Depression in children and adolescents (1) 소아청소년 우울증(1)

Depression in children and adolescents (1)

소아청소년 우루울증(1)

Overview and statistics of depression in children and adolescents

· The young human being below the age of puberty are children.

· The period from birth to puberty is called childhood.

· Children before puberty are called children for convenience.

· Children and adolescents referred to children within the age range of 0-18.

· Depression is one of the most serious mental disorders that can occur to anyone in all walks of life, the poor or rich, the young or the old.

· If anyone had suffered from severe depression in childhood, the depression may recur within five years thereafter.

· Bipolar disorder has increased 40-fold since 1994 in pre-adolescent and adolescent children (source- Dr. Mark Olson, The Journal of archives of general psychiatry 2007).

· One in 10 children and adolescents (ages 0-18) can develop depression.

· It is reported that 4 to 18% of adolescent children develop depression.

· 30% of adolescent children with severe psychosis are receiving treatment.

· It is reported that 50% of adults with severe psychosis start at age 14-years-old (source; Journal watch pediatrics and adolescent medicine, August 2008. p 769).

· The main symptoms of depression can lead to impaired feelings and behaviors, and an overall weird health condition.

· Most depressed adolescents are treated appropriately soon, but some depressed adolescents don’t even know they are depressed, and sometimes parents don’t know if their children are depressed. Because of this, some of the adolescent children suffering from depression do not receive appropriate treatment for depression.

· In addition, there are many cases where treatment for depression is not recommended even though it is recommended.

· Depression in adolescent children is a major cause of suicide.

· Suicide is the third leading cause of death among adolescent children and young adults aged 15-24 years-old.

· Suicide is the third cause of death among 15-years-old adolescent children.

· ⅔ of adolescent children with depression are not receiving treatment from a psychiatrist for various reasons.

· Drinking alcohol, alcoholism, and addictive drug abuse can result from depression. Conversely, alcoholism or substance abuse can lead to depression.

· If the depression of adolescent children is not properly treated, symptoms become more and more severe without knowing, and they penetrate deeply into their daily life, and eventually, they may not be able to perform their daily life normally and their entire life may be ruined.

Diagnosis of symptoms of depression in children and adolescents

If anybody with the following symptoms and signs and/ or conditions he or she most likely has depression.

If there are at least 5 or 5 more symptoms and signs which are described as 1 to 11 below, and /or such symptoms persist for at least more than two weeks, and /or such symptom and signs are severe, and /or if they cannot perform their daily activities normally

1. · Thinking about death.

· Thinking of wanting to die.

· “I think I’m dying”,

· Thinking about how to die from suicide,

· Sometimes they commit suicide.

If the children experience symptoms of depression with thinking about death like this, parents should seek immediate consultation with their doctor or take them to the hospital emergency room for psychiatric treatment.

2. · Feeling sad

· “There is no hope”

· Symptoms of crying for no reason may persist.

3. · Lack of pride

· Guilty feeling for no reason

· Feeling that ‘I am no longer a good human being’.

4. · It means nothing to live

· Think there will be anything better in the future’.

5. · There is no feeling

6. · Saying “I lost interest in studying, social activities, physical activities, extracurricular activities, etc”.

· Saying “I don’t hang out with my close friends anymore”

· Saying “I spend time alone almost”.

7. · Saying “It’s difficult to decide what to do”.

· Saying “I can’t start or do anything new”

· Saying “my memory is definitely lost and I can’t concentrate well”.

8. · Saying “my nerves become sensitive”.

· Saying “I get mad at the little things”.

· Excessive reaction.

9. · Saying “I can sleep too much or less than normal”.

· Saying “I can eat more or less food than usual”.

· Saying “My weight is abnormally increased or decreased”.

10. · Saying “I am always tired for no specific reason”.

11. · Some of the depressed adolescent children may have problems such as substance abuse, alcoholism, indiscriminate heterosexuality, school problems, poor grades, etc. and may have problems with family or friends, he can be rebellious and destructive to authorities or parents.

