Depression in children and adolescents - Causes, symptoms and treatment. MF.

Recently, in the press, reports of suicide among teenagers have become more frequent. The most common causes of suicide are depressive states. Such states develop not in an hour or a day. Depression is a long-lasting state. The duration of depression is often more than two years, however, there may be less short-term conditions( from 2 weeks to 2 years).

The causes of depression in children

The following factors contribute to the development of depression:

1. Early neonatal pathology: chronic intrauterine fetal hypoxia, the birth of children with asphyxiation, the presence of neonatal encephalopathy, intrauterine infections. All these conditions lead to brain damage.

2. Family climate: incomplete family, conflicts in the family, "overreaction" by mothers, lack of care on the part of parents, lack of proper sexual education by parents. Very often in single-parent families, children can not tell their parent about all their problems, especially in families where the daughter is raised only by the father. In such families, children are locked in themselves, the whole burden of problems lies only on their shoulders, and sometimes they can not cope with this burden. Frequent conflicts in the family lead to ideas for the child, that it is a burden to parents that without it they would have lived much easier. If there is a "superoperation" from the mother, the children are not able to adapt to the environment and society, without the lack of support from the mother, they become completely helpless. Adolescence is a period of experimentation, especially in a sexual way. In the absence of sexual experience, very often there may be problems and failures in the first sexual encounter. If the child is sufficiently informed in sexual terms, this circumstance will not cause a negative reaction in the adolescent, however, in the absence of sex education, such a situation can negatively affect the adolescent, which will lead to his isolation.

3. Adolescence. As already mentioned above, adolescence is a period of experimentation. In addition to the previously described problems, hormonal and structural alteration of the organism takes place during this period. Girls have the first months, the boys have nocturnal pollutions( nocturnal ejaculation), the shape of the body changes, and youthful spots appear. Because of the overabundance of hormones, children become more aggressive, in their environment there are leaders who dictate this or that way of life. If you do not match this image, you can not get into the group of communication, which means that you are out of the public life. All this can lead to the alienation of a child from society, the emergence of thoughts that he is not like everyone else.

4. Frequent change of residence. The child should have a circle of friends, friends. With frequent changes of place of residence, a child can not make full friends, with whom he could spend his free time, share secrets.

5. Problems in study. The modern educational process is too overloaded with subjects, not every child is able to cope with the school load. The lagging behind the school program isolates the child from his classmates, making him very vulnerable mentally.

6. The presence of a computer and the Internet. The achievements of technology allowed to unite the whole world, narrowing it to the computer monitor, however, this had a bad effect on the ability of young people to communicate. Children have narrowed the circle of interests, they are not able to discuss anything with their peers, in addition, how much he "pumped" his hero or how many "bots" he "soaked" yesterday. Children become shy at personal meeting, it is difficult to find words for them, because it's so easy to hide behind a pair of emoticons in a computer. In this case, the only form of communication they have is chatting.

Depression in a child can develop due to acute or chronic stress( death or serious illness of loved ones, family breakdown, quarrel with close people, conflicts with peers, etc.), but may start out of communication with some visible causes in the backgroundcomplete physical and social well-being, which, as a rule, is associated with disturbances in the normal course of biochemical processes in the brain. Isolate the so-called seasonal depression, the emergence of which is associated with a particular sensitivity of the organism to climatic conditions( often manifested in children who underwent hypoxia, who received various trauma in childbirth).

Symptoms of depression in a child

Depression is most affected by adolescence. Isolate early( 12-13 years), middle( 13-16 years) and late( over 16 years) depression.

Depression is a classic triad of symptoms: decreased mood, decreased mobility and reduced thinking.

Decreased mood during the day with depression is uneven. Most often in the morning the mood is more upbeat, children quite willingly go to school. During the day, the mood gradually decreases, the peak of low mood occurs in the evening. Children are not interested in anything, they may worry about a headache, in rare cases, an increase in body temperature is possible. Children complain that they are all bad, that they have constant problems in school, conflicts with teachers and students. No successes do not please them, they constantly see only the negative sides, even in the nicest things.

In addition to the reduced mood, there are so-called flashes of a very good mood. Children joke, have fun, however, this elated mood does not last long( from a few minutes to an hour), and then is replaced again by a lowered mood.

The decrease in mobility is manifested in the unwillingness to move, children either constantly lie or sit in the same position, most often hunched. Physical labor does not cause them any interest.

The thought process in children is slow, speech is quiet, slow. Children with difficulty pick up the necessary words, for them it becomes problematic to build an associative series( for example, a wedding-bride-white dress-veil).The children answer the questions after a pause, more often with just one word or just a nod of the head. There is a loop on one thought, most often with a negative connotation: nobody likes me, everything is bad for me, I can not do anything, everyone is trying to do something to me bad.

Children have reduced appetite, they refuse to eat, sometimes they do not have a few days. Sleep a little, disturb insomnia, because a loop on one thought prevents the process of falling asleep. Sleep in children is superficial, restless, does not allow the body to rest in full.

