SEMINAR ON

CHILDHOOD
DEPRESSION

LUMINA.S
M.SC NURSING
HCON
 STORY OF ALEX
• “Alex, l0-years-old, lives with his mother and
grandmother. His parents separated when he was six.
Alex's teacher reports that he is in danger of failing,
that he becomes preoccupied, often staring out the
window, and seldom finishes his work. Alex has stated
that the other children in the class are much smarter
than he is. He seldom attends Boy Scout meetings or
plays baseball, which he used to enjoy. When he gets
home each afternoon, he watches television and eats
all the cookies he can find. He usually telephones his
mother to make sure she's all right and then goes to
bed until his mother comes home. "I don't have any
reason to stay up; nothing good is going to happen," he
said. “
DEFINITION:
• Depression is a period of intense sad mood and
other physical symptoms that exist nearly everyday
for at least 2 weeks.
• Individual with major depression experience
disturbances in sleep, appetite and weight, energy,
concentration, and physical activity and may
entertain thoughts of death and suicide
PREVALENCE
• 2.2% in children younger than 12 yrs
• 5.6% adolescents 13 to 18 years of age
• 5% of children and adolescents in general
population suffer from depression at any given
time (2% children, 4-8% adolescents)
• Male: Female ratio 1:1 during childhood, 1:2 in
adolescents
• 1.7% of children suffer from dysthymia (1.6-8% in
adolescents)
• Depressive disorders are appearing at a younger
age of onset
• EPIDEMIOLOGY
• Gender difference – girl: boy – 2:1
• Socio economic status: lower socio economic
backgrounds had nearly a twofold increase in
life time risk for major depression compared to
those from high socio economic background
• Age variation: Infants 0.5-3%
• Prepubertal children 1-2%
• Adolescents 3-8%
• Adolescent onset is associated with a strong risk
for reoccurrence in adulthood
• The gender difference in prevalence first appears
in adolescence
• RISK FACTORS
• Biologic
• Family history of depression
• Female sex
• Hormonal changes during puberty
• Low birth weight
• Maternal age younger than 18 years
• Medical illness (e.g., asthma, diabetes mellitus,
migraines)
• Obesity
• Other psychological disorders (e.g., anxiety, learning
disorders)
• Sleep disruptions
Psychological
• Emotional dependence
• History of suicide attempts
• Ineffective coping skills
• Low self-esteem
• Negative body image
• Negative thinking styles (e.g., “Things like this
always happen to me,” “Nothing will ever go as
planned”)
• Self-consciousness
Environmental
• Antisocial peer group
• Decreased physical activity
• Increased parental conflict
• Loss of relationship (e.g., death of family member or friend,
romantic relationship, friendship)
• Low socioeconomic status
• Overeating
• Poor academic performance
• Poor peer relationships
• Substance use
• Traumatic event (e.g., physical or sexual abuse, accident)
Etiology: Theories of Depression
 Psychodynamic: anger turned inward; severe
superego
 Attachment: insecure early attachment
 Behavioral: inability to obtain reinforcement
 Cognitive: depressive mindset
 Self-Control: deficits in self-monitoring, self-
evaluation, and self-reinforcement
 Interpersonal: characteristic to individual, roles
and events
 Socioenvironmental: stressful life circumstances
exacerbate vulnerabilities
 Neurobiological: neurochemical, endocrine, and
receptor abnormalities
Subtypes of depression
• Major depression recurrent
• Major depression single episode
• Major depression with psychotic features
• Major depression with atypical features
• Major depression with seasonal pattern
• Major depression with post partum onset
Symptoms of major depressive episodes – DSM-IV
• 1. Depressed or irritable mood
• 2. Extremely diminished interest or pleasure
• 3. Significant weight loss or weight gain, or
decreased or increased appetite
• 4. Insomnia or hypersomnia
• 5. Agitation or psychomotor retardation
• 6. Fatigue or loss of energy
• 7. Feelings of worthlessness or excessive or
inappropriate guilt
• 8. Diminished ability to think and concentrate, or
indecisiveness
• 9. Recurrent thoughts of death, suicidal ideation,
suicide attempt or plan
Depression symptoms in preschool children
• 1. Pain (headache and stomachache)
• 2. Diminished pleasure in playing and going to
school
• 3. Difficulty in acquiring age-appropriate social
skills
• 4. Anxiety
• 5. Phobias
• 6. Agitation or hyperactivity
• 7. Irritability
• 8. Diminished appetite
• 9. Sleep disorders
Depression symptoms in school age children
1. Sadness, irritability and/or dullness
2. Lack of ability to enjoy himself/herself
3. Sad appearance
4. Easy crying
5. Fatigue
6. Isolation with weak relationship with peers
7. Low self-esteem
8. Diminished or weak school performance
9. Separation anxiety
10. Phobias
11. Death desire or ideation
Depression symptoms in adolescents
1. Irritability and instability
2. Depressed humor
3. Loss of energy
4. Lack of motivation and significant lack of interest
5. Psychomotor retardation
6. Feelings of hopelessness and/or guilt
7. Sleep disorders
8. Isolation
9. Difficulty in concentrating
10. Poor school performance
11. Low self-esteem
12. Suicidal ideas and attempts
13. Severe behavioral problems
• DIAGNOSTIC EVALUATION
• DSM IV CRITERIA: MAJOR DEPRESSIVE EPISODE
• A. Five (or more) of the following present
during same 2-week period and represent
a change from previous functioning; at
least one symptom is either (1) depressed
mood or (2) loss of interest or pleasure
B. The symptoms do not meet criteria for a
Mixed Episode (Mania + Depression)
C. The symptoms cause significant distress
or impairment in social, occupational, or
other important areas of functioning.
D. Symptoms are not due to the direct
effects of a substance (e.g., a drug of
abuse, a medication) or a general medical
condition (e.g., hypothyroidism).
E. Symptoms are not accounted for by
Bereavement; or the bereavement
symptoms persist for longer than 2
months or are characterized by marked
functional impairment, morbid
preoccupation with worthlessness,
suicidal ideation, psychotic symptoms, or
psychomotor retardation
• Dexa methazone suppression test – to
measures of circulating amount of cortisol in
the blood
• The Beck depression inventory
• The Hamilton depression rating scale
• Treatment for depression

