inhibitors, in the two weeks before your period or throughout the month can be very effective, says Dr. Sit.
Certain types of contraceptives can also help. Researchers at the University of California at San Diego are exploring the use of light therapy to improve the quality of sleep and mood in women with PMDD.
Great changes in mood and energy, from joy to despair, are the hallmarks of bipolar depression, also called bipolar disorder or manic-depressive illness.
To be diagnosed with this form of depression, a person must have experienced at least one episode of mania. It usually appears in adulthood.
While women and men are diagnosed in equal numbers, studies point to possible gender differences: men seem to have more manic behavior while women tend towards depressive symptoms.
Bipolar disorder usually gets worse without treatment, but it can be treated with mood stabilizers, antipsychotic medications, and talk therapy.
Although more research is needed, a recent study by Dr. Sit and colleagues suggests that light therapy may also be a potential treatment for bipolar depression.
Compared to the dimmed placebo light, daily exposure to bright light at noon can reduce symptoms of depression and improve functioning in people with bipolar disorder, according to the study.
Derangement disorder of disturbing mood:
Temper tantrums may be characteristic of disruptive mood disorder dysregulation disorder (DMDD), a type of depression diagnosed in children struggling to regulate their emotions.
Other symptoms include an irritable or angry mood most of the day almost every day and problems getting along at school, at home or with classmates.
“These are children with strong emotional outbursts,” says Dr. Noble. “They just are not able to contain their emotions,” so they “act” on their feelings.
Currently, DMDD is treated using medication, psychotherapy, and training for parents on how to deal effectively with a child’s irritable behavior.
Seasonal affective disorder:
Seasonal affective disorder (SAD) is a recurrent type of depression (also known as seasonal depression) that usually attacks in the fall or winter.
Along with a change in mood, patients with SAD tend to have little energy. They may overeat, fall asleep, crave carbohydrates, gain weight, or withdraw from social interaction.
Women and younger adults are at greater risk of developing SAD. It can also work in families.
This disorder is diagnosed after at least two years of recurrent seasonal symptoms.
While the exact cause is unclear, the research suggests that it may be related to an imbalance of brain chemical serotonin .
An overabundance of the sleep hormone melatonin and insufficient levels of vitamin D may also play a role.
Substance-induced mood disorder:
Using or abusing sedative drugs can change your mood.
Symptoms, such as depression, anxiety and loss of interest in pleasurable activities, usually appear shortly after taking or abusing a substance or during abstinence.
Substances that can lead to this type of depression include alcohol (if you drink too much), opioid analgesics and benzodiazepines (which act on the central nervous system).
To diagnose someone with a substance-induced mood disorder, doctors should rule out other possible causes of depression, and depression should be severe enough to interfere with daily activities.
People with psychotic depression have severe depression accompanied by psychosis, which is defined as losing contact with reality.
Symptoms of psychosis usually include hallucinations (seeing or hearing things that are not really there) and delusions (false beliefs about what is happening)
One of Dr. Noble’s patients, two years after beginning treatment, confessed that she had a year in which she did not eat anything that her father cooked because she believed that he was poisoning her.
The woman was otherwise lucid, she simply suffered from a psychotic depression that had not been treated completely.
Doctors usually prescribe antidepressants and antipsychotic medications to treat psychotic depression.
Depression due to illness:
Coping with a serious chronic illness, such as heart disease , cancer, multiple sclerosis and HIV / AIDS, can be depressing in itself.
To make matters worse, there is now evidence that inflammation related to the disease may also play a role in the onset of depression.
The inflammation causes the release of certain chemicals by the immune system that crosses into the brain, leading to brain changes that can trigger or worsen depression in certain people, Dr. Noble explains.
Antidepressants can help prolong your life and improve your ability to function, he says, and therapy can help many patients cope with mental and physical illness.
Medications for depression
When treating depression, there are several medications available. Some ” pills for depression ” of the most commonly used include:
Selective serotonin reuptake inhibitors (SSRIs): such as citalopram (Celexa), escitalopram oxalate (Lexapro), fluoxetine (Prozac), luvoxamine (Luvox), paroxetine HRI (Paxil) and sertraline (Zoloft), and are newer medications They act as SSRIs and also affect other serotonin receptors.
Selective inhibitors of serotonin and norepinephrine (IRSN): such as desvenlafaxine (Khedezla), desvenlafaxin succinate (Pristiq), duloxetine (Cymbalta), levomilnaciprán (Fetzima) and venlafaxin (Effexor).
Vortioxetine (Trintellix formerly Brintellix) and vilazodone (Viibryd) are newer drugs that act as SSRIs and also affect other serotonin receptors.
Tetracyclic antidepressants: which are noradrenergic and serotonergic-specific antidepressants (NaSSA), such as Remeron .
Older tricyclic antidepressants such as Elavil, imipramine (Tofranil), nortriptyline (Pamelor) and Sinequan.
Drugs with unique mechanisms: like bupropion (Wellbutrin).
