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Behavioral Health Care
Q: I’m worried that my child may be depressed. What are the symptoms?Ask Our Expert About Mood Disorders in Youth
About Our ExpertJohn-Paul Gomez, M.D., is a child and adolescent psychiatrist with Lehigh Valley Hospital and Health Network
Q: I’m worried that my child may be depressed. What are the symptoms?A: Depressed young people are more likely to be irritable than sad, and the other telltale symptom is a loss of interest in favorite pastimes. As with adults, changes in sleeping and/or eating habits, attention problems, fatigue and low energy are causes for concern. So are feelings of hopelessness, guilt, worthlessness, and especially, thoughts of suicide. In major depression, these symptoms last two weeks or longer. Q: What if the symptoms don’t quite fit that description?A: The problem could be a condition called dysthymia, which is minor depression. The symptoms are low mood, poor energy and/or lack of motivation for longer than a year. Dysthymia is more of a chronic condition, and frequently occurs along with major depression. Q: Could there be another explanation for my child’s low mood?A: Use of alcohol and certain drugs (prescription or illegal) can mimic depression by making someone feel wiped out or 'down.' So can some illnesses, such as thyroid problems or anemia. It’s important to rule out medical or substance-related issues before considering a diagnosis of depression. Q: What treatments are available for childhood depression?A: Generally, all psychiatric conditions are treated with some form of supportive therapy. Cognitive behavioral therapy is particularly helpful in children. The therapist identifies the distorted thoughts that frequently occur in depression and tries to show why these thoughts are not correct. Combating such 'cognitive distortions' tends to help the child heal emotionally, which in turn improves his or her mood. Medications also can be effective, and for more severe cases, this tends to be the recommended treatment. Severe forms of depression often respond to a combination of medication and therapy. Q: My son’s moods swing wildly up and down. It’s taking a toll on our family. Could he have bipolar disorder?A: It takes an expert eye and a careful medical history to know for sure. Children may have characteristics of mania—the classic, euphoric state that defines bipolar disorder—but it’s less common or obvious than it is in adults. Instead, children tend to have what’s called a mixed episode, where they exhibit symptoms of both mania and depression. Make an appointment with a mental health professional if your child seems excessively excitable, irritable or talkative, is sleeping less, is highly distracted, exercises poor judgment or engages in risk-taking behaviors such as reckless driving, spending sprees or hypersexuality. Symptoms that last longer than a week and can’t be explained by another condition define a manic episode. Q: Is there any way to predict who will develop bipolar disorder?A: A family history of the condition places a young person at higher risk. So does severe pre-puberty depression or symptoms of psychosis (delusions, hearing voices). Sometimes, taking anti-depressants can trigger a manic episode, which compounds the risk of developing bipolar disorder. Experts estimate that 20 percent of children who have depression will go on to develop bipolar disorder. Family dysfunction can be another contributing factor. Children traumatized by abuse and neglect often have erratic, aggressive or very uninhibited behavior—all symptoms of bipolar disorder. Q: Some experts feel that bipolar disorder is overdiagnosed. What do you think?A: I think it is, among the young. Right now, it’s being diagnosed at a higher rate in children than in adults. Q: What’s happening to those kids when they grow up? Are they all getting cured? Or are people being diagnosed with bipolar disorder when they have something else?A: There is a lot of controversy in the field right now, because diagnosing children is complicated. They can have different symptoms, depending on their age. And we often have to make the diagnosis based on information from multiple informants, including families, schools and social service agencies. There’s typically a lot of family chaos and other stressors involved, and there’s a lot of symptom overlap with other disorders. Q: How do you treat bipolar disorder?A: Medications called mood stabilizers are the treatment of choice for bipolar disorder. Lithium (various forms), divalproex sodium (Depakote) and carbamazepine (Tegretol) are commonly prescribed for children. Medication compliance is key to preventing recurrences, so a lot of effort goes into educating the family and the patient about their illness, risk factors and managing the possible side-effects of drug therapies. Q: Can you recover from bipolar disorder?A: It’s a recurrent condition, but it is treatable. Studies show that if a family is doing pretty well, is intact and supportive, there is a greater likelihood of successful treatment. The goal is to identify the illness as early as possible and reduce the number of manic episodes. Research suggests that recurrent manic episodes tend to increase in severity, and that leads to problems socially, in school and even legally. These patients are also at considerable risk for suicide, which is the number three cause of death between ages 15 and 24. So you really want to attack bipolar disorder aggressively to prevent recurrence. Q: Have you any specific advice for the parents of children with mood disorders?A: If you suspect a problem, seek treatment. And don’t play the blame game. One reason why these children escape identification is that the parents fault themselves for their child’s difficulties. Consequently, the child doesn’t get the help he or she needs. This guilt isn’t necessary, because there are effective treatments. Resources for ParentsGood information on mood disorders is available on the Internet as well as from your primary care doctor or a psychiatrist. Here are some helpful Web sites:
This page last updated 10/14/08 10:10 PM
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