|
Depression And Anxiety In Children And Adolescents: When To Consider Treatment MARK P. FABER, M.D. Childhood and adolescence should be a time of growth, carefree fun and learning within a kind, nurturing environment. As parents, we know just how quickly the years pass and respect the impact of our childhood years later in life. Depression and anxiety, however, may take their toll and prevent children from enjoying their friends, families, school or after-school activities. Causes of Depression and Anxiety
Family history and genetics are real factors. In fact at the National Institute of Mental Health, researchers are using blood tests/DNA samples to identify who may develop clinical depression when under stress and which medication may be helpful. Brain biology plays a role with a decrease in neurotransmitters. Current and major past stressors also contribute. Evaluation of Depression It is very important to first rule out other medical factors which may contribute to or cause depressive symptoms. Lab workincluding thyroid testing, blood count, and electrolytes/liver enzymes may be done. Hypothyroidism and anemia may look like depression. Also evaluating sleep for excessive snoring, decreased breathing or leg movements in sleep may indicate sleep apnea or periodic limb movements in sleep. A careful history and clinical interview then may lead to a diagnosis of depression. Treatment of Depression For an adjustment disorder with depressed mood, a supportive family, friends and possibly brief counseling are usually effective. For dysthymia or major depression, a combination of medication combined with cognitive behavioral therapy is often the most successful treatment. Medication Treatment of Depression
The Antidepressant Controversy Recently in the media there have been concerns that antidepressants may cause suicidal behavior in children and adolescents. The FDA has instructed drug companies to place a “black box” warning on allantidepressants because studies indicate a possible increase in suicidal thinking. The risk of such thinking may be seen as medication is started or increased. Antidepressants however are effective and actually treat major depression more effectively than psychotherapy alone (TADS Study - Treatment of Adolescents with Depression). The key is gradual dosing and close follow up to minimize any risk. An increase in restlessness or irritability with medication use may be an important factor requiring a decrease or change of medication. Types of Anxiety
Evaluation of Anxiety As with depression, it is important to rule out other factors which appear like anxiety. For example, excessive caffeine use may contribute to anxiety. Also an overactive thyroid may be ruled out with lab work. Finally, 50 percent of those with depression also experience significant anxiety. When the depression is treated, the anxiety also decreases. Treatment of Anxiety with Psychotherapy
Medication Treatment of Anxiety Zoloft and Luvox are FDA approved for treating OCD in children and adolescents (Zoloft: age 6 and above, Luvox: age 8 and above). Other SSRI's (except Paxil) may also be considered. These medications, in combination with psychotherapy may be effective in the various anxiety disorders beyond OCD. The key remains careful assessment and close follow up to assure the safe use if these medications. Conclusion Depression and anxiety may often be seen together in children. This may lead to difficulties functioning at home, in school, and socially if not treated. These conditions tend to run in families and may also be affected by stress. With careful evaluation and an effective plan of treatment, children may show a full improvement and enjoy their lives. Despite the recent controversy regarding antidepressants, these should be considered for major depression and severe anxiety with great care. For an appointment with the Division of Pediatric Psychiatry, please call (973) 322-7600. Prior to her appointment at Saint Barnabas, Dr. Friedman, board-certified in pediatrics, pediatric cardiology and pediatric critical care medicine, was Acting Chairman of Pediatrics and Director of Pediatric Cardiology at St. Luke's-Roosevelt Hospital Center in New York. She received her medical degree from the University of Chicago Pritzker School of Medicine and completed her internship and residency at Albert Einstein College of Medicine in the Bronx. She has completed a Fellowship in Pediatric Cardiology at New York University Medical School. In addition, she had written more than 100 publications, abstracts, and book chapters. Currently, she is an investigator in a five year grant for $1.9 million which is studying the effects of Dexamethasone in Neonatal Lupus Congenital Heart Block. [ top ] |
|
||||||||||||||||
In children and adolescents (age 7 and above), only Prozac is FDA approved for treating depression, However there are studies to support the value of Zoloft and Celexa as well. Often a child will respond to a medication which has helped another family member if there is a family history of depression. Paxil and Effexor are not currently recommended for pediatric patients. Serotonin Reuptake Inhibitors (SSRI's) such as Prozac may cause headache, stomach upset, and decreased sleep.
Cognitive Behavioral Therapy is very helpful. The “cognitive” part of treatment includes identifying exaggerated thoughts or worries, then challenging them with reasonable alternative thoughts. The “behavioral” part of treatment includes practicing diaphragmatic breathing (in through the nose, slowly out through the mouth) daily for 5-10 minutes. The breathing can gradually be combined with the stressful situation to help "desensitize" the child to this stressor. This therapy can be modified for the various anxiety disorders.
