Treatment of Depression and Bipolar Disorder in Children and Adolescents

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Severe, untreated depression can be life-threatening to a child. One in ten children who suffer a major depressive episode before puberty goes on to commit suicide as an adult. Adolescents who have one major depressive episode are three to four times more likely to have another major depressive episode. Adolescents who are depressed are three to four times more likely than their peers to abuse alcohol and drugs. The risk of completed suicide is also high. Early recognition and thorough treatment of this major public health problem can save lives and avoid a great deal of misery.

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For mild depression, a counselor can begin by meeting with the family and child regularly, to talk about the illness and teach the family about depression. Knowing what you are coping with can decrease the guilt and anger you are feeling, so you can start to deal with the illness without blame. A counselor can also look for stresses that are affecting the child and making the depression worse; for example, the child’s teacher may be asked to decrease homework assignments for a time. Another question is how difficulties in communicating and solving family problems may be affecting the child. If the child has other psychiatric problems, such as anxiety, a learning disability or attention deficit disorder, these conditions can be treated as well.

Other forms of therapy will help if the child is more depressed. Cognitive Behavioral Therapy has shown good results in children, particularly when conducted in groups. The children learn to question their pessimistic and self-deprecating thoughts, and they may have homework assign¬ments to help them sort out why they see the world so negatively. The group interaction is helpful as teenagers are very good at picking up inconsistencies and false assump¬tions, and pointing them out to each other.

Social skills training is a method of teaching children how to interact with others in a constructive manner, how to control their impulsiveness and anger, and how to ask appropriately for what they need. Social skills groups teach children how to behave with other children so they will be included and liked. They also help children deal with frustration. The children learn to talk about feelings, rather than physically attack someone, when they are upset.

Interpersonal Therapy has been modified for children and teenagers, and a protocol to meet the needs of a single-parent family has been developed. After all, three of the premises of interpersonal therapy – grief, role transitions and role disputes – are involved in separation and divorce. An open discussion and acknowledgment of the stresses can be very helpful to a child. When people are going through the turmoil and sadness of a divorce, they may have few resources left to help their children. Often the children are reluctant to admit how hurt they have been by the divorce, because they are aware of their parents’ pain and they don’t want to cause them further trouble.

Family therapy can also be helpful with children and teens. Often, discord in the family can best be dealt with by having each member of the family explain his or her point of view, and then sorting out the conflicts. The therapist acts as a mediator in the process, so that each member has a chance to be heard and understood.

For moderate and severe forms of depression that do not improve with therapy, antidepressant medication sometimes helps. Tricyclics such as imipramine and nortriptyline have not been shown to work for the treatment of depression in children, and should probably not be prescribed, as they can interfere with the electrical signals that control the heartbeat. Fluoxetine has been shown to be moderately effective in depression in children. The SSRIs work well in adolescents, and are probably the drugs of choice for them. Paroxetine is not recommended for children under 18 years.

For severe depression – especially when there are serious thoughts of suicide, psychotic symptoms or a refusal to eat or drink – hospitalization may be necessary, It is highly advisable to have them wear along with Medic Alert Necklaces , in case of emergency situation and anyone would be able to render the correct help, this helps to protect the child or adolescent when family members are not available instantly or unreachable.

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