Spotting the signs
In spotting the signs of depression, you may notice physical changes such as sleep disturbances, appetite changes (eating more or less than usual), gaining or losing weight, complaining of headaches, stomach aches, joint and muscle aches. During a physical state, children’s thinking processes can often get confused, meaning they are unable to understand their shifting mood states; thus, their ability to cope environmentally (e.g., at school) is reduced. It can be seen that while this condition causes physical symptoms, and on rare occasions has physical causes, it is not a disease, yet is often unpreventable except with medication.
Variation in moods
You may also notice changes in mood; for example, feelings of sadness, hopelessness, anger, agitation and despair. Variation in moods can change throughout the day for a child, which might be worse in the morning yet improve later in the day; or vice-versa. You may see your child seemingly apathetic and thus losing interest in school work and the activities and hobbies they used to enjoy.
Also be on the look out for cognitive symptoms, which include a child’s experiencing persistent negative beliefs about themselves and their abilities. Cognitive symptoms can slow down thoughts, making concentrating difficult. Taking in central coherence during class and remembering and making decisions can also be part of depressed moods, so something else to consider if you find your child’s grades are suffering.
You may notice your child’s lack of social activity deteriorating. Hanging out with friends or visiting/receiving visitors starts to become a struggle. Also, withdrawing from immediate family where your child will spend much of their time in their room starts to become apparent; and further, showing a lack of motivation in getting ready for school or out-of-school activities, such as swimming or other sport. Teenagers may also appear to lose interest in close relationships.
Depression could be caused by one or more of the following:
- Biological factors – there could be an increased chance of developing depression if a family member has it
- Biochemical factors – low levels of serotonin have been linked to depression
- Anxiety factors – as a result of living with an on-going anxiety disorder such as obsessive compulsive disorder (OCD)
- Psychological factors – depression can be triggered by an external factor, for instance, a bereavement, divorce, moving or other change in circumstances
- Behavioural factors – learned helplessness resulting from an external factor (bereavement, parents divorce) and the attention the depressed person has received due to this. In other words they learn to continue being depressed
- Cognitive factors – in terms of learned helplessness, a depressed child/teen learns not to try to help themselves because they believe they will fail; therefore, they may see their failure as internal (their fault) or external (caused by something else) or global (applies to all situations); maybe specific (just applies to this situation) or stable (likely to continue) or unstable (could change, but possibly for the worst)
Early Warning Systems
“Early Warning Systems” are factors that can help you support your child/teen by evaluating why they are feeling a particular way. For example, if your child starts to feel low in the afternoon he might think that his mood will worsen and never get better, where in fact it might actually mean he had little sleep the night before. In terms of understanding and using the “early warning system” you can help your child how to grasp the difference between feelings and facts, and in which to determine what it is that caused their mood change in the first place. As such, and in this example, observe how to question key factors such as:
- Environmental – Was your child exposed to a stimulus that had an adverse effect on him, for example, had he been somewhere where he was sensitive to loud noise, bright lights, too many people rushing around? Would it have helped if he’d moved away from this environment to help gather his thoughts and to put in some perspective?
- People – Had your child met with a negative interaction with someone? Was she able to resolve this issue by questioning how she “sees” that person’s behaviours and looking for alternative perceptions? Perhaps she could consider making amends or asking the other person to help rectify the problem.
- Physical – Did he miss a meal? How can he check his meal times in the future?
- Emotional – Could the emotions be transitory or depression? For example, being exposed to a particular stimulus can trigger a negative response. Was she able to recognise this and check her resources to get through it, for example, talking it through with you, a teacher, or someone else; or using coping strategies learned in therapy?
- Negative lifestyle – Could he have worsened his mood by using alcohol, caffeine, drugs, binge eating? Could he be taught to consider the impact that these can cause, for example, too much may lift the mood for a while, giving brief respite, but dampens the mood in the long run, and for longer, which adds to the depression.
- Sustainable – Has she lost a sense of balance and stability by doing too little, or too much? Could she strike a balance by separating personal activity with school work, which might be some social contact, gentle physical exercise, creative project? Would this help to maintain her emotional well-being?
- Medication and medical supervision – Has he stopped taking his medication, or overdosed accidentally? Has he been keeping up with appointments for medical check-ups? Can he be taught that complying with his treatment team and taking medication and maintaining that is helpful; and that keeping up with medical check-ups is important for his overall well-being?
- Disillusionment – Does she feel she has had enough of fighting depression and feel like giving up? Has she forgotten that not fighting is actually worse than “giving up”? If this is the case then her treatment team must work together, if possible, to help her “pick herself up” and encourage her to try again (not to be confused with being forced, as this is counter-productive).
