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Depression and Children

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Pain in Disguise
A True Story

“What is representative democracy?” I immediately circled ‘D’, recognizing it as the correct answer. That one was simple. I had spent hours studying to get the ‘A’ I needed to have as a final grade for the ‘Formative’ category in this class.

“Excuse me ladies and gentleman, I have some very important news.” Our principal’s deep British accent filled the room. I decided to focus on my quiz and ignore the announcement, knowing it must be something irrelevant to me. He continued, “This past Tuesday, April 22nd, one of our students, Ryan, attempted suicide and he is now in the hospital in critical condition.” That one sentence made every muscle in my body stiff. I was frozen. My throat was tightening, making it difficult to breathe. My vision was becoming blurred from the tears welled up in my eyes.

“Two minutes everyone.” my teacher informed the class. I couldn’t even control my body, how would I be able to finish 5 questions in 2 minutes? I glanced around the room, noticing everyone focusing on their quizzes, completely unaffected by the horrid news that was just delivered by our principal. But they weren’t close to Ryan. They didn’t enjoy hot summer days playing football, soccer, basketball or any other sports with him.  They didn’t gather with Ryan and our other friends to watch horror movies together, holding each other in fear of non-existent creatures. They didn’t know the charming boy with warm chocolate eyes and the most beautiful smile you’ve ever seen. If they did, they would be incapable of even thinking about anything but him at this very moment.

“Thirty seconds.” my teacher stood up, slowly making her way towards the first row of desks to collect the papers. Somehow, I broke free from my trance and was able to circle five random answers and write my name on the assessment. But after passing up the quiz, I got up and left, eager to escape the news I’d heard only ten minutes ago.

As I sped out, I saw other students filing out of their classrooms. But my eyes were scanning everywhere to find Ryan. We met in the corner of this hallway every day after 3rd period and we walked to our next class together. But after waiting for the full five minutes, it hit me. My friend really had tried to leave this world and was now in the hospital struggling for life.

“Sim…” my friend Rosa hugged my torso tightly, almost like she was trying to squeeze my pain away, but it was hopeless. I tried to speak and comfort her too, but I was weak. So instead, I hugged her back and let a tear slide down my cheek, leaving a trail of warmth and a burning feeling that led straight to my heart.
During lunch, my friends and I gathered at our usual table in the cafeteria, but this time everything was different. We weren’t cracking bad jokes or talking about random things that entertained us. Instead, we were silent, besides the gasps for air from the continuous sobs. Even the guys cried. No one ate anything, our appetites diminished by the tragic news. All of us were sitting close to each other, grabbing each other’s hands tightly as if we feared that one of us would have done what Ryan had done.

Somehow, I managed to make it through the day with the kindness of friends, teachers and strangers who hugged me with sympathy. Now that it was the end of the day, it was time to go home to my parents who had been worrying about me.  I entered the car, and I sat silently, dreading to have to talk about what I had heard. Thankfully, my parents accepted that I didn’t want to talk about it.  The ride home was silent, but my mind was noisy with unwanted thoughts.   As soon as I entered the house, I went straight to my room.  My eyes were weighing down on me, not letting me stay conscious.  I lay my head down on my soft pillow and I slowly drifted off into a deep slumber. My mind started vanishing into a dark, secluded place, the only ticket in being pain.

My eyes flickered open, and it took a few seconds to adjust to the darkness of my room. I sat up and glanced at the time to see that it was only 9:00 P.M. Suddenly all the events of today came flooding into my mind, destroying all thoughts but leaving the least wanted one. Tears threatened to spill as I pictured my best friend in the hospital, unconscious and injured. Images flashed of him doing it. I grabbed my head tightly, trying to pull out the images, but it was impossible. Teardrops rolled down my cheek; like a never-ending waterfall.

It seemed like ages passed as I lay on my bed, staring at the ceiling, reflecting. My phone buzzed. It was Paul, a close friend of Ryan’s and his twin brother, Matthew.  I unlocked my phone and read the text expecting more supportive words and comfort like I had experience throughout the day.

“Hey Sim, I just wanted to let you know that Ryan passed away earlier today. Please let Rosa and Luna know? And if you ever want to talk, I’m here. I’m so sorry Sim.” My heart was thumping hard, each beat being amplified in my ears. Then, it felt like my heart shattered into a million pieces. The sound that came out of my mouth was a mixture of pain and grief; a sound of pure distress. I started wailing like a little baby begging for its parents.

“Sim? Sim? Are you okay?” my mother grabbed my shoulders and stared at me with eyes filled with worry. I tossed my phone next to her and let her read the text. Once she finished, she let out a gasp. Immediately, she cradled me like when I was little, comforting me and begging me to stop crying. But I couldn’t. My chest had an excruciating and fierce pain. I dug my hands into my chest, trying to take away the pain, but it wouldn’t go away as hard as I tried. No amount of tears could ever take away the pain I was feeling.

I felt like I was swimming in my tears, the salty water burning my flesh and causing an uncomfortable and irritated feeling. I swam and swam but there was no way out. My energy was slowly disintegrating, my body flailing, struggling to stay afloat. Then a feeling of numbness took over.  My body was letting go and being enveloped into the dark water.