If parents suspect that their child or adolescent has depression

① Tell your family or friends that “I think he or she is depressed and consult with a depression treatment specialist or a pediatric psychiatrist.

② Otherwise, he or she will receive diagnostic treatment from your regular pediatrician immediately.

③ Get help from school counselors, nurses, and social workers.

④ Get help from a psychiatrist. If possible, seek help from a pediatric psychiatrist.

⑤ Seek the help of a priest, pastor, or rabbi who is qualified and experienced to provide counseling.

⑥ It is important to seek help and treatment from a pediatric psychiatrist in the early stages of depression before symptoms become more severe.

⑦ Weak mind and body, lack of sound healthy self-esteem, problems with studying at school or doing extracurricular activities, and not trying to do their best to do something well or not doing anything at all can be a symptom of depression.

⑧ Most adolescent children with depression are well treated with counseling or anti-depressant drugs.

⑨ Depression is a relatively common psychotic disease and can occur in both men and women of all ages. If you think they are depressed, you should immediately seek help and treatment from a pediatric psychiatrist.

Treatment of depression in children and adolescents

Drugs used to treat depression

· Fluoxetine,

· Paroxetine,

· Sertraline,

· Fluvoxamine,

· Citalopram.

· Escitalopram,

· Amitriptyline,

· There are several other types, including imipramine.

One or more of them can be used to treat one or two of several antidepressants.

However, according to a February 2008 study by Irv Kirsch of the University of Hull, most of the drugs used to treat depression are effective in treating severe depression, but not in treating mild depression.

Major Depressive Disorder is also treated with escitalopram oxalate (LEXAPRO).

Figure 3-249. The rate of using antidepressants is higher among adolescent girls than among adolescent boys. (The number above is the number of children treated with antidepressant drugs out of 1,000 adolescent children aged 10-19 years old)

Source-Medico Health Solutions Inc. and Elsevier Medical News, 2007

Depression of adolescent children (2)

Overview of depression of adolescent children

For reference, some of the following content is the same as that of depression of children and adolescents.
Depression is one of the most serious mental illnesses that can occur to anyone from all walks of life, regardless of gender, young and old.
One in ten children and adolescents can develop depression.
Most children with depression get appropriate treatment soon, but some do not know.
It is common for people not to receive adequate treatment even though they are encouraged to receive adequate treatment.

The causes, triggers, types, and incidence of depression in adolescent children

The cause of depression is unclear.
Depression is one of the most serious mental illnesses.
Depression is caused by a combination of heredity, physiology, social, and mental factors, and life-long stress.
Depression can occur in adults, children, and adolescents, regardless of age, and can occur in both men and women of all ages.
Especially today, adolescent children are more prone to depression.
Although the cause of depression is not known for certain, it is believed that depression occurs when abnormalities in the brain metabolism of two brain biochemicals, norepinephrine, and serotonin.

Factors of depression in adolescent children

Adolescent girls are more susceptible to depression for a number of reasons, and the symptoms can take many forms.
Depression can be triggered by the death or separation of a parent, divorce, death of a family member, living in solitude far away from home, separation from a partner, and other reasons. In other words, depression is triggered by multiple factors.
Until a few decades ago, it was believed that children do not develop depression. However, depression is relatively more common in adolescent children and young people today.
Depression can also be triggered in newborns, infants, and school-age children before puberty.

Types of depression in adolescent children

Acute depression
The chronic type of depression,
Mild depression,
Moderate depression
Severe depression.
Depression can progress and recur. This type of depression is called recurrent depression.
Depression in adolescent children,
Adult depression.
Adolescent children can develop smiling depression.

Incidence of depression in adolescent children

According to the U.S. NCS statistics on the incidence of depression in 8,000 Americans aged 15-54 years-old,
In 14% of young people who experienced severe depression, depression started before puberty,
Eleven percent of young people who have experienced mild depression say that depression started before puberty ends.
Depression was found in 18% of 9,800 male and female students in grades 6, 8, 9, and 10 in the U.S.
It is reported that 25% of female students and 10% of male students had depression. Source: US NICHHDD, Depression or Bipolar Disorder, Dwight L. Evans, MD and etc.

