Depression

Understand the diagnosis, what to do next and access resources

Depression is the constant feeling of sadness intensified by feelings of hopelessness and helplessness over the course of weeks. There are many different types of depression including: Major depression, Chronic depression (disthymia), Bipolar depression, Seasonal depression (SAD), Psychotic depression, Postpartum depression, Substance-induced mood disorder (SIMD). Here we cover depression as a whole.

Depression diagnostic criteria

According to the 5th edition of the Diagnostic and Statistical Manual depression occurs when a person has at least five of the following symptoms at the same time:

• A depressed mood during most of the day, particularly in the morning.
• Fatigue or loss of energy almost every day.
• Impaired concentration, indecisiveness.
• Insomnia (an inability to sleep) or hypersomnia (excessive sleeping) almost every day.
• Markedly diminished interest or pleasure in almost all activities nearly every day.
• Recurring thoughts of death or suicide (not just fearing death).
• A sense of restlessness or being slowed down.
• Significant weight loss or weight gain.

Another key sign for parents is to observe whether their children loss interest in activities they previously enjoyed. In order to be diagnosed with depression, these signs should be present most of the day either daily or nearly daily for at least two weeks. They must also cause clinically significant impairment or distress to the child.

It is important to rule out other existing conditions before a depression diagnosis is made including: death of a loved one, substance abuse, moving to a new town or area, medical condition, etc.

Depression manifests itself differently in every child. These feelings may be long or short and vary on intensity. Evaluating your child will be the job of the parent and mental health professional. Parents may observe some of the following behaviors if their child is depressed:difficulty concentrating, difficulty making decision, decreased energy, overeating or appetite loss, physical pains that do not improve even after treatment, irritability, thoughts of suicide or suicide attempts.

READ: 5 SIGNS OF DEPRESSION IN TEENS

Diagnosis confirmed. Now what?

After a diagnosis is confirmed a parent will need to evaluate what kind of help their child needs. Children who are at risk for self harm or suicidal behaviors should set up a safety plan that includes monitoring the child for signs of injury.

READ: CHILDHOOD DEPRESSION. WHAT DOES IT LOOK LIKE?

Become informed and know your options

Each individual is different. Depression also manifests itself differently in every person. It is important to be educated about depression and treatment options in order to find what will work best for your child. Depression is most often treated with psychotherapy, medication or a combination of both. Mindfulness is also an increasing practice in treating depression. Regardless of the approach, parents and children should be patient. It takes time for improvement to happen. Be sure you check with your child’s physician to verify there is no underlying cause for the symptoms of depression.

Therapy

It is important to find a therapist that your child is comfortable with where they can build a good relationship. Building a strong relationship will help reduce isolation often associated with depression and can be an important piece toward recovery. A therapist will use various techniques to address the symptoms of depression. They may even recommend group therapy. Therapy approaches used for depression may include: Cognitive Therapy (how we think and interpret events in our lives), Behavioral Therapy (looks at what we do) and Interpersonal Therapy (how we relate to others and how good our communication styles are.)

Medication

Medication can help alleviate some of the symptoms of depression but it is not a long-term solution. Anti-depressant medication also come with various side effects and withdrawal from these medications can be extremely difficult. The National Institute of Mental Health reports that in some cases, children, teenagers and young adults under 25 years of age may actually experience an increase in suicidal thoughts or behavior when taking anti-depressants. The warning comes from the U.S. Food and Drug Administration (FDA). Becoming informed about medications, their effects and their limitations will help you determine if medication is right for you.

Consult a physician about any supplements your child may be taking as well. Especially if you are trying to treat depression using natural remedies. This includes the use of St. John’s wort. It has not been approved by the FDA as safe to use. This should never be combined with other medications as it can be dangerous.

Mindfulness

Mindfulness has roots in Buddhism. It is a meditation technique that helps shift thoughts away from your usual preoccupations toward appreciation and acceptance of what is occurring in the moment. Professor Jon Kabat-Zinn is perhaps the most famous pioneers of the current mindfulness movement in the areas of stress reduction and improving the overall health.

Individuals with depression also benefit from physical exercise, social support networks and good nutrition.

Tips for parents using this skill for Depression:

• Communicate about what symptoms manifest for your child.
• Work out a system to communicate when they are feeling sad and what the intensity it is.
• Communicate often about treatment and if it is working. Be patient but expect progress, even small progress after a few weeks.
• Set up a “safe time” for you and your child to communicate. Around 1-4 consecutive minutes. Allow your child to talk about whatever they would like during this time. Do not provide solutions or interject your opinions. Just listen. When it is over, do not reply. You can restate what is said but you cannot interject your own opinions or thoughts. This allows them to share whatever they want. The only instance you would interject your authority is if they talk about harm to self or others. Do this as often as needed by your child.

Customizing ABC’s of Behavior for Depression

Understanding how thoughts precede our behaviors is an important concept for children to understand, especially with depression. Watch the following video and work with your child to understand how to address their inner thoughts. This approach goes hand-in-hand with mindfulness.

Tips for parents using this concept for Depression:

• Focus on the thought process (Antecendents) first related to the symptoms of depression and talk about them with your child.
• Relate Antecedents to their “thoughts” and what they are thinking while experiencing depression. Write down those thoughts on a piece of paper and explore what behaviors happen after those thoughts occur.
• Discuss how those thoughts influence mood. Work on addressing those thoughts to find a way for your child to deal with them in a new way.
• Continue to work with them on understanding how thoughts are Antecedents and how the behaviors that follow can be chosen and changed at will.

Both of these lessons also contain additional games, activities and printable materials to help teach these concepts more effectively with your child. Visit their individual pages on the Smarter Parenting website.

The following resources may be helpful

Print out these suggestions about Depression for parents from the American Psychiatric Association.

The National Institute of Mental Health has additional information about depression that may be helpful.

Read this report on Major Depression with Severe Impairment Among Adolescents.

Smarter Parenting blog posts

5 signs of depression in teens

Childhood depression. What does it look like?