My phone buzzed, dragging me out from the newly found dark place. I was reminded that I had to call Luna and Rosa, knowing that they deserved to know the news.

“Luna.” “Yes?” “He’s gone.” I said, silently crying again, “I’m sorry. I’ll give you your space. Text me okay? I love you.”

That night, Rosa, Luna and I got together, crying with each other and being there for each other. We told stories about our memories with Ryan while holding hands and hugging each other.  The night was agonizingly slow, every second we were reminded that our best friend was gone forever. He chose to take himself out of this world and now we would never get to joke with him, tell funny stories with him or even get to play our favorite sports in his company. Luna, Rosa, and I made a promise that night, something that we would always remember to do. Anytime we see something beautiful, we will always stare a second longer so Ryan can see it too.

Depression in Children

Childhood depression is not easy to think about. For many years, children who showed signs of depression, a disease earlier believed to effect only adults, suffered quietly while being regarded as shy, lazy, or disobedient. It was only in the past two decades that depression in children has been taken seriously.

The depressed child may pretend to be sick, refuse to go to school, cling to a parent, or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, grouchy, and feel misunderstood. The symptoms might be attributed to an adjustment disorder (a temporary response to recent stress), attention deficit disorder, or conflicts with their parents, teachers, classmates, and playmates.

The normal behavior in children vary drastically from one childhood stage to another; therefore it can be difficult to tell whether a child is just going through a temporary “phase” or is suffering from depression. If you feel that your child’s behavior has changed or if your child’s teacher at school notices unusual behavior, you should consider paying visit to a pediatrician. If the pediatrician rules out physical symptoms, s/he will probably suggest that a psychiatrist who specializes in the treatment of children evaluate the child.

How Common is Depression in Children?
Depression is experienced by approximately five percent of children. Both boys and girls can be affected by this illness. Some vital statistics:

  • As many as one in every 33 children may have depression; in teens, that number may be as high as one in eight
  • Depression is more common in teenagers – affecting approximately nine percent of young men and 18 percent of young women
  • It is estimated that two percent of children and four to eight percent of adolescents in the US suffer from depression
  • Suicide is the third leading cause of death in older adolescents, and the fifth leading cause of death in children between five and 14 years of age

Children and young people who are very stressed, have learning or behavior difficulties, or have experienced a loss are at higher risk for depression. So it’s wise for parents and caregivers to learn about depression and how to help if your child, or a child you know, seems depressed.

What Causes Depression in Children?
No one knows the exact cause of depression in children, but a combination of environmental and biological factors are thought to play a role. Research has indicated that depression can run in families who may have vulnerable genes. Stressful and negative events can also cause depression. Also, a child who focuses on negative aspects of life is also more likely to experience depression.

As in adults, depression in children can be caused by any combination of things, including:

  • Alcohol or drug use
  • Environment (including family problems)
  • Family history (others in the family have depression)
  • Physical illness (i.e., diabetes or epilepsy)
  • Life events

Key Points to Remember
Depression is the most common mental health problem in the US. Each year it affects 17 million people of all age groups, races, and economic backgrounds.

  • Depression is a serious illness that interferes with everyday life
  • It is important to get help if concerned about child depression
  • Depression can be treated effectively

Diagnosing Depression in Children
Depression in children and young people is different than adults as they may be more irritable and rebellious than sad. Children and young people may not be able to express in words how they are feeling because of their age. Children suffering from depression often describe themselves as feeling hopeless about everything or feeling that nothing is worth the effort.
They also feel a sense of low self-esteem and often go through the feeling that their world is a difficult place, and that they’re helpless to do anything about it.

Kids and teens who are depressed are more likely to use alcohol and drugs than those who aren’t depressed. Since these substances can momentarily allow a person to forget about depression, they seem like easy fixes. However, substance abuse can make someone with depression feel even worse.

For an accurate diagnosis of major depression, a detailed clinical evaluation must be done by a medical or mental health professional (such as a psychologist or psychiatrist). To meet criteria for a diagnosis, five or more of these symptoms must be present for longer than two weeks:

  • Feeling of being down in the dumps or really sad for no reason
  • Lack of energy, feeling unable to do the simplest task
  • Inability to enjoy the things that used to bring pleasure
  • Lack of desire to be with friends or family members
  • Feelings of irritability (especially common in kids and teens), anger, or anxiety
  • Inability to concentrate
  • Marked weight gain or loss (or failure to gain weight as expected), and too little or too much interest in eating
  • Significant change in sleep habits, such as trouble falling asleep or getting up
  • Feelings of guilt or worthlessness
  • Aches and pains even though nothing is physically wrong
  • Lack of caring about what happens in the future
  • Frequent thoughts about death or suicide

When Should I Seek Help?
If you are concerned that a child or young person is depressed and they have been experiencing symptoms for a long period of time (longer than a few weeks) it is important that you seek help immediately. It is important that an assessment takes place by a professional who knows about depression in children and young people. Physical examinations are also recommended to ensure that there is no underlying illness causing the symptoms.