Symptoms of depression in adolescent children

Figure 2-23. Very Depressed Teen Girl

The main symptoms of depression are feeling disorders and behavioral disorders, resulting in abnormalities in general health.
Symptoms of depression vary depending on age, sex, the severity of depression, and factors that cause depression.
When depression occurs in infants and toddlers, hyperactivity disorder can occur, and infants and toddlers who have had toilet training and may not have toilet training and become regressive behavior.
When adolescents become depressed, they can act rebelliously against their parents, siblings, family members, or authorities.
Especially when adolescent girls suffer from depression, their concept of body image is not good, become disappointed about everything themself,
They think their life has reached the point of failure,
Adolescents, who loved to study before becoming depressed, lost interest in the social life, physical and social activities that they had enjoyed without studying hard anymore. They no longer hang out with their close friends and spend time alone.
They may have attention deficit disorder and They can’t concentrate well,
Interpersonal problems can also arise.
Eating more than usual or limiting food intake above normal
They may be more interested in their weight.
When parents become depressed, their children are more prone to depression.
Depression can be triggered by habitual substance abuse, alcohol drinking, alcoholism.
They may have reckless, promiscuous, and complex sex,
Makes it easier to get stressed
Can commit violent behavior
Runaway, indiscreet sex, teenage pregnancy, and other problems can occur.
Conversation between parents and children can also cause problems,
School study problems can also arise.
Depending on the menstrual cycle, depressive symptoms may get worse.
Regardless of gender, helplessness, despair, desperation, self-deprecation, low concentration and concentration deficit, daydreaming, boredom, fatigue, sluggishness, physical depression, degenerative behavior, depressive dissemination, substance abuse, teenage pregnancy, criminal behavior, suicide, etc.
And more symptoms of depression can occur other than above.
When adolescent children who have studied well become depressed, they often tarry, leave early, and absent from school for no reason, and grades begin to decline.
They complain excessively about everything, don’t feel well, and can be aggressive in everything.
They may not fall asleep well or may wake up frequently during sleep.
You can dream a lot or sleep too much.
They spend a lot of time alone and hate making friends.
In the meantime, They gradually lose interest in the work, They worked hard every day, and they try not to start anything at all.
Losing the taste of rice and not eating well, or vice versa can lead to obesity by eating too much.
Complaining that the head hurts often or that stomach hurts and often can cause constipation.
When a parent or a teacher asks anything, it can be upset or annoying.
They often cause hard-to-understand safety accidents, get angry with trivial things, and break things.
They can invade houses or destroy objects.
Sometimes they say they want to die, and sometimes they actually commit suicide.
Depression in adolescent children can be a major cause of suicide.
Adolescent children with depression sometimes drink too much and become addicted to drugs or habit-forming drugs.
Parents and most teachers who are unaware that their adolescent children are doing that type of behavior due to depression can be treated as bad behavior because they are bad children.
This can lead to a number of problems between parents and children with depression and between teachers and students with depression.
Most adolescent children with depression will receive treatment for depression soon, but some do not know they are depressed, and of course, even adolescent children who are diagnosed with depression and are encouraged to seek treatment for depression do not receive treatment for depression.
Depression is the leading cause of suicide and is the third leading cause of death among adolescents and young people aged 15 to 24. And it has already been mentioned as the third leading cause of suicide in 15-year-old adolescent children.
If a child or an adolescent suffers from severe depression, the depression is likely to recur within 5 years thereafter.
If depression is not properly treated, symptoms of depression become more and more severe without knowing, and they penetrate deeply into the child’s daily life, eventually preventing a normal life.