Inhibitors of monoamine oxidase (MAOI): such as isocarboxazide (Marplan), phenelzine (Nardil), selegiline (EMSAM) and tranylcypromine (Parnate).
Although technically it is not considered an FDA drug, l-methylpholate (Deplin) has been shown to be successful in the treatment of depression.
It is classified as a medical or nutraceutical food, requires a prescription and is the active form of a vitamin B called folate. L-Methylpholate helps regulate the neurotransmitters that control moods.
Your doctor can determine which medication is right for you.
Remember that medications usually take between four and eight weeks to become fully effective. And if a medication does not work, there are many others to try.
In some cases, a combination of antidepressants may be necessary.
Side effects vary, depending on the type of medication you are taking, and may improve once your body adjusts to the medication.
If you decide to stop taking your antidepressants, it is important that you gradually reduce the dose for a period of time recommended by your doctor.
Stopping antidepressants suddenly can cause withdrawal symptoms , such as headache or dizziness, or increase the chances of the symptoms returning.
It is important to talk first about how to gradually reduce (or change) medications with your health care provider.
What medications are used to treat anxiety disorders?
In the treatment of anxiety disorders, antidepressants, particularly SSRIs, have been shown to be effective.
Other anti-anxiety medications include benzodiazepines, such as alprazolam (Xanax), diazepam (Valium) and lorazepam (Ativan).
These medications carry a risk of addiction or tolerance (which means that increasing doses are needed to achieve the same effect), so they are not as desirable for long-term use.
Other possible side effects include drowsiness, lack of concentration and irritability.
Some anticonvulsant medications (such as gabapentin [Neurontin] or pregabalin [Lyrica]) and some atypical antipsychotics (such as aripiprazole or quetiapine or Seroquel) are also occasionally used “without a label” to treat symptoms or anxiety disorders.
How do you know if you have depression
Depression can be short-term, lasting only a couple of weeks, or long-term, lasting for years.
It is normal to feel sad, lonely or desperate at times, such as after experiencing a loss or during a moment in your life in which you are struggling.
However, it is a problem when these feelings do not disappear, cause physical symptoms or begin to interfere with your normal daily activities.
If you think you may be depressed, it is important to seek medical help as soon as possible. Untreated depression can continue for months or years and can even threaten your life.
Considering your thoughts and feelings:
Pay attention to your emotions and moods. Depression is a medical condition that prevents the brain from regulating their emotions.
Everyone feels depressed from time to time, but people who suffer from depression often experience certain emotions, or a combination of them.
If you experience these emotions, or if they prevent you from functioning in your daily life, then it is important to seek help. Some emotions you may feel if you are depressed include:
- Sadness: Are you often a sad or cranky person?
- Emptiness or numbness: Do you feel that you have no emotions or have trouble feeling some emotion?
- Hopelessness: Have you been tempted to “give up” or have you had trouble imagining any improvement? Have you become more pessimistic since you began to suspect depression?
- Guilt: Do you often feel guilty for little or nothing? Do these feelings stay with you and interfere with your ability to concentrate or enjoy?
- Uselessness: Do you have a low sense of self-esteem?
- Irritability: Have you been criticizing people or arguing without a good reason? A bad temper is another example of a mood change sometimes caused by depression, especially between men and teenagers.
- Low energy: Do you often feel tired, unable to perform routine tasks or concentrate, and prone to avoid active movement?
- Indecision: Do you have difficulties making minor decisions? Does trying to make decisions make you feel overwhelmed and hopeless?
Pay attention if you have the following indicators:
Be alert to a desire to withdraw or isolate yourself from friends and family : People who suffer from depression often stop spending time with friends or lose interest in other things they used to enjoy.
This is because they want to isolate themselves or withdraw from their usual activities.
Consider your desire to withdraw or isolate yourself from people and how your social life and daily activities have changed in recent months or during the past year.
Make a list of the activities you participated in regularly before you started to feel worse, and calculate how often you did each one.
Over the next few weeks, take note each time you do one of these activities and see if your index has decreased significantly.
Identify any suicidal thoughts : If you have thought about harming yourself or even committing suicide, then it is important to seek immediate medical attention.
Some other indications of suicidal tendencies include:
- Fantasizing about hurting yourself or committing suicide.
- Giving away belongings and / or putting your affairs in order.
- Saying goodbye to people.
- Feeling that you are trapped or that there is no hope.
- By saying things like “I’d be better dead” or “people would be happier without me.”
- Make a quick transition from feeling hopeless and depressed to feeling happy and calm.
Identification of changes in behavior:
Watch for appetite changes: Sudden weight gain or weight loss can be a sign of any number of medical problems, but even if depression is not the cause, you should still see a doctor.
If you have noticed that your appetite has increased or decreased significantly, then be sure to talk to your doctor about this too.
This can be a symptom of depression or it could indicate another underlying problem.
Consider any risky behavior: You can also consider any risk behavior you have adopted as a symptom.
This is especially true for men with depression.
If you have recently started using drugs and / or alcohol, having unprotected sex, driving recklessly or playing dangerous sports, this may indicate depression.
