Depression in Children
- 7 Oct 07, 8:05 PM
When I was eleven years old I wrote a story:
I was standing on a small stone arched bridge. I was all on my own and there was not another person for miles around. Not a sound could be heard except for the whoosh of the fast flowing water beneath, and the gentle rustling of the leaves in the trees on the banks of the river. I could see the water rushing underneath the bridge, the white spray against the rocks an indication of its depth and power. If I looked carefully I could just make out the odd fish shooting past, coasting with the flow down the river. I was enjoying the moment, being completely alone with nobody else there to bother me.
My story was meant to celebrate the power of nature and being in the moment, the value of solitude and meditation. So I was somewhat bemused when my teacher at the time took me aside and with a concerned look on her face asked me ‘You don’t really feel like that do you K?’
At the age of eleven the concept of depression had not even entered my head and I really didn’t understand what all the fuss was about. I simply replied ‘Of course not, it’s only a story’ and that was that.
However, for some reason this event has stayed with me. It only occurred to me years later the significance of what had happened. Perhaps my teacher was worried that I was unhappy at home, or worse, suicidally depressed and planning to jump off the bridge in my story.
I’m not sure at what age children start to experience symptoms of hypomania or depression that could be distinguished from the normal ups and downs of growing up but I don’t remember any such significant symptoms until the age of about seventeen.
I have often looked through the diaries that I kept from age thirteen to fifteen to see if there is any evidence of this, but all that resounds from the pages is a repetitive enthusiasm for holidays, friendships and sports activities, unless I have forgotten how to interpret the code of multi-coloured pen.
As a result, I am strongly against early diagnosis of severe mental health conditions and over-medicating children such as is the practice in the USA. My own preference would be to treat them with counselling and cognitive behavioural therapies, a healthy diet, vitamin supplements and fish oil. Unnecessarily poisoning children with antipsychotic drugs and risking obesity and diabetes at a later time in their lives is not the answer.
What do you think? Is it a help or hindrance to have an early diagnosis? Are you for or against the use of antipsychotic drugs at a young age?
• Visit
Help and support for overcoming discrimination at work for people with bipolar disorder and other mental health conditions
Comments
I don't think generalising from your own experience is very useful in this case. If you never felt unhappy or frustrated as a child until the age of 17, then fine, but others have very different experiences of childhood! I had episodes of feeling depressed or isolated going back about as far as I mixed with other children. Not all of the time, of course, and it wasn't anything more than mild depression, but I was in and out of it. No medication needed, though, I think you may be right on that one.
I was depressed since the age of 6, writing poems about suicide at 11, and on Prozac at 16. For me, the best treatment would have been getting me out of my family, into a better school, and treating my arthritis better. I think I could have handled Prozac at an earlier age as well. I started counselling at 13 and that helped tremendously.
I think each case is extremely individual: overgeneralization from one's own personal experience is rarely the best way of deciding blanket policies in cases where no one, single blanket policy is ever going to be appropriate for everyone.
I've been fortunate in that I've never had to struggle with depression. But I did know someone who has dealt with depression for her entire life, from childhood on. (In her case, apparently primarily a neurochemical imbalance. I know the causes of depression can vary a lot from person to person and in some cases removing the environmental triggers, if that is physically possible, can be enough to treat the depression. But in her case, she apparently struggled with depression pretty much 24/7, year in and year out, even when she believed things were basically going pretty well for her.) She told me she really wished that she had been diagnosed much younger --i.e. in childhood--and is still angry (or at least, when I last knew her she was) that the therapist she had as a teenager completely missed it. I don't know for sure if she would have wanted medication as a child -- but given that she feels medications transformed her life once she was finally diagnosed and prescribed, I'm guessing probably yes.
Obviously her situation doesn't apply to everyone either. Sometimes I think medical professionals DO get a little too hung up on the medicaiton side of things (probably because that's seemingly more straightforward, or at least more in the psychiatrist's control) and forget to look at environmental factors that, at least in some cases, may be more critical than whatever neurochemical imbalance there might be. As was apparently the case in Zephyr's depression above.
But I do think that, ALTHOUGH there IS such a thing as "over" medication (medicating when it either isn't needed at all or when there are other things that really ought to be done either instead of or at least in addition to the medication, such as removing a child from an unhappy home situation or whatever), there is ALSO very much such a thing as "under" medication (not prescribing medication when it could actually make an enormous difference, and may be the best hope). In YOUR case, if you had been prescribed medication as a child, then from what you say here it sounds like it would probably have been "over" medication. But in the case of the woman who I knew some years ago, being deprived of medication or treatment beyond the counseling she did get as a child apparently may have been a case of "under" medication. BOTH over medication AND under medication have potentially serious consequences. BOTH are undesireable. (For some people, one might be more "undesireable" than the other -- well and fine, except that for some "under medication" will be more undesireable, for others "over medication" will be more undesireable).
The only thing we can really do (IMO, at least) is to push for more careful case-by-case anaylsis of whether medication is appropriate FOR THAT INDIVIDUAL, and also push for a more holistic picture of depression so as not to overlook environmental triggers, both immediate (e.g., death of a loved one) and on-going (e.g., on-going child abuse, etc).
I suspect (mostly just a guess) that it is the on-going triggers that may get overlooked more, maybe especially with children for whom there may be no comparison point--their life now may be pretty much what their life has been like all along. So unless they tell you what's bugging them -- and even they might not always be able to identify their environmental triggers--a psychiatrist might not pick up on them.
I appreciate your viewpoint; there may be a case to make that some children are over-medicated psychiatrically speaking (though not as much here as in some other countries). But I spent ten years on mood stabilizers and other psychotropic medication because of a lack of early intervention - I fully believe that, had I been treated when I first became withdrawn and unwell aged about 13, I wouldn't have needed to be on medication for nearly as long, and perhaps my bipolar disorder wouldn't have become 'full-blown'. Nowadays I only need a low dose of antidepressants, which (to my mind) is because the medication slowly started to re-adjust my brain chemistry (although, of course, I am by no means 'cured'). I honestly believe this would have happened earlier if I had been treated earlier - but of course, I can't prove this. I actually think the biggest problem is MIS-treatment of younger people. At sixteen I was put onto a very high dose of anti-depressants, because that's what we do with depressed people, isn't it? Had I been sent to a decent psychiatrist instead, they would probably have realised that I was bipolar, and NOT given me the wrong medication that threw me into a rapid cycle of highs and lows, long-term. So, I think your point is a good one, but I think that what is needed is very careful treatment of young people who have mental health problems, rather than not treating those who need it.
Thank you all for your replies. From what you say I agree with you, that each case is highly individual and therefore requires an individual response as far as treatment is concerned.
With regard to medication, I meant that I am against giving the more powerful antipsychotic medications to children such as risperidone and olanzapine which cause nasty side effects such as horrendous weight gain.
I feel that it is innappropriate for teenagers to be on these drugs unless it can be avoided. As far as anti-depressants go, however, I believe that these do help and can be life savers in some cases.
Zephyr raised a good point that many issues are socially related and can only be solved by changing circumstances, which of course, can be very difficult.