Diagnosis of depression in adolescent children

Depression is diagnosed by medical history, symptoms, and examination findings.
School grades gradually decline,
Daydreaming at home or at school,
Lose interest in everything,
Like to be alone,
Headache, abdominal pain, loss of appetite, sleep disturbance, destruction of objects, suicidal attempts and suicide, alcohol and behavioral disorders such as criminal behavior, emotional disorders, and thought disorders are very helpful in diagnosing depression.
Depression and other diseases are differentially diagnosed with blood, urine, brain waves(EEG), and thyroid function tests.

Diagnosis of depression in pre-adolescent or adolescent children

Among the symptoms of depression in the following items ①~⑪, at least 5 or more symptoms are present at the same time or such symptoms persist for at least 2 weeks and more.

Treatment of depression in adolescent children

Treatment varies depending on the cause, severity, and symptoms of depression.
Even if depression is induced in adolescent children for various reasons and triggers, depression may not be diagnosed correctly early.
Also, he or she may not be able to get the right expert help on time.
So, it is said that only 1/4 to 1/3 of adolescent children suffering from depression receive adequate treatment.
We must do our best to mentally stabilize depressed adolescent children and eliminate causes and triggers.
Parents should work with their doctor to consult with their depressed adolescent children to find out what triggers the depression.
When a parent’s child-rearing parenting is wrong and adolescent children become depressed, do not hesitate to apologize to the child, correct the wrong parenting method immediately, and if the adolescent child’s thoughts are correct, they must acknowledge the thoughts.
When a depressed adolescent child prays to commit suicide or says he will commit suicide, the depression should be treated as an emergency according to the doctor’s instructions.
This is because the majority of adolescent children who have committed suicide at least once in the past or who have said they will commit suicide will one day actually commit suicide (see suicide).
For this reason, when adolescents with severe depression say they will commit suicide or attempt suicide, they should be hospitalized for a while and treated with special attention to prevent suicide.
In addition, depression is treated with medication, psychotherapy, and counseling.
Among the various treatment methods for depression, the most important thing is to truly love a depressed adolescent child without condition and give focused attention love, and care.
Both children and their families with depression should seek counseling treatment by a psychiatrist.

Drugs to treat depression in adolescent children

Drugs used to treat depression include Fluoxetine, Paroxetine, Sertraline, Fluvoxamine, Citalopram, Escitalopram, Antitriptylin, Imipramine, Trintellix and more.
Your doctor can choose one or more than one antidepressant medication to treat depression.
However, according to a study by Irv Kirsch of the University of Hull, published in February 2008, most of the drugs used to treat depression are effective in treating severe depression, but not very effective in treating mild depression.
A major depressive disorder is also treated with Escitalopram oxalate (LEXAPRO).
The following antidepressants and anxiolytic drugs can be treated according to the doctor’s prescription.
Figure 2-25. The rate of receiving antidepressant medication is higher in adolescent girls than that of adolescent boys.
Higher for adolescent girls (the number above is the number of children treated with antidepressant drugs out of 1,000 adolescent children 10-19 years old).

Antidepressants and Anxiolytics (Anxiolytics) (I)