Consider how often or how easily you cry: Frequent crying combined with other symptoms may indicate depression, especially if you are not sure why you are crying.
For example, if you find yourself crying for no reason or for something trivial, such as spilling a cup of water or losing your bus, then this is a good indication that you may be depressed.
Be sure to share this symptom with your doctor.
Tearing or frequent crying is a common symptom of depression in adolescents.
Reflect on any mysterious pain and discomfort you have had : If you have frequent unexplained headaches or other pain, this is another good reason to see a doctor.
A medical condition may be the culprit or the pains may be due to depression.
Physical pain is one of the most common and often overlooked signs of depression in men.
If you are a man with back pain, headaches, stomach, sexual dysfunction or any other physical symptom, be sure to tell your doctor.
Older people often complain of physical problems over mental or emotional ones, so depression can be hidden for a long time.
Consider the physical changes, the deaths of friends and the losses of independence that can trigger depression.
You may also notice things like having trouble sleeping or sleeping too much.
Find the cause of depression:
Consider the possible causes and risk factors for depression : Depression is a complex disorder, and there are no simple tests that doctors can do to see if they have them or not.
However, there are many tools that a therapist can use to control depression, including completing a questionnaire.
Certain experiences can also cause or put you at risk for depression and sharing this information with a doctor or therapist can help you make a diagnosis.
Some possible causes and risk factors for depression may include:
Trauma and pain : Abuse or other violent experiences can cause depression, whether it happened recently or otherwise.
Pain after the death of a friend or another traumatic event can turn into total depression.
Stressful events: Sudden changes, even positive, such as getting married or starting a new job, could be responsible.
More long-term stress when caring for a sick person or going through a complicated divorce are common triggers as well.
Health conditions: Chronic pain, thyroid disease and many other medical conditions can cause depression, especially if you are fighting a long battle against an illness.
Medication and Substances: Read the label of the side effects of any medication you are taking.
Avoid alcohol and other drugs to see if your symptoms improve. Depressed people often abuse drugs, which makes the problem worse.
Relationship problems: If you have difficulties in one or more of your personal relationships, this can also put you at risk for depression.
Family history of depression: If a relative has had problems with depression, then you are at a higher risk of developing it yourself.
Loneliness, isolation or lack of social support: If you do not have a support system and spend a lot of time on your own, this can also put you at risk for depression.
Financial stress: If you have been struggling with debt or simply trying to keep up with your monthly expenses, this can put you at risk for depression.
Consider whether your depression may be related to autumn or winter : If your symptoms appear as the days get shorter and darker, your depression may be a seasonal affective disorder, caused by too little sunlight.
Exercise outdoors during the day to see if it improves, or ask a doctor about artificial light treatment.
Not all temporary depression is a seasonal affective disorder. Many people have depressive episodes that occur every few weeks, months or years.
If you are especially manic and energetic when you are not depressed, tell a doctor that you may have a bipolar disorder.
Do not rule out your depression if none of these causes apply: Many episodes of depression have a primarily biological or hormonal cause, or a cause that is difficult to identify.
This does not make it less serious or that it is not worth trying. Depression is a real medical condition, it is not something to be ashamed of because you do not think you have a reason to be sad.
Clinically significant depression can usually be understood as severe enough to interfere with one’s ability to function.
It is quite common in all ages, affects more than 16% of children in the United States at some point in their lives and is believed to be increasing in children and adolescents, both in that country and elsewhere.
Other statistics about depression include its tendency to occur at a rate of about 2% before adolescence and about 5% to 8% when considering both adolescents and children under the age of adolescence.
It is a major cause of deterioration of health (morbidity) and death (mortality).
About 3,000 adolescents and young adults die by suicide each year in the United States, making it the third leading cause of death in people 10-24 years of age.
What are the types of depression in children?
Children may experience episodes of moderate to severe depression associated with a major depressive disorder or a lower, mild or moderate mood of dysthymia .
Depression can also be part of other mood disorders such as bipolar disorder, as a result of psychosis (for example, having symptoms of delusions or hallucinations).
Also as part of a medical condition such as hypothyroidism , or as a result of exposure to certain medications, such as cold or drug abuse medications, such as cocaine abstinence .
What are the causes and risk factors for depression in children?
Depression in children does not have a specific cause.
On the contrary, people with this disease tend to have a number of biological, psychological and environmental contributors for their development.
Biologically, depression is associated with a deficient level of the neurotransmitter serotonin in the brain, a smaller size of some areas of the brain and increased activity in other parts of the brain.
Girls are more likely to be diagnosed with depression than boys, but this is thought to be due, among other things, to biological differences based on gender and differences in how girls are encouraged to interpret and respond to their experiences in opposition to children.
It is believed that there is at least a partially genetic component in the pattern of children and adolescents with a depressed father are up to four times more likely to develop the disorder.
Children who have depression or anxiety are more likely to have other biological problems, such as low birth weight, problems sleeping and having a mother under 18 at the time of birth.
Psychological contributors to depression include low self-esteem, negative body image, being overly self-critical and often feeling helpless when dealing with negative events.
