| Childhood depression is a very real but sometimes | | | | guide by and large. Nevertheless, this is merely a guide |
| elusive illness that affects the young today. We take a | | | | and should not ne taken as set in stone. For example, |
| look at what it actually means and how unity and | | | | a 12 year old boy may show signs of depression by |
| support in the family can help fight its hold over a | | | | aggressive behaviour and phusical complaints."For Dr |
| child.At the recently concluded Asia Pacific Suicide | | | | Chan, "Depression before the age of six is very rare. In |
| Prevention Convention 2006, we learnt a few startling | | | | fact, I do not think that there is general agreement that |
| facts about children and suicide. For example, in a | | | | it exists. In a young child, the common emotional |
| worldwide survey, 7.3% to 38% of the children | | | | condition is anxiety, not so much depression. From six |
| surveyed demonstrated suicide ideation, which is the | | | | years onwards, I would agree with the given |
| idea of wanting to kill themselves. In Singapore, close to | | | | description."Children under stress, who experience loss |
| 4.7% of children entertain this morbid thought. While the | | | | , or who have attention , learning , conduct or anxiety |
| figure may be alarming, there is no need to panic as it | | | | disorders are at a higher risk for depression. |
| is actually not uncommon to think about suicide.Ask | | | | Depression also tends to run in families.Lena's |
| anyone in the street if he had thought about suicide | | | | experienceLena (not her real name) is a 17 year-old |
| before and the answer will most probably be a `yes'. | | | | student who recently suffered a relapse and fell into |
| Thinking about something as serious as killing oneself | | | | depression once more. Lena has been troubled by |
| and actually doing it are two different matters. Out of | | | | depression since the age of 12. Once again, she has |
| all childhood suicides, approximately 23.5% are | | | | no appetite for food, is feeling listless and confused, |
| associated with mental illness such as depression, | | | | lost alot of weight and is isolating herself from |
| schizophrenia and others. Seeing the numbers and | | | | others.Lena's mother, 49 year old clerical staff Sonia |
| understanding that depression is one of the key | | | | (not her real name), recounts her daughter's |
| causes that drive our young to suicide. It is time we | | | | experience with depression, " It all started after Lena's |
| understand a little more about this elusive illness called | | | | father passed away. At first , nothing seemed wrong. |
| "Childhood Depression".The Definition of Childhood | | | | SHe was very sad but she did not shed a tear at his |
| DepressionIn a 2004 article published by the American | | | | funeral. It was a year after that she started to miss |
| Academy of Child and Adolescent Psychiatry , | | | | him badly. This was compounded by being bullied in |
| childhood depression is defined as "an illness when the | | | | school and stressed by schoolwork. Always a quiet |
| feelings of depression persist and interfere with a child | | | | child, Lena became even more withdrawn. She had |
| or adolescent's ability to function."Feelings of | | | | trouble sleeping, would cry for no reason, refused to |
| depression are represented in the forms of mood, | | | | eat and talked about hurting herself."Seeing her |
| physical, mental and behavioural changes in a child. Dr | | | | daughter's condition, Sonia brought Lena to a Polyclinic |
| Ken Ung, Senior Consultant Child, Adolescent & Adult | | | | which referred them to a psychiatrist at a hospital. |
| Psychiatrist & Psychotherapist at Adam Road Hospital | | | | Lena was given antidepressants and started having |
| describes the signs of childhood depression as | | | | regular therapy sessions with psychiatrists and |
| persistent "irritability or loss of interest, loss of appetite | | | | counsellors. She tried to follow their advice of not |
| and weight, poor sleep , lethargy, headache, stomach | | | | thinking negatively, to focus on developing her interests |
| pain, loss of concentration, preoccupation with | | | | and to make a timetable for each day. Everyday was |
| self-harm or suicide, refusal to go to school, increased | | | | a struggle but she managed to recover with time."She |
| temper tantrums and antisocial behaviours such as | | | | said she liked the counselling sessions where she could |
| smoking, drinking and running away from home. Any | | | | talk to someone about her feelings and problems." say |
| combination of these changes that lasts for more than | | | | Sonia of Lena's reaction to treatment. "Slowly, she got |
| two weeks could spell a child falling into depression | | | | better to the point that she was more cheerful and |
| and warrants a closer look.Many of the symtoms | | | | could laugh and giggle like a normal young girl. She |
| listed are actually applicable to both adults and children | | | | even enrolled in yoga classes that helped her gained |
| but there are telling differences. Age, in a | | | | fitness and to relax."For Sonia, being supportive of |
| non-categorical way, does make a difference in the | | | | Lena through the down times and being sensitive to |
| presentation of depressive behaviour. "We don't tend | | | | her needs are her priorities. "I told her that her health is |
| to categorize (childhood depression) in terms of age | | | | more important than studies. When I'm at work, I try to |
| groups," says Dr Ung, " but we can generally say that | | | | call her and talk to her whenever I can. She will tell me |
| adolescent depression tends to look more like adult | | | | things like, " Mummy, I'm useless and I don't know what |
| type depression , whereas, childhood depression can | | | | to do," and I will try to encourage her to look on the |
| be more `a typical' perhaps manifesting in bodily pains | | | | bright side, not to think too much..etc.. I have to try to |
| and behaviour changes. The closer the age of a child | | | | give her lots of love, my full support and |
| to adulthood - the more we can expect to see an | | | | attention."TreatmentWhat most doctors agree on is |