Thoughts on suicide do not arise immediately, most often for their occurrence, a long term of the disease( from a year or more) is needed. One thought of suicide is not limited. Children come up with an action plan, think out options for leaving from life. This variant of the course of the disease is the most dangerous, since it can easily lead to death.

In addition to psychological disorders, somatic symptoms often occur. Such children often seek medical help with complaints of general malaise, weakness, chest pain, heart, stomach, headache, possibly a rise in body temperature, which is often regarded as a persistent( circulating) infection in the body.

In connection with the presence of psychoemotional disorders, children begin to lag behind in school, the interest to any entertainments is lost, children cease to engage in hobbies, even if before that they devoted all their time to it.

As mentioned earlier, the course of the disease is long and can last for years. Therefore, if a child lives in a family with his parents, it is quite easy to notice symptoms. Another thing is if the child lives in a dormitory. In the afternoon, fellow students see him as usual, unchanged, since deterioration usually occurs in the evening, and in the evening the child is most often alone in the dorm room, where no one can see him. For the administration of such a child does not represent any interest, because it does not violate the order.

What should parents pay attention to?

First of all you need to talk with the child, take an interest in his life, problems in school. It is necessary to pay attention to intonation, the presence of plans for the future, optimistic views on tomorrow. Pay attention to having friends with your child, to be interested in what he does after school. It is necessary to pay attention to how much the child spends time, not doing any business. Some children - it's lazy, but even the laziest child can be forced to do something, bribing him, the child with depression does not interest anything, no gifts, no encouragement.

Closedness and absence of friends can sometimes be observed also with onanism, when children try to seclude themselves, avoid prying eyes. Frequent mood swings can be observed when the child takes drugs. In this case, they turn to themselves and other signs of drug addiction: preference for wearing long-sleeved clothing, photophobia, increased irritability, not the ability to concentrate on one session( restlessness), the detection of syringes, needles, incomprehensible sachets.

Examination of a child with depression

To clarify the diagnosis, a mandatory psychiatric consultation is necessary. In schools, there is a need for psychologists to monitor children dynamically, and to whom, if necessary, children can seek advice. It is also necessary for a psychologist to visit children at risk for developing depression regardless of the condition. This will help to avoid the development of severe symptoms, and will allow children to find an interlocutor with whom you can share secrets and get advice.

Treatment of children with depression

In severe cases, when a child expresses suicidal oils, especially when he has a specific plan for passing out of life, treatment should be carried out only in a hospital, in the separation of border states.

In more mild forms of the disease, treatment can be carried out at home. The child throughout the course of treatment should live a normal life: going to school, doing homework, going to the store for shopping.

In pediatric practice, the drug Adaptol is very well proven. This drug is very well tolerated, has no side effects, does not cause drowsiness. The drug normalizes sleep, improves mood, strengthens the body's resistance to psycho-emotional stress. Take the drug at a dosage of 300 mg for 1 tablet 3 times a day. Duration of treatment is from 2 weeks to a month. With severe symptoms, adaptol should be taken at a dosage of 500 mg 2-3 times a day for 3 weeks, and then go for a dosage of 300 mg and continue taking one more month. This drug, in addition to psycho-emotional symptoms, as well removes somatic manifestations of depression: pain goes away, the temperature normalizes. The use of adaptol with frequent headaches, pains in the heart, frequent body temperature rises, is one way to accurately establish a diagnosis and isolate patients from a depressed group from a group of children.

Also in an outpatient setting, a drug such as tenotene can be used. Tenoten is a homeopathic drug that blocks some brain proteins. It reduces anxiety, improves sleep, normalizes appetite. The drug helps to improve concentration, normalization of memory.

In severe cases, antidepressants are used: amitriptyline, pyrazidol, azafen. These drugs should be used only under the supervision of a doctor, and preferably only in a hospital.

But no treatment for depression in children will not be complete without positive changes in his family, parents should take the "real child", his needs and aspirations instead of his own expectations, instead of "the child of his dreams."When carrying out psychotherapy, they work to strengthen the child's self-esteem, develop his ability to express his feelings, share them, step by step cope with problems and constructively influence himself on the current situation.

Prevention of depression in children

To prevent the development of depression in children, it is necessary to organize psychological assistance in schools and colleges, children need to explain the necessity of visiting a psychologist in case of problems. It is necessary to improve the climate in the family, try to deal with some things the whole family( picnics, hiking in the woods, sports games).Be interested in your child's life, show how interesting it is, what he is addicted to, for you. Try to know your child's friends, however, it is necessary that it is unobtrusive, everything should happen in the form of a conversation, when the child himself tells you everything. Pay attention to the behavior of the child, notice all the new addictions of your child.

The child alone will not be able to get out of the depressed state of , so the parents' task in time is to pay attention to the change in the child's personality and seek medical help.

The child should be more often on air, to be active at a daylight and to have a rest in full darkness. This favorably affects the entire body, normalizes biorhythms.

Doctor pediatrician Litashov M.V.