Children who suffer from conduct disorder, attention deficit hyperactivity disorder, clinical anxiety or who have cognitive or learning problems, as well as problems participating in social activities are also more at risk of developing depression.
Depression can be a reaction to the stress of life, such as trauma, which includes verbal, physical or sexual abuse, the death of a loved one, school problems being abused or suffering from peer pressure.
Young people struggling to adapt to the culture of the United States have found an increased risk of developing depression. The research differs as to whether children who are obese have an increased risk of developing depression.
Other contributors to this condition include poverty and financial difficulties in general, exposure to violence, social isolation, parental conflict, divorce and other causes of disruption in family life.
Children who have limited physical activity, poor school performance or who lose a relationship are also at increased risk of developing depression.
What are the symptoms and warning signs of depression in children?
Clinical depression, also called major depression, is more than sadness that lasts a day or two.
In true depressive illnesses, symptoms last for weeks, months or sometimes years if left untreated.
Depression often results in the patient being unable to perform daily activities, such as getting out of bed or getting dressed, performing well in school, or playing with peers.
General symptoms of major depression, regardless of age, include having a depressed mood or irritability or difficulty experiencing pleasure for at least two weeks and having at least five of the following signs and symptoms:
- Feeling sad and / or irritable
- Significant changes in appetite, with or without significant weight loss, without being able to gain weight properly or gain excessive weight.
- Change in sleep pattern (difficulty sleeping or sleeping too much).
- Agitation or physical delay (for example, restlessness or sensation of slowing down).
- Fatigue or low energy / energy loss.
- Difficult to focus.
- Feeling worthless or excessively guilty.
- Thoughts of death or suicide.
Children with depression may also experience classic symptoms, but may also have other symptoms, such as:
- Altered school performance.
- Persistent boredom
- Frequent physical discomforts, such as headaches and stomach aches.
- More risk-taking behaviors and / or less concern for their own safety.
- Examples of risk behaviors in children include unsafe play, such as climbing too high or running on the street.
Parents of babies and children with depression often report that they observe the following behavioral changes in the child:
- They cry more often or more easily.
- Greater sensitivity to criticism or other negative experiences.
- Mood more irritable than normal or compared to others according to their age and gender, leading to vocal or physical outbursts, defiant, destructive, angry or other behaviors.
- Eating patterns, sleep patterns or significant increase or decrease in weight change, or the child does not achieve an adequate weight gain for their age.
- Unexplained physical complaints (for example, headaches or abdominal pain).
- Social isolation, in which the young person spends more time alone, away from friends and family.
- Develop more “attachment” and more dependent on certain relationships (This is not as common as social isolation).
- Very pessimistic, hopeless, helpless, excessively guilty or worthless.
- Express thoughts about hurting yourself or engaging in reckless behavior or other potentially harmful behavior.
How do health professionals diagnose depression in children?
Many health care providers can help determine if the diagnosis of clinical depression is appropriate for children, including authorized mental health.
Because of the social stigma that can be associated with receiving mental health treatment, pediatricians and other primary care physicians are often the first professionals approached for the diagnosis and treatment of depression.
The professional who is consulted to evaluate a child’s depression will probably perform or refer for a complete medical interview and a physical examination as part of the assignment of the correct diagnosis.
Depression is associated with a host of other mental health conditions, such as attention deficit hyperactivity disorder (ADHD), autism , bipolar disorder, post-traumatic stress disorder (PTSD), and anxiety disorders.
So the evaluator is likely to detect the signs and symptoms of manic depression (bipolar disorder), a history of trauma, and other mental health symptoms.
Childhood depression can also be associated with a series of medical problems, or it can be a side effect of several medications, exposure to drugs of abuse or other toxins.
Therefore, routine laboratory tests are often performed during the initial evaluation to rule out other causes of symptoms.
Sometimes, you may need an x-ray, a scanner, or another imaging study.
As part of the evaluation, the patient can be asked a series of questions based on a standardized questionnaire or a self-assessment to help determine the risk of depression and suicide.
What should parents do if they suspect that their child is depressed? How to fight depression?
Family and friends are advised to seek a mental health assessment and treatment for the depressed child.
Adult members of the family can consult with the child’s primary care physician or seek mental health services.
Once the child with depression receives treatment, family members can promote good mental health by encouraging them to have a healthy lifestyle, which includes encouraging the child to maintain a healthy diet.
Also get enough sleep, exercise regularly, stay socially active and participate in healthy stress management activities.
Parents and other loved ones can also be useful for the depressed child by discouraging them from engaging in risky behaviors.
What is the treatment for depression in children?
If it is determined that your child has clinical depression, it is likely that the health professional will recommend treatment.
Treatment may include alleviating any medical condition that causes or worsens depression.
For example, a person who has low levels of thyroid hormone could receive a hormone replacement with levothyroxine (Synthroid).
Other aspects of treatment may include supportive therapy, such as lifestyle and behavior changes, psychotherapy, complementary treatments, and possibly medication for moderate to severe depression.