Pharmaco
therapy

Nursing
Psycho
manage
therapy
ment

Coping
with Behaviour
depressi therapy
on
Pharmacotherapy
• selective serotonin reuptake inhibitors, or SSRI’s).
– clomipramine (Anafranil)
– flouxetine (Prozac),
– fluvoxamine (Luvox),
– paroxetine (Paxil)
– sertraline (Zoloft).
• Other new anti depressent
– Amoxapine
– Bupropion etc
• Serotonin antagonist reuptake inhibitors
– Nefadozone
– trazodone
• Serotonin nor epinephrine inhibitors
– vemlafaxin
• Tricyclic anti depressant drugs
– Tertiary – amitriptylin
– Doxepine
– Secondary – nortryptylin
– Tricyclic – amoxapine, maprotylin
• Monomine oxidase inhibitors
– Isocarbaxazid
– phenelzine
Behavior therapy:
• The ability to complete task and be attentive
depends on various factors hat apply to both
depressed and manic patient
• Expectation and goals to be small enough to
ensure successful performance, relevant to
their needs and focused on positive activities
Psychological therapy:
• CBT:
– Focused on identifying cognitive distortions
– It also includes psycho education, self
monitoring(eg) diary keeping, enhancing
emotional regulation and activity scheduling
– Plays useful roe in preventing recurrence of
depression after remission and preventing new
onset depressive episodes
Interpersonal psychotherapy:
• For depressed teenagers, Interpersonal therapy
(IPT) is a well-established treatment for depressed
adolescents.
• The focus of IPT is on helping older children and
adolescents understand and address problems in
their relationships with family members and
friends that are assumed to contribute to
depression.
• This approach (which may contain some elements
of CBT) involves what most of us think of when
we hear the term “psychotherapy” as it is usually
conducted in an individual therapy format, where
the therapist works one-on-one with the
child/adolescent and his or her family.
• Family therapy:
• More effective than supportive psycho
therapy in changing aspect of family
interaction