Once the key to an early warning system is found, a depressed child/teen can then consider how to manage their moods. So in the example earlier it would become clear why your child’s mood lowered in the afternoon – that is, by realising they’d slept for only three hours the night before, and further identifying that playing video games was partly the cause. When considering feelings and facts a child is then able to differentiate how sleeping little can cause someone to feel low, but that this does not mean their depression will worsen. Therefore, they learn that maintaining a good sleeping pattern means better moods. By identifying this, they can then be encouraged to find ways to induce sleep, e.g., by reading an easy-to-follow book at bedtime, and instead of playing video games which can make a child feel negatively alert or agitated. Having a soothing drink such as warm milk can also be helpful instead of a fizzy drink or energy drink, which can bring on restlessness.
Obsessive Compulsive Disorder
There is a clear relationship between OCD and depression in terms of either people developing obsessions during a depressive episode, where symptoms can reduce dramatically when the depression lifts; or becoming depressed following the onset of OCD, which is noted as secondary depression. Although a distinction can be made between depression and OCD, there is however a continuum where a person experiences on the one end depression without obsessions and on the other end experiencing OCD without depression, while at the same time swinging in the middle of the continuum where they tend to suffer a combination of both. What should be noted in this instance is recognising the features that describe depression (see symptom categories at the start of the article) and the relationship between the two disorders. When treating OCD it is important that the depression is treated first, usually with medication, and before cognitive behavioural therapy (CBT) is applied, or continued. This is because depressed moods often result in depressed thinking or clouds thinking, leading to depressed behaviours. When this alters, OCD can be treated while keeping a regular check on moods.
Journals, self-assessment scales, and problem-solving forms can help your child backtrack early warning systems in terms of identifying triggers, helping them make sense of their moods, and how to better manage shifting states. Keeping records can also help with other problems such as acknowledging and accepting the concept that feelings are not facts. This can lead to improved moods which subsequently means your child starts to show interest in things again, taking up hobbies again, mixing socially again, and feeling more motivated to get up in the morning for school and also having the energy for joining out-of-class activities, and so on.
Major Depressive Disorder
Major Depressive Disorder has all the signs of clinical depression but on a much higher scale. It can be caused by external factors such as when a loved one passes away, or it can be caused by internal factors – for example, neurological.
If you find that your child reaches their late teens or becomes depressed in their teens, and the helping techniques discussed for clinical depression are not enough, look out for signs that tell you their symptoms could be major depressive disorder. For example, you may notice comfort behaviours increasing. These might be comfort eating, self-medicating with alcohol, compulsive shopping, reassurance seeking and so on. These become problematic when comfort eating becomes bingeing, self-medicating becomes addictive, shopping becomes an emotional high, and reassurance seeking is constant.
These negative coping behaviours might occur when your teen feels they have no other choice but to escape their emotions. However, negative activities can increase the depths of their already fixed emotional insecurities. Worrying about weight issues, friendships and close relationships, college or work problems, debt due to unnecessary shopping trips and doubts about self-esteem when reassurance isn’t helping anymore all take their toll.
The worst scenario is when a teen fails to respond to alternative methods that would otherwise improve their condition. As a consequence, self-soothing behaviours often get worse and can lead to ill-health. This compounds the sypmtoms of depression where for some young people, this may lead to further withdrawal, self-harm and either suicidal thoughts, or suicide itself.
When treating major depression, a therapist’s role is much the same as when they support a person who has clinical depression. Basically, they act as complementary therapist, meaning they liaise with a teen’s treatment team and do not take on their problems independently. One important factor therefore is to make sure your teen’s therapist ensures they attend regular medical supervision and encourages them to take the advice of their medical doctor, specialists and other professionals. A therapist’s role is to encourage your teen to take and maintain prescribed medication, and refer him or her to their prescribing physician should any issues arise. Their job is to support your teen in following through with their care-pan, and other safety mechanisms, for example “early warning systems” (see above), self-assessment scales, TLC and emergency contacts.
A therapist’s level of competence
There are times when additional supervision is needed. For instance, self-medication is a crucial issue since this can add to an already serious low mood, noted earlier. A teen’s general practitioner will monitor, for example, appropriate reduction in terms of withdrawal methods to help guard against him or her tipping over the edge. Whilst minor health issues can be complemented by a therapist then, severe mental health issues differ in that these go beyond a therapist’s level of competence.
Therefore in the first instance, it is the therapist’s job to only support a patient during medical supervision, and to stick to the plan implemented by the medical specialists, especially since this is not straightforward and thus needs careful monitoring and collaboration. In the second instance the therapist’s role is to only complement and assist with the consent and knowledge of a specialist, psychiatrist, community health team; or mental health social worker, who coordinates and manages the patient.
“Early Warning Systems” are factors that can help you support your clinically depressed child/teen by evaluating why their moods are low and to determine if certain factors are contributing to what initially seems to be a more serious outlook. Additional supervision is required for a teen with a more severe case of depression as in the case with major depressive disorder. Subsequently, they can then be helped to manage and monitor their moods and overlapping problems, which might include anxiety disorders, such as OCD.
Carol Edwards © 2016. Updated June 2018
Disclaimer: this document is information-based only; therefore if your child/teen is experiencing any of the symptoms discussed in this article please consult with your medical practitioner for their advice, and before going ahead with suggested strategies.
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