Chapter 8

Depression and Other Mood Disorders

History of thinking about depression

• Once thought to only to be strictly an adult disorder

• Children once considered naturally happy. – But vulnerable to depression under adverse

genetic and environmental conditions– Prepubescent depression sufferers rarely suffer

become suicidal

Awareness of childhood depression

• Primary care physicians began to realize that children could be clinically depressed

• Children’s rights to mental health treatment, including relief from anxiety and depression, received increased public recognition

• Research on genetics of emotional disorders flourished

• Many reliable measures of depression became available

Types of Mood Disorders

• Major Depressive Episode – may follow identifiable loss or severe stress, but doesn’t have to be an obvious preceding event

• Major Depressive Disorder – diagnosed when two or more major depressive episodes

• Bipolar Disorder – (manic depressive disorder) person switches between normal mood, depressive moods and hyper excited manic moods – Manic episodes – inexplicable exhilaration,

tireless activity, sleeplessness, talkativeness, impulsiveness

– Usually appears in early adulthood– Rare in childhood

• Minor Depression – (subclinical depression)– Person feels and appears depressed but doesn’t

meet all diagnostic criteria for major depression– Typically occurs after stressful events and

usually fades

• Dysthymic disorder – (dysthymia) persistent mild depression that interferes with functioning or causes person significant stress over an extended period– Can begin in early childhood– Can develop into more serious depression

Prevalence of Depression

• “Common Cold” of psychiatric illnesses

• Diagnosable depression much less frequent in children than adults – Very rare before 6– Rates gradually climb during childhood– Rates climb rapidly in adolescence

• Teenagers more likely to experience other psychological disorders with depression. Other disorders can mask depression– Disorders occurring together tend to be more

severe

Age Differences in Depressive Symptoms

• No separate category for childhood depression in DSM-IV-TR

• Children don’t know what it is and are unable to report feelings of depression to adults

• More likely to express their depression through somatic or physical complaints

Sex Differences and Depression Rates• Twice as many women as men suffer from major

depression

• Sex differences in childhood depression not apparent

• Girls depression rates increase dramatically during puberty, but boys’ do not

• Boys generally welcome signs of physical maturation; girls experience more conflict about their changing bodies

• Differences in coping – Boys expected to overcome stress on their own – Girls are expected to need more comforting

Risk Factors for Mood Disorders

• Adverse Family Environments– Parents own mental health, not able to to

provide adequate emotional support, model depressive behavior

– Family violence

• Children’s Contributions– Some infants temperamentally negative and are

management challenge for mothers. Can undermine parents’ ability to be good caretakers

– When a teen experiences one major depressive episode (after a romantic break-up for example) more likely to have recurrence when faced with even less severe stress in future

Major Theories of Depression

Theory Predisposing Event Precipitating Event

Psychoanalytic Constitutional over reliance on oral stimulation

Real or imagined loss or rejection

Attachment theory Attachment insecurity, early loss

Major loss or rejection

Beck’s Cognitive theory

Early rejection, loss, or failure Major loss or disappointment

Learned helplessness theory

Unavoidable pain or failure Major loss or traumatic event

Social cognitive theory

Overly demanding parents, inadequate coping

Threat to self-efficacy

Reinforcement-loss model

No necessary predisposition Massive reduction in reinforcement

Biological Basis of Depression: Genetic, Brain and Biochemical Functions

• Much research suggests a substantial genetic contribution to depressive disorders in adulthood

• Genetic basis less clear for childhood onset depression– Heritability has larger role in less severe form– Environment has stronger influence on severe

forms

• Effectiveness of medications for depression does not prove biological basis

• Researchers examining sensitive periods in neural development

Treatment

• Antidepressant medications– Most developed for adults; effects on children

untested– SSRI’s prescribed for children before

effectiveness proven– Little is known about potential hazards

Psychotherapy

• Cognitive behavioral therapy can help youngsters manage depression and anxiety

• Courses emphasis that depression comes from life stress; teaches new skills to deal with stress

• Treatments with long-term effectiveness are still needed

Prognosis for Depressed Children

• Once established, adolescent depression is not easy to overcome

• Steps to follow – Call mental health professional if child feels

miserable for 2 weeks or more– Show you understand child is suffering and you

understand– Don’t urge depressed children to cheer up and

use will power to overcome their unhappiness– Be a facilitator

Prevention in Infants and Children

• Intervention programs for depressed, stressed single-mothers

• Toddler-parent psychotherapy

• Programs for postpartum depression

Programs for School-Age Children

• The Penn optimism program – Training in relaxation and assertiveness skills– Training in cognitive and social problem

solving skills– Longer term benefits yet to be demonstrated– Effects stronger in boys than girls

Suicide

• Rare in children under 12; 3rd leading cause of death in 15-24 year olds

• Warning Signs– Adjustment problems

– Past psychiatric disorders

– Depressive thought patterns

– Inadequate coping styles

– School or health problems

– Past attempts

• More girls have these risk factors and attempt suicide more than boys. But, boys actually kill themselves more often

• Many suicidal youngsters not depressed, but have different motivations

• Completed suicide more often associated with depression

Cultural and Social Factors

• In places like Japan, suicide is an honored tradition; rates are high

• Rate is consistently high on Indian reservations– Loss of culture, lack of acceptance and opportunity in

majority culture leads to hopelessness

• Rate is high in decaying, violent inner cities • Rate High among Gay and Lesbian youth

Suicide Prevention

• Removing all means to commit suicide until person calms down and receives counseling

• Decisive action is required

• Saving a life is more important than preserving privacy or sparing someone’s feelings