Major Depression
As mentioned in my textbook, Nelson Textbook of Pediatrics, there are three major types of affective disorder seen in children and adolescents.
These are major depressive disorder, dysthymic disorder and bipolar disorder with alternating mania and depression.
Today, let us focus our discussion on Major depression.
Major depression is characterized by dysphoria and an obvious loss of interest in the usual daily activities. There is associated:
– change in weight
– change in sleeping patterns
– psychomotor agitation or retardation
– fatigue or loss of energy
– feelings of worthlessness and excessive guilt
– decreased ability to think and concentrate
– and recurring thoughts about death
Although, the causes of depression have not been fully established, there is an evidence of a genetic basis for major depressive disorders. Also, the following have been related to play a role in the development and maintenance of depression:
– social skills deficits
– learned helplessness
– problems with self- control
– and life stress
Clinically, depressive symptoms vary according to age and developmental level. Among the less than 1 yr old children, there will be crying, searching, panic- like behavior and hypermotility of both arms and legs after separation from a primary caregiver.
This will be followed by the infant’s close scrutiny of each approaching adults looking for his caregiver.
Then finally, the infant will have apathy in which the infant becomes hypotonic and inactive and exhibits a sad facial expression.
When they are being picked up, they cling to stranger and cry but they are never consoled. This is called by Spitz as “anaclitic depression of infancy”.
Among the school-aged children, depression will manifest as: sad facial expressions, easy tears, irritability, withdrawal from pleasurable interests, change in sleeping patterns, eating disorders.
While in adolescents, they typically present with:
impulsivity, fatigue, depression, and suicidal ideation
The symptoms of a major depressive episode usually develop over a period of days or weeks.
Sometimes the symptoms develop suddenly secondary to a severe precipitant and the duration of the symptom is variable.
Untreated symptoms may persist for 6 months or they may continue for 2-3 years before they remit.
So, it is very important for caregivers and family members to have a high index of suspicion so that these children can be given full attention and management.