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When the house becomes silent

One of the most goose-bump moments in my practice was when a mom told me during a follow-up consultation that she heard her little girl laugh again. Only then did she realise how long the house had been silent.

The American Academy of Child and Adolescent Psychiatry estimates that as many as one in 20 children and adolescents are depressed. On average at least one child in every classroom will be suffering, often in silence. And the worst outcome of depression? Suicide which is one of the top three leading causes of death amongst youth between 10 and 24 years old.

 

For a long period of time, it was commonly believed that children do not get depressed, and that adolescents all went through a period of “sturm und drang”. Luckily we now know more, and understand the symptoms and can recognise them for early intervention.

 

It is normal to feel sad and angry when you experience a major setback or disappointment, but these negative feelings usually ease with time. While normal sadness comes and goes, depression is a pervasive condition and is more than just feeling down or being in a bad mood. It manifests as a dark cloud draining the light and the laughter from life. What should parents be on the lookout for?

 

The symptoms of depression can be divided into four groups:

 

  • Emotional symptoms: sadness, tearfulness, being withdrawn, loss of interest and enjoyment in (previously favoured) activities, anxiety, irritability and anger outbursts
  • Cognitive (i.e. involving thinking) symptoms: problems with concentration (not completing tasks, or a deterioration in performance at school), pessimistic thoughts, feelings of worthlessness, helplessness, hopelessness, and guilt, rejection sensitivity, thoughts that life is not worth living, or even thoughts of suicide
  • Physical symptoms: changes in appetite and weight, sleeping problems, fatigue, sluggishness, or fidgetiness and restlessness
  • Behavioural changes: withdrawing from activities, friends, and family (“hiding in the bedroom”), clinginess and demanding behaviour, “escape” into activities such as videogames, eating, substance use, and reckless behaviour; and even self-harm

 

But what causes depression in this period of life which should be “care free”?

 

Depression is usually caused by interplay of different factors, of which a genetic vulnerability (a family history of depression) may be one. Studies show that 25 percent of kids who have a parent who has suffered from clinical depression will experience their own depressive episode. When both parents are depressed, the risk increases to about 75 percent.

 

Depression may be triggered by psychological and environmental risk factors and significant life events or stressors such as death, divorce, a breakup, a move (changing house, school or town), or chronic illness may all be major catalysts. The adolescent years are a time of emotional and social turmoil – things that are difficult for anyone to handle can be devastating to a teenager. The result of this acute or chronic stress may be a lowered levels of neurotransmitters (chemical messengers in the brain) such as serotonin, dopamine and noradrenaline.

 

How is depression treated?

 

Treatment for childhood and adolescent depression may include addressing any medical conditions that could contribute to the depression. Your psychiatrist may request special blood tests and in some cases even a brain scan. Treatment will also include lifestyle changes, psychotherapy (which focuses on developing realistic, practical ways to cope with depression-distorted thoughts and reactions), and for moderate to severe depression, medication. Medication focuses on restoring the neurotransmitters in the brain. If used correctly medication for the treatment of depression is not addictive and is safe. Medication should also be used long enough for healing to set in and to reduce the risk of future episodes. Your psychiatrist will discuss the treatment options with you and your child. Engaging with the psychiatrist, seeing them as a partner in your child’s long term health and by asking questions, you will soon find that depression, although traumatic for the child and their family members, is a condition that can be treated with much success.

 

Ten tips to help your child overcome depression and find their laughter:

 

  1. Keep your ears open to spot the silence in the house of a child who has lost his/her laughter. Keep your heart soft to know that the “noise” of an adolescent with behavioural changes could be depression.
  2. Don’t put off your child’s treatment. Get professional help as soon as you notice a problem. MRI studies have shown that prolonged untreated depression can actually change the shape of the brain. For an accurate diagnosis of major depression to be made, a detailed clinical evaluation must be done by a medical or mental health professional such as a psychologist or psychiatrist.
  3. Make sure your child takes any prescribed medicines and attend therapy sessions. About 60% of children who take antidepressants improve. It may take up to six weeks of treatment with medication at its effective dose to start noticing improvement.
  4. Encourage healthy eating and regular exercise (at least 5 times a week for 30 minutes) and remember it is important to practice what you preach!
  5. Establish regular sleeping patterns – and avoid screen time (phones, television, and computers) one hour before bedtime.
  6. Offer your love and support repeatedly. Kids with depression need to hear it a lot because sometimes they feel unworthy of love and attention.
  7. Remind your child that you’re there and want to hear what he or she has to say, even if it isn’t pleasant. But don’t panic and “push” if your child doesn’t want to talk to you! It is normal for adolescents to rather talk to their peers or their therapist than their parents.
  8. Never tell your child to “snap out of it.” If they could, they would have and then it wouldn’t have been depression. Remind yourself that it isn’t laziness causing your child’s inability to get out of bed, complete chores, or do homework.
  9. Stop blaming yourself. Parents often feel responsible for their child’s happiness and although it is true that parental factors can contribute to the development of depression, you are not the cause of your child’s depression. However, if your family is experiencing big changes or stressful changes, do consider seeing a therapist for support too.
  10. Watch out for warning signs of self-harm and suicide. If your child talks about suicide, to you or anyone else, or shows warning signs such as giving belongings away and being preoccupied with death, call your doctor or therapist immediately.