| adult-type depression.Types of childhood | | | | that medication should not be used unnecessarily on |
| depressionThere is no clear categorization of childhood | | | | children and that when used, it should be accompanied |
| depression. According to Dr Ung, "Typing depression is | | | | with the right counselling and therapy. " It's interesting |
| notoriously difficult and fashions come and go. We | | | | that recent studies have not been able to prove that |
| now tend to type it according to severity i.e. mild, | | | | antidepressants work in children. This could be |
| moderate and severe. Sometimes, we use the term | | | | because children are not mini adults and what works |
| `reactive' depression to denote the type that is due to | | | | for adults may not work for kids," says Dr Ung.There |
| a reaction to some stress (such as the sudden | | | | is also little research of how antidepressants work on |
| passing of a loved one). Although very rare in children, | | | | children and prescription drugs may increase the risk of |
| `psychotic' depression refers to the presence of | | | | self-harm for some vulnerable ones. However, Dr Ung |
| psychotic symptoms, which are symptoms that show | | | | adds, "To keep a perspective on things, the increase |
| that the person has lost touch with reality, i.e. hearing | | | | of antidepressants prescriptions is small, probably |
| voices, believing irrational, bizarre or incredible | | | | around 2% in affected children given inactive |
| thoughts."Another childhood psychiatry expert, Dr | | | | medications (placebos) to about 4% of those on |
| Sharon Chan of Sharon Chan Child Guidance Clinic, | | | | active medication."Counselling, it seems , plays the key |
| who has been practicing child psychiatry since 1988 | | | | role in helping children recover from depression. "A |
| concurs, "I am not sure that there is such a | | | | good counsellor will try to get information from parents, |
| categorization (of childhood depression).. because the | | | | child and school and will try his or her best to |
| entity is still controversial, it follows adult depression | | | | co-ordinate the counselling to incorporate all these |
| patterns (sic) - chronic, single episode or recurrent, | | | | parties. Cognitive-behavioural therapy is one of the |
| adjustment disorder, bipolar etc."Bipolar disorder, also | | | | commonest forms of counselling techniques used |
| known as manic-depression, is a type of mood | | | | nowadays - it seeks to change the negative thoughts |
| disorder marked by extreme changes in mood, energy | | | | of the child to more realistic and positive ones and also |
| levels and behaviour. Symptoms can begin in early | | | | t help the child make action/behavioural changes that |
| childhood but more typically emerge in adolescence or | | | | will help lift the mood," adds the psychiatrist.Cyber Help |
| adulthood. Children with bipolar disorder usually | | | | With the computer-savvy generation of today, some |
| alternate rapidly between extremely high moods | | | | children or teens may choose to express their |
| (mania) and low moods (depression). These rapid | | | | thoughts and feelings in cyber space. is a community |
| mood shifts can produce irritability with periods of | | | | website launced in March to provide information and |
| wellness between episodes, or the young person may | | | | counselling services for depression. A `diary' services |
| feel both extremes at the same time. Parents who | | | | allows members to post daily updates on their mental |
| have children with the disorder often describe them as | | | | and emotional experiences while a `letterbox' service |
| unpredictable, alternating between aggressive or silly | | | | provides them with an opportunity to ask questions to |
| and withdrawn.Stages of childhood | | | | a panel of experts. Most importantly, a service like this |
| depressionAccording to a Harvard Medical School | | | | seeks to educate the public on the existence of |
| Publication, " The picture changes with age. Up to age | | | | depression and encourage those who are depressed |
| three, the signs (of childhood depression) may include | | | | to seek help. Following examples, depressed children |
| feeding problems, tantrums, and lack of playfulness | | | | may be inspired by a strong sense of community to |
| and emotional expressiveness. AT ages 3-5, | | | | step out of a possible state of isolation. Adults too, can |
| depressed children may be accident-prone and | | | | visit to gather more information and advice before |
| subject to phobias. Even before age 5, they may | | | | deciding how best to seek help.Understanding is |
| show signs of self-reproach by apologizing | | | | Key."Sometimes, depressed children are mistakenly |
| unnecessarily for minor mistakes and transgressions | | | | labelled as lazy, stubborn or difficult," says Dr Chan. |
| like spilling food or forgetting to put clothes away. | | | | This is largely due to a lack of knowledge and |
| Children of early school age (6-8) sometimes show | | | | understanding on the adults' part. Children, unlike adults |
| depression with vague physical complaints and | | | | are dependent on their families and guardians to |
| aggressive behavior. They may cling to their parents | | | | identify their troubles and seek help.Dr Ung adds," One |
| and avoid new people and challenges. At ages 9-12, | | | | common misconception is that the child is mad. This is |
| some common symptoms are morbid thoughts and | | | | totally not so. Another is that the child is `weak'. Some |
| lying awake worrying about schoolwork. By then, | | | | famous people who are strong of character and have |
| children have enough intellectual capacity and social | | | | suffered depression include Abraham Lincoln. Another |
| understanding to think about reasons for their | | | | misconception is that it is incurable or that the child is |
| depression , and they may blame themselves for | | | | `bad'. Depression is a very treatable condition and the |
| disappointing their parents."When asked for his opinion | | | | change of behaviour from depression should not be |
| on this analysis, Dr Ung says, " I think that this is a good | | | | mistaken for `badness'. |