Going to your health care provider (HCP) is the recommended first step as they will be able to provide further guidance and referrals.

What Can I Expect Long-Term?
Studies have found that depression in young children may re-occur again in later stages of life. Therefore, proper diagnosis, early treatment, and close monitoring are crucial.
Studies have found that depression in children is occurring at younger ages. In addition, depression and anxiety disorders may occur again later in life. Therefore, proper diagnosis, early treatment, and close monitoring are crucial.
For parents, it sometimes seems that an easier option is to be in a denial mode if your child has depression because of the social stigmas associated with mental illness. But the reality is that the treatment of this illness can allow your child to continue to develop into a healthy adult, physically and emotionally. Without treatment, depression has the potential to affect your child throughout the rest of his or her life.

Parents should be especially alert for signs that their child is at risk for suicide. Warning signs of suicidal behavior in children include:

  • Severe depressive symptoms (significant changes in eating, sleeping, activities)
  • Social isolation
  • Talk of suicide, hopelessness, or helplessness
  • Increased acting out behaviors (sexual/behavioral)
  • Increased risk-taking behaviors
  • Frequent accidents
  • Drug and/or alcohol abuse
  • Focus on morbid and negative themes
  • Talk about death and dying
  • Increased crying or reduced expression of emotions
  • Giving away possessions

Depression can be frightening and frustrating for your child, you, and your entire family. With the proper treatment and your help, your child can start to feel better and go on to enjoy the teen and adult years.
http://www.icontrolmyhealth.org/kid-s-health/depression-in-children

General Principles for Assisting Children with Depression

Be Supportive and Make Time to Listen
Provide unconditional support to your child and let them know that it is okay to ask for help. Assure your child that you are ready to listen to whatever s/he wants to say. If depression is caused due to a particular situation, help the child to solve the problem or find ways yourself to improve the situation.

Keep a Focus on Normal Routines and Activities
Negativity comes along depression, and often children who are depressed become a victim of this negativity. Encourage your child to keep up with the normal routine activities, such as playing, watching television, engaging in conversation with friends, etc. which will help them stay distracted from negative thinking patterns.

Encourage Your Child to Keep Active
Depression slows down children’s bodies as well as their minds. Keeping active helps to restore physical health and improves children’s mental health and wellbeing. Make sure your child takes any prescribed medicines and encourage healthy eating too, as this may help improve mood and outlook.

Remind Your Child that You’re There for Support
Say this over and over again — kids with depression need to hear it a lot because sometimes they feel unworthy of love and attention.

Accept the Situation and Never Tell your Child to “Snap Out of It”
Remind yourself that it isn’t laziness causing your child’s inability to get out of bed, complete chores, or do homework. He or she simply doesn’t have the desire or the energy. However, you can still praise and reward your child for making extra effort.
Watch for warning signs, and make sure the prescribed treatment is followed, whether it’s medication, therapy, or both. Call the doctor if you see signs that your child may be thinking about self-harm. If your child talks about suicide, to you or anyone else, or shows warning signs such as giving belongings away and being preoccupied with death, call your doctor or a mental health professional immediately.

FAQs about Depression in Children

Q: How common is suicide in children and teens?
A: In 2009, suicide was the third leading cause of death for young people ages 15–24. In this age group, suicide accounted for 14.4 percent of all deaths in 2009.

While these numbers may make suicide seem common, it is important to realize that suicide and suicidal behavior are not healthy or typical responses to stress.

Q: What are some of the risk factors for suicide?
A: Risk factors vary with age, gender, or ethnic group.  They may occur in combination or change over time. Some important risk factors are:

  • Depression and other mental disorders
  • Substance-abuse disorder (often in combination with other mental disorders)
  • Prior suicide attempt
  • Family history of suicide
  • Family violence including physical or sexual abuse
  • Firearms in the home
  • Incarceration
  • Exposure to suicidal behavior of others, such as family members or peers

However, it is important to note that many people who have these risk factors are not suicidal.

Q: What are signs to look for?
A:
 The following are some of the signs you might notice in yourself or a friend that may be reason for concern.

  • Talking about wanting to die or to kill oneself
  • Looking for a way to kill oneself, such as searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings.

Seeking help is a sign of strength, if you are concerned, go with your instincts, get help!

Q: What can I do for myself or someone else?
A: 
If you are concerned, immediate action is very important. Suicide can be prevented and most people who feel suicidal demonstrate warning signs. Recognizing some of these warning signs is the first step in helping yourself or someone you care about.

**If you are in crisis and need help: call this toll-free number, available 24 hours a day, every day 1-800-273-TALK (8255). You will reach the National Suicide Prevention Lifeline , a service available to anyone. You may call for yourself or for someone you care about and all calls are confidential. You can also visit the Lifeline’s website at http://www.suicidepreventionlifeline.org .

http://www.nimh.nih.gov/health/publications/suicide-a-major-preventable-mental-health-problem-fact-sheet/index.shtml

Have more questions about depression and children? You can write to us at info@icontrolmyhealth.org

Take a Depression Self-Assessment Test

http://www.icontrolmyhealth.org/all-health-tools/depression-test