Depression In Children And Adolescents

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Depression In Children And Adolescents
Depression In Children And Adolescents
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Video: Depression in Children and Adolescents - Part 1 2023, February
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Depression & Bipolar Disorder in Children / Adolescents

When children and adolescents are depressed, the characteristics are sometimes very different from affected adults. In addition, in many cases a child's depressive episode is the harbinger of bipolar illness ("manic-depressive").

20 percent of children and adolescents experience a depressive episode before they come of age. Depression and bipolar illnesses are serious and sometimes serious illnesses that can also be life-threatening (e.g. risk of suicide).

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  • How does depression or bipolar illness develop?
  • How can the disease be prevented?
  • What are the symptoms?
  • How is the diagnosis made?
  • How is the treatment carried out?
  • Whom can I ask?
  • How are the costs going to be covered?

How does depression or bipolar illness develop?

Environmental factors are particularly important in the development of depression: experiences of loss, abuse (emotional or sexual), neglect or constant stress (especially in the family). An acute stress in life is often a factor. But other mental or physical illnesses can also be (partly) responsible. Girls are more often affected after puberty. The depressive episodes last between three and twelve months. Anxiety disorders in childhood, in particular, increase the likelihood of later depression or bipolar illness. Substance abuse (drugs, etc.) is increasingly becoming a risk factor in adolescence. Often there are also ADHD or behavioral problems. Genetic factors are essential. This is particularly pronounced in bipolar disorder,where the risk in children is four to six times higher if close relatives suffer from the disorder.

How can the disease be prevented?

Depression or bipolar disorder cannot be prevented with certainty. Loving and empathetic caregivers and a good development environment enable stable growth in personality. It is also important to spot any signs early and seek professional help. Stress management training and other forms of psychosocial support in stressful situations can also make a contribution to prevention.

What are the symptoms?

Symptoms of a depressive episode

Symptoms of a depressive episode include:

  • Gloomy mood / depression
  • Listlessness
  • Irritability
  • Loss of interest in, for example, leisure activities
  • Pessimistic ideas about the future
  • Low self esteem
  • Feelings of guilt
  • Fears (e.g. real fears due to a current situation, such as a divorce, but also unreal feelings of fear, e.g. of monsters)
  • sleep disorders
  • Appetite disorders
  • Inhibition in thinking and acting
  • fatigue
  • Concentration or memory problems
  • Unsuccessful brooding "in an endless loop"
  • Social withdrawal

Signs of depression are often harder to spot in young children. Observing everyday behavior helps here. For example, reluctance to play, quick frustration or nightmares can occur.

Note Thoughts and actions related to suicide can also occur. You can find more information and important information on emergency aid and emergency numbers under When young people no longer want to live and at bittelebe.at.

The more symptoms there are and the more severe they are, the more serious the condition is. One also speaks of mild (light), moderate or severe depressive episodes. You can also find more information on different forms of depression under Depression: Types and course.

Symptoms of a mania / manic episode in bipolar illness

In bipolar illness, the following symptoms of a manic episode occur between depressive episodes:

  • Urge to talk
  • Flight of ideas (hardly an idea has been expressed, others already follow - sometimes incoherently - "from the hundredth to the thousandth")
  • Decreased need to sleep
  • Loss of inhibition
  • Exaggerated self-assessment
  • Distractibility
  • Increased libido (sexual desire) in teenagers
  • Sometimes hallucinations or Delusion

To speak of bipolar disorder, there must be at least two affective (mood disorder) episodes. At least one of these must be hypomanic (characteristics similar to those of a manic episode, but milder), manic or mixed (depressive and manic or hypomanic). Mood changes occur more often in adolescents than in adults. In this context, one speaks of "ultra-rapid cycling". The episodes only last a few days or only four hours ("ultradian cycling").

Note Thoughts and actions related to suicide can also occur. You can find more information as well as important information on emergency aid and emergency numbers under When young people no longer want to live and at bittelebe.at

How is the diagnosis made?

In any case, affected children and adolescents need professional help quickly. The first point of contact are child and youth psychiatrists. In most cases, clinical psychologists or doctors from other specialties (e.g. for pediatrics and adolescent medicine) are also consulted for the diagnosis.

Involvement of the family

Younger children in particular can often not describe their symptoms so well. Behavioral observation and precise inquiries about the medical history (anamnesis) from the caregivers (especially in the family) are necessary here. It must also be ascertained whether other family members (blood relatives) already suffer or have suffered from a mood disorder. On the one hand to determine the genetic risk, on the other hand to provide suitable support measures for the whole family if necessary, because a poorly supportive parenting relationship is a risk factor for a relapse.

Adolescents should be given the opportunity to speak to the doctor or therapist alone. Often this shows a greater willingness or openness to talk about the problems.

Exclusion of physical illness

Physical illnesses can appear accompanying or as a (co-) trigger and must be clarified or excluded, such as thyroid diseases or neurological diseases. A thorough physical and neurological examination as well as laboratory tests (including drug screening) are carried out. Imaging using MRI is important if symptoms reappear in order to rule out organic diseases of the brain. Important differential diagnoses include ADHD, schizophrenia and the emotionally unstable personality disorder. It is also essential for diagnostic or therapeutic considerations to consider whether medication or contraceptives are being used. On the one hand, because drugs can have an effect on mood. On the other hand, because this is importantto select substances for additional drugs for depression or mania that go well with the previous ones.

Standardized questionnaires are also used for diagnosis. For example, the Child Behavior Checklist (CBCL) and disorder-specific questionnaires such as the Depression Inventory for Children and Adolescents (DIKJ) or the Young Mania Rating Scale (YMRS) for bipolar disorder. It can also be useful to use a mood journal to keep track of changes in mood.