If the symptoms are severe enough for drug treatment to be appropriate, the symptoms tend to improve more quickly and over a longer period of time when the medication is combined with psychotherapy.
Most mental health professionals will continue the treatment of major depression for six months to a year to prevent the reappearance of symptoms.
Treatment for children with depression can have a significantly positive effect on the child’s functioning with peers, family members and at school.
Without treatment, the symptoms tend to last much longer, may not improve or may get worse.
With treatment, the chances of recovery improve significantly.
Psychotherapy (“talk therapy”) is a type of mental health counseling that involves working with a trained therapist to discover ways to solve problems and cope with depression.
It can be a powerfully effective intervention, even resulting in positive biochemical changes in the brain.
For babies, music therapy and infant massage has been found to be useful interventions.
Two main types of psychotherapy are commonly used to treat childhood depression: interpersonal psychotherapy and cognitive behavioral therapy .
In general, these forms of treatment take weeks to months and are aimed at relieving depressive symptoms.
More intense psychotherapy may be needed for a longer period of time when treating very severe depression or depression that is accompanied by other psychiatric symptoms.
Interpersonal therapy (IPT): this form of psychotherapy seeks to alleviate depressive symptoms by helping the child with depression to develop more effective skills to cope with their emotions and relationships. IPT uses two strategies to achieve these objectives:
- Educate the child, his parents and other family members about the nature of depression: The therapist will assure the child and their loved ones that depression is a common disease and that most people tend to improve with the treatment.
- Definition of problems (such as abnormal grief or interpersonal conflicts):Once the problems are defined, the therapist can help the child to set realistic goals to solve these problems and work with him and the child’s family using different treatment techniques to reach these objectives.
Cognitive-behavioral therapy (CBT): this approach to psychotherapy helps to reduce depression and the likelihood that it will return by helping the child to change his way of thinking about certain topics.
In TCC, the therapist uses three techniques to achieve these goals.
- Teaching component: this phase helps establish positive expectations for treatment and promotes the child’s participation in the treatment.
- Cognitive component: This promotes the identification of thoughts and assumptions that play a role in the child’s behaviors, especially those that may predispose the patient to be depressed.
- Behavioral component: uses methods of behavior modification to teach the child more effective ways of dealing with problems.
The most commonly used group of antidepressant medications prescribed for children are selective serotonin reuptake inhibitors (SSRIs).
SSRI medications influence serotonin levels in the brain.
For many prescription professionals, these medications are the first choice due to the high degree of effectiveness and safety of this group of medications.
The examples of these medications are listed here first with the generic name and branding in parentheses:
- Fluoxetina ( Prozac ).
- Sertraline (Zoloft).
- Paroxetine (Paxil).
- Fluvoxamina ( Luvox ).
- Citalopram ( Celexa ).
- Escitalopram ( Lexapro ).
- Vortioxetina (Trintellix).
- Vilazodone (Viibryd).
Only Prozac and Lexapro are approved by the Food and Drug Administration (FDA) to treat childhood depression and only those 8 years of age and older for Prozac, 12 years of age or older for Lexapro.
Therefore, it is considered that any other medication used to treat this condition in children or the use of an antidepressant in younger children is used “without label”.
In fact, the use of Paxil has fallen out of favor due to what is believed to be its lack of constant efficacy in the context of the risk of possible side effects.
Non-neuroleptic mood stabilizing medications are also sometimes prescribed with an antidepressant to treat children with severe unipolar depression that do not improve after receiving trials with different antidepressants.
These medications can also be considered in addition to or in place of an antidepressant in children suffering from bipolar disorder.
Of the non-neuroleptic mood stabilizers, lamotrigine (Lamictal) appears to be unique in its ability to also treat unipolar depression effectively on its own and in addition to an antidepressant.
However, it is only used in people 16 years of age or older because of potentially serious side effects.
Other antidepressant medications work differently than the commonly used SSRIs.
The following medications may be prescribed when the SSRIs have not worked: bupropion (Wellbutrin), venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq) or levomilnacipran (Fetzima).
About 60% of children who take antidepressant medications improve and are thought to be highly suggestible to improve (placebo effect).
It may take one to six weeks to take the medication in its effective dose to start feeling better.
The prescribing professional will probably evaluate the depressed child who is receiving the medication again soon after it has been determined whether the medication is being well tolerated and if the symptoms have begun to improve.
Otherwise, the doctor or other prescriber may adjust the dose of the medication or prescribe a different one.
After the symptoms begin to improve, the health professional is likely to prescribe the parents of the depressed child to continue administering the medication for six months to a year because stopping too soon may cause the symptoms to return or worsen.
Some people need to take the medication for a longer time to keep the depression from coming back.
Stopping treatment abruptly may cause depression to return or abstinence (withdrawal syndrome) to occur, depending on what medication is prescribed.
The side effects of antidepressant medications vary significantly from one medication to another and from person to person.
In rare cases, it is believed that some people of all ages have become much more depressed with the medication, even attempting or completing a suicide or homicide.