Antidepressants and anxiety-relieving drugs (anxiety-relieving drugs), Common name	Brand name	Initial dose (12 years old or younger)	The maintenance dose (12 years old or younger)	Initial dose (12 years old or older)	The maintenance dose (12 years old or older) More)	Side effects and notes
Fluoxetine	Prozac	5-10 mg/1 day	10-30 mg/1 day	10 mg/ 1 day	20-40 mg/1 day, up to 60 mg/1 day, maximum 20-40 mg/1 day	It is the most effective antidepressant drug for childhood depression. If you have been treated with MAOI before 14 days, you cannot use this medicine, Side effects to the central nervous system, headache, nervousness, sedation, gastrointestinal disorders
Fluvoxamine	Luvox	25 mg Once every evening before bedtime 25 mg	100-200 mg/1 day	25-50 mg/1 day before bedtime 25-50 mg/	150-300 mg/1 day before bedtime	–
Paroxetine	Paxil	5-10 mg/1 day 10-20 mg/1 day	10-20 mg/1 day	10-20 mg/1 day	20-40 mg/1 day	Purpura, low sodium, may interact with many different types of drugs
Sertraline	Zoloft	25 mg/1 day	100-150 mg/ 1 day	25-50 mg/1day	150-200 mg/1 day	Purpura, low sodium, interactions with many different drugs
Citalopram	Celexa	–	10-20 mg/ a day	–	10-40 mg/1 day	Fluoxetine, which may interact with different types of drugs.
Venlafaxine	Effexor	37.5 mg/1 day	75-150 mg/1 day	37.5 -75 mg/1 day	150-300 mg/1 day	Side effects such as nausea, vomiting, dizziness, drowsiness, constipation, Serotonin-norepinephrine reuptake inhibitor
Nefazodone	Serzone	–	Depend upon the treatment effect is seen the dose may increase by 50 mg every 3 days. In children 12 years old and younger, the maximum amount is 300mg/1 day	–	children 12 years and older, the maximum amount is 600 mg/1 day	5-HT blocker. Nausea, vomiting, dizziness, genital erection, dry mouth, visual impairment

Table 59. Antidepressant and anti-anxiety drugs (anxiolytics) Anxiolytics (II)

Antidepressants and anxiety-relieving drugs (anxiety-relieving drugs), Common name	Antidepressant and Anxiety Relief (Anxiety Relief), Brand Name	–	–	Dosage (18 years old or older)	–	Side Effects and Notes
Bupropion sustained-release drug	Wellbutrin SR	–	–	100 mg twice a day for 3 days treatment, if no side effect, 100 mg 3 times a day (every 6 hours in small doses), max. One dose is 150 mg	–	If side effects such as central nervous system irritation, weight change, dry mouth, headache, gastrointestinal disorders, insomnia, convulsions, or visual impairment develop It cannot be used for treatment with this medicine.
Mirtazapine	Remeron	–	–	Begin treatment with 15 mg daily before bedtime and gradually increase every 1-2 weeks	–	Before beginning to use this medicine, CBC tests,, liver function tests should be performed and periodically thereafter. Side effects such as increased appetite, weight gain, dizziness, nausea, dry mouth, constipation, excessive sleep, increased or decreased blood pressure
Buspirone	BusPar	–	–	2.5-5mg/1 day, followed by 2.5mg/1 day incremental treatment every 3-4 days, the maximum amount is 20 mg/1 day. 5-10 mg/1 day for adolescent children, Every 3-4 days, 5 mg/1 day, increase treatment. Maximum 1 dose is 60mg/day	–	Tachycardia, headache, insomnia, confusion, dizziness, gastrointestinal problems
Trazodone	–	–	–	Children (1-18 years-old), Take 1.5-2 mg/kg as the total daily amount and take it orally 2 or 3 divide dose. If necessary, take 6 mg/kg every 3-4 days as the total amount per day, 3 divide doses per day, and take 1 dose 3 times. Adults 150 mg/day, 3 divide dose 3 times a day, if necessary, increase the amount of treatment	–	Side effects such as dizziness, irritation, dry mouth, diarrhea, anemia, weakness, and convulsions
Imipramine	Tofranil –	–	–	Children: 1.5 mg/kg is the total daily amount, and the total daily amount is 3 divided doses and taken orally 3 times a day. Depending on the treatment effect, 1-1.5 mg/kg can be increased to the total daily amount every 3-4 days, so the maximum daily dose is 5 mg/kg/24 hours. Adolescent children: Take 25 -50 mg/kg as the total amount per day and take orally a day for 3 divide doses. The maximum daily dose is 200 mg.	–	If having glaucoma and if to treat with this medicine such as MAOI products is contraindicated. Side effects dizziness, irritation, and dry mouth may occur.

Trintellix has an average rating of 6.0 out of 10 from a total of 489 ratings for the treatment of Depression. 47% of those users who reviewed Trintellix reported a positive effect, while 32% reported a negative effect. Update 12/16/2020