Note The risk of suicide must always be clarified in order to avert the risk of self-harm.

How is the treatment carried out?

In any case, the patient and the family should be informed about the disease and treatment prior to therapy. Individual therapy goals are also defined. A stay in hospital (sometimes in accordance with the Accommodation Act) is necessary, for example, in the event of severe stress or acute suicidality. Parents are included in the therapy as a stable and understanding family environment is important for recovery. Family therapy can also be used. Parents can also find support in self-help groups.

Note From the point of view of evidence-based medicine, it cannot be clearly stated which therapy brings the best benefit. This must be discussed individually with the respective doctor.

Treatment of Depressive Disorders / Episodes

The therapy of pure depression is based on the S3 guideline of the German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy. For older adolescents, adult guidelines should also be used for treatment.

In the case of mild depressive episodes, psychosocial support and psychoeducation for younger children may be sufficient to begin with. For older children and adolescents with mild to moderate depression, psychotherapy is the treatment method of choice. Approaches from cognitive behavioral therapy and interpersonal psychotherapy are particularly scientifically proven to be effective. However, a general important factor for the therapeutic success of psychotherapy is also the therapeutic relationship. It is therefore essential that the child or adolescent can work well with the psychotherapist.

Drug treatment in childhood and adolescence is recommended for the following types of depressive disorder:

  • Insufficient effect of psychotherapy alone over twelve weeks
  • Severe depressive disorder
  • Suicidality
  • Delusions

In the case of winter depression, morning light therapy (10,000 lux for 30 minutes over two to four weeks) can be carried out.

Severe depression

In the case of severe depression, treatment should consist of a combination of SSRIs (selective serotonin reuptake inhibitors) and psychotherapy right from the start and is usually inpatient. Fluoxetine is approved for children aged eight and over; alternatively sertraline (approved from ten years for obsessive-compulsive disorder) or escitalopram or citalopram. Look out for signs of side effects and inform the doctor immediately - especially if thoughts of suicide, aggression, fears and insomnia occur. If there is no improvement within twelve weeks of psychotherapy or four weeks of taking medication, the therapy should be changed (different form of psychotherapy, different medication). Even if those affected are symptom-free for at least two months,they should take medication for at least half a year. Further therapy depends on the severity of the first episode or on the frequency of previous episodes, remaining symptoms (residual symptoms) and the side effects. It is important that parents / caregivers and, from a certain age, young people themselves recognize renewed depressive symptoms as quickly as possible in order to take therapeutic countermeasures at an early stage. Because the risk of another episode occurred.to take therapeutic countermeasures at an early stage. Because the risk of another episode occurred.to take therapeutic countermeasures at an early stage. Because the risk of another episode occurred.

Note There is no evidence of effectiveness for the treatment of depressive states in children and adolescents for St. John's Wort.

Treatment of bipolar depression

Depressive phases in bipolar disorder are treated differently than pure depression. For example, no antidepressants are used in this case (with the exception of adolescents) because they encourage a so-called "switch" (high mood quickly falls into a low mood or vice versa). Medicines for depressive episodes in the context of bipolar disorder in children and adolescents are currently only possible outside of approved drugs - in the sense of "off-label use" or as part of a clinical study. Mood stabilizers or atypical neuroleptics are used.

Treatment of mania

In the therapy of pure mania, drug treatment is of central importance. In the case of high arousal with overestimation of oneself or risky behavior (possibly with suicidality), an inpatient stay (sometimes according to the Accommodation Act) may be necessary.

It is essential that there is precise psychoeducation - both for the patient and for the family. The clinical picture should be explained in detail and the possible individual treatment measures discussed.

The treatment of mania in children and adolescents has only offered a few scientifically proven measures to date. A so-called atypical neuroleptic is recommended, eg aripiprazole (approved from the age of 13), quetiapine, olanzapine or Risperdon. A mood-stabilizing agent can also be used (e.g. valproate or lithium). The acute treatment is followed by what is known as phase prophylaxis (possibly also with lamotrigine). This is recommended after the second manic phase. How long this treatment lasts is determined individually. In addition, psychotherapy is one of the pillars of treatment for mania. Since most drugs have not been tested on children, they have to be used “off-label”. This generally applies to many substanceswhich are used in paediatrics and in child and adolescent psychiatry.

Whom can I ask?

If you suspect that your child is suffering from depression, bipolar disorder or mania, contact a child psychiatrist or a specialized outpatient department. In acute cases, please call the ambulance on 144. You can find contact addresses for aid facilities in crisis under crisis telephones and emergency numbers as well as under crisis facilities and psychosocial assistance.

If you are a teenager and feel like you may have depression, mania, or bipolar disorder, talk to a trusted person you care about or get help. It's good when you take your feelings seriously.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Basically, your doctor or the outpatient clinic will settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles. Information on costs for a hospital stay can be found under What does a hospital stay cost?

When making use of psychotherapy, full cost coverage is possible in the health insurance institutions' own or contractually bound institutions, as well as in institutions that are subsidized by the public sector. In these cases, there is the option of paying a deductible. Otherwise, you have the option of applying for a subsidy from the health insurance company if you are undergoing psychotherapy with a resident psychotherapist. If this is approved, the health insurance provider will reimburse you for part of the fee paid to the psychotherapist.

Clinical-psychological diagnosis is a service provided by the health system, the costs of which are borne by the health insurance carriers. You have to bear the costs for treatment or advice from resident clinical psychologists, as this is not a benefit from health insurance.

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