It is believed that children and adolescents are particularly vulnerable to this rare possibility.
However, when considering this risk, it is imperative to also consider the risk of potentially serious outcomes that may be the result of untreated depression.
A series of over-the-counter herbal supplements such as St. John’s Wort and dietary supplements such as vitamin C and B complex vitamins are used as remedies for depression.
Little is known about the safety, effectiveness or appropriate doses of these remedies, even though they are taken by thousands of people around the world.
While some of the best-known alternative remedies continue to be studied to see how well they work, there is still little evidence that herbal supplements effectively treat moderate to severe clinical depression.
Medical professionals often hesitate to recommend herbs or dietary supplements to treat depression, particularly in children, because they are not regulated by the FDA, such as prescription drugs, to ensure their purity, quality and effectiveness.
What are the complications of depression in children?
Depression during childhood puts people at risk of developing other mental health problems.
Children with depression are also more likely to have poor academic performance and to participate in the abuse of alcohol and other drugs.
As adults, people who had depression during childhood and adolescence are at risk of having problems maintaining employment, as well as family and other types of disorders during adulthood.
What is the prognosis of depression in children?
Depression can be chronic, since 85% of people who have one episode of the disorder will have another within 15 years after the first episode.
Depressed people who have been exposed to trauma are less likely to respond to treatment with antidepressant medications than those who have not experienced trauma.
Young people with depression are more likely to develop severe mental illness during adulthood compared to children who do not suffer from depression.
Depression is the leading cause of disability in the United States for people over 5 years of age, especially for women.
Childhood depression is a risk factor for a series of potentially negative outcomes, such as academic and interpersonal problems, as well as problems with drugs and attempted suicide.
Is it possible to prevent depression in children?
For children, from infancy to adolescence, a strong and healthy bond between the child and his parents can help protect the child from developing depression.
Parental behaviors that tend to foster attachment to health with their children involve constant love and care, as well as responsiveness to the child’s needs, including steps appropriate for their age to the child’s gradual independence.
The prevention of childhood depression tends to include risk factors, both specific and non-specific, the strengthening of other protective factors and the use of an appropriate approach to the child’s level of development.
Such programs often use cognitive-behavioral and / or interpersonal approaches, as well as family-based prevention strategies because research shows that these interventions are the most effective.
Protective factors for adolescent depression include supportive adult participation, strong relationships between family and peers, health coping skills, and emotional regulation.
The children of a depressed parent tend to be more resilient when the child is better able to focus on age appropriate tasks in their lives and relationships, as well as being able to understand the condition of their parents.
For depressed parents, their children seem to be less likely to develop the disorder when the parent is able to demonstrate a commitment to parenting and relationships.
Depression in pregnancy
With pregnancy comes joy, emotion, baby showers and the wonder of a new life. But for some, pregnancy is marred by depression, a condition that not only puts the mother at risk, but also the child.
For more than 10% of pregnant women, the next birth of a child is mixed with constant feelings of sadness, hopelessness and anxiety, as well as a decrease in appetite and sleep problems.
Fortunately, expectant mothers do not need to suffer from this condition: depression is treatable during pregnancy, with psychotherapy and antidepressant medications.
“During pregnancy, doctors try to keep women without antidepressants unless they have severe depression or if they have a history of relapse if antidepressants were removed in the past.”
Victoria Hendrick said. “In contrast, other interventions, such as psychotherapy, are used to help reduce the need for an antidepressant.”
“But if the depression is so bad that a pregnant woman is not eating or gaining weight, for example, then it should be treated as aggressively as possible.”
For women at risk of depression during pregnancy (those who have struggled with major depression in the past or who experienced depression during a previous pregnancy) the news is good: the risk associated with the use of antidepressants during pregnancy is small.
But what should be taken into account when deciding whether or not to take an antidepressant or try other therapies first? And, what research is available to help reassure a future mom’s mind?
“For mild or moderate depression, I prefer to use psychotherapy or group therapy than antidepressants,” says Hendrick, assistant professor in the department of psychiatry and biobehavioral sciences at UCLA.
But for pregnant women with major depression, the risk of a relapse after stopping antidepressant medication is greater than the risks posed by treating it with medication.
“If health behaviors are not good because of depression, that could have a negative impact,” says Hendrick.
“If a woman does not eat, does not sleep, feels stressed or anxious, this could have an adverse impact on a developing fetus. And obviously, suicidal feelings are another adverse risk associated with depression. ”
Untreated depression can interfere with a woman’s ability to care for herself, affect nutrition, increase tobacco, alcohol and drug use, cause preterm birth and low birth weight babies, and interfere with feelings of attachment to an unborn baby.
Major depression not treated during pregnancy can also cause babies to be more sensitive to stress.
In cases of major depression, Hendrick explains that women need both psychotherapy and antidepressant medications.
“The more multidisciplinary the treatment, the more likely they are to improve,” says Hendrick. “The use of both therapy and medication greatly increases a woman’s chances of seeing an improvement in her symptoms.”
Antidepressants are generally safe:
When the symptoms of depression justify psychotherapy and antidepressant medication, the good news is that certain medications can help treat depression with little or no risk to the fetus.
“There is no evidence to suggest that taking antidepressants during pregnancy carries a risk of birth defects, and that is reassuring,” says Hendrick.
“But it’s important to keep in mind that we can not ensure that antidepressants are 100% safe to take during pregnancy.”
According to a study published in the American Journal of Psychiatry, women who took antidepressant medications throughout their pregnancies, both selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft and tricyclic antidepressants, had children with preschool education normal and early.
The data also suggested that, on the other hand, depressed and untreated pregnant women and those suffering from long-term depression or multiple episodes of depression may have children with behavioral problems and delayed cognitive and language development.
A concern associated with the medical treatment of depressed women during pregnancy is the possible increased risk of preterm birth.
A review of medical records showed that women treated with SSRIs during pregnancy had an increased risk of giving birth to their babies early, before 36 weeks, according to a study published in the American Journal of Psychiatry.
But the women in this study who were treated with another class of antidepressants known as tricyclics did not have an increased risk of preterm labor.
The researchers noted that the risk associated with SSRIs is not overwhelming enough to ensure that women do not take antidepressants if their condition requires medication.
Also reassuring is that the study showed no risk of birth defects associated with SSRIs.
Drug withdrawal problems?
An additional concern is whether a newborn baby whose mother took antidepressants during pregnancy will experience withdrawal symptoms.
“While SSRIs, such as Zoloft, Prozac and Paxil, are unlikely to cause a major birth defect. Several, including Prozac and Paxil, have been reported to increase the risk of withdrawal symptoms in the newborn. ”
“Especially if they are used in the third trimester,” says C. Neill Epperson, MD, assistant professor of psychiatry and obstetrics / gynecology at the Yale University School of Medicine.
Studies that evaluated the risk of SSRI during pregnancy showed that Paxil could cause withdrawal symptoms, such as nervousness, vomiting and irritability in infants.
But the researchers noted that the cause of the symptoms is not entirely clear: they could not say definitively whether the symptoms were the result of the withdrawal syndrome, the toxicity of the drugs or another unknown factor.
The last cause for concern arises when a mother gives birth and decides to breastfeed her baby while taking antidepressants. Here, the news is very promising.
“Breastfeeding has been well researched in terms of antidepressants,” Hendrick tells WebMD.
“And the results of the research show that women who breastfeed should not be told that they have to stop taking an antidepressant to breastfeed.”
Hendrick explains that babies are very sensitive to their mothers’ mood, and there is a lot of evidence that suggests that the mother’s mood can affect the child.
“The mother should not remain depressed for both her benefit and that of the baby,” she says.
“Antidepressants can be useful, and exposure to a baby through breast milk is so small, there is no reason not to take them if they could be useful.”
Balance between benefits and risks:
“Have a conversation with your doctor about the risk and benefits of taking an antidepressant if you are pregnant,” says Epperson.
“If you can stop taking a medication, of course you should stop, but if you can not, and many women can not, then antidepressants can help.”
Both with psychotherapy and with antidepressants, a pregnant woman can overcome depression and enjoy the birth of her child, and be sure that the risk that antidepressants represent for her child is small.
Postpartum depression is a serious mental health condition that can occur in the weeks and months after a child is born.
What causes postpartum depression?
While every case of postpartum depression has a different combination of factors that drive it, researchers believe that, in general, hormones, neurochemistry and life history play a role in the development of the disease.
This disease affects between 14 and 20 percent of women. And those numbers can be even higher, since experts believe that the condition is often not reported.
The risk of postpartum depression is higher among people who have a history of mental health problems, such as depression, anxiety or bipolar disorder.
One study found that the risk was more than 20 times higher for women with a history of depression. Having an episode of postpartum depression can also increase your chances of having another.
But the condition is not permanent. With time and help, both medical and otherwise, you can return to your normal routines.
What role do your life circumstances play?
Pregnancy and birth are intensely emotional events. These milestones can bring joy, but they can also bring challenges that make you feel sad, tired and anxious. These feelings are normal.
According to some estimates, up to 85 percent of mothers feel some degree of sadness after the birth of their baby.
But while this sadness rarely lasts more than a week or two, the symptoms of postpartum depression can persist for months.
Said Diane Young, a staff physician in the department of regional obstetrics and gynecology at the Cleveland Clinic based in Willoughby Hills, Ohio. “If the symptoms go beyond a period of two weeks and the mother still has problems, that will generally lead to a diagnosis of postpartum depression.”
But these feelings can be exacerbated and can lead to postpartum depression if there are past or current tensions that make you feel that you have no support and stability.
Your relationship with your spouse or partner can be difficult, or your finances can be unstable.
Your pregnancy or delivery could have been difficult, or if you have a very needy newborn.
Maybe you lost a father while you were pregnant. It can be a very young mother or have suffered trauma and abuse as a child.
What role do your hormones play?
External circumstances such as these can also make you more vulnerable to the hormonal disruptions that occur after birth.
During pregnancy, the levels of estrogen and progesterone increase to strengthen both the uterus and the placenta. But delivery alters the levels of these and other hormones.
“After giving birth, hormone concentrations are reduced 100-fold in a matter of days,” says Katherine Wisner, Professor Norman and Helen Asher of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology at the University Feinberg School of Medicine. Northwestern in Chicago.
The sudden interruption in hormone levels can create alterations in mood, particularly in women who have a previous history of depression or anxiety.
Periods of hormonal fluctuation, such as menstrual cycles and perimenopause, are associated with major depressive episodes, says Dr. Wisner.
It could be that fluctuations that occur during and after pregnancy can affect certain neurotransmitters or affect brain function in other ways.
“This massive drop in hormones, along with the initiation of breastfeeding, interrupted sleep and adaptation to motherhood contribute to the risk of developing depression,” he adds.
There is also research that suggests that both pregestational and gestational diabetes can increase the risk of the disease.
Can men suffer from postpartum depression?
Yes, men can also suffer from postpartum depression.
Studies have found that approximately 4 to 10 percent of parents suffer from depression in the first year after birth.
In one study in particular, which examined more than 1,700 parents with 1-year-old children, the researchers also found that depression had a negative effect on parenting.
Depressed parents were more likely to whip their children and less likely to understand them.
What is postpartum psychosis?
In rare cases, 1 or 2 of every 1,000 births, a new mother will experience postpartum psychosis.
The symptoms are more severe than in postpartum depression, and appear quickly, usually in the first days after delivery.
Those who suffer from puerperal psychosis may have strange, grandiose or delusional thoughts, and their moods may oscillate from one extreme to the other.
They may also hallucinate, hear voices or see things that are not there, and may have recurring thoughts of harming themselves or their baby.
In some cases of postpartum psychosis, there may be a history of mental illness, such as bipolar disorder, schizophrenia, or schizoaffective disorder.
If you notice any of these changes in someone you love or who is nearby, it is important to seek help immediately so that both the mother and the child remain safe.
What are the risk factors for postpartum depression?
Any parent can develop postpartum depression, but the following factors can increase your risk:
- Personal or family history of depression, anxiety or other mental illness.
- Previous postpartum depression.
- History of severe premenstrual syndrome.
- Sleep deprivation
- Chronic pain.
- History of fertility treatments or miscarriage.
- Abrupt interruption of breastfeeding.
- History of trauma or abuse.
- Traumatic or disappointing birthing experience
- Substance abuse.
- Have children when you are very young
Symptoms of postpartum depression
The symptoms of postpartum depression vary from person to person. You are unlikely to experience them all, but these symptoms are included:
- Irritability or anger
- Humor changes.
- Sleep problems, such as insomnia or excessive sleep.
- Changes in appetite
- Suicidal thoughts.
- Lack of interest in the baby
- Feeling disconnected from the baby.
- Thoughts of harming the baby.
- Memory loss.
- Sense of guilt or shame.
- Feeling of fatality.
- Thoughts of fear or strangers that repeat themselves in your mind.
How to overcome and get out of postpartum depression?
Your doctor can detect signs that you are at risk for postpartum depression during your monthly prenatal visits or during the typical six-week appointment after the birth of your baby.
Often, with postpartum depression, signs of depression appear during pregnancy, so if you notice any of the above symptoms before giving birth, tell your doctor.
Regardless of the extent of your symptoms, it is important to be frank with your doctor so that you can receive appropriate treatment during this important time in your life and that of your baby.
If you develop postpartum depression, your doctor may suggest one or more treatment options:
Antidepressants: You may be prescribed an antidepressant before you even have your baby, one that is safe to take during pregnancy and during breastfeeding.
After your pregnancy and if you are not breastfeeding, you will have a wider range of antidepressant options, which you may need for six months or more.
Conversation therapy: You may not need any medication at all, if you find a psychologist who can provide a safe emotional outlet and who is trained to help you find ways to control your emotions.
Thyroid medications: Sometimes, this type of depression is a sign that your thyroid hormone level is too low.
Your doctor can check the level with a simple blood test and treat it with medication to restore the balance of the thyroid.
How do you deal with postpartum depression?
In addition to psychotherapy and medications, the following strategies will help you during treatment:
Take some time to take care of yourself: It is important for people who have postpartum depression to take time to do things like eat healthy meals, exercise, and, most importantly, get enough sleep.
Be patient: Treatment may help, but it may take some time before you feel like you again.
Say yes to the help of a caregiver: Your friends and family can help at home, take care of the baby to sleep, run errands or be there to listen when you need to talk.
Find a support group: Help to be close to other people who have experienced postpartum depression and can share experiences and skills to cope with situations.
Weaning slowly: Interrupting breastfeeding can cause a hormonal change. Some doctors recommend that you wean slowly if you are going to stop breastfeeding.
Consider alternative treatments: Complementary and alternative therapies can help, although more research is needed to confirm their benefits.
Light therapy, omega-3 supplements, aromatherapy and music therapy are among the approaches that have shown some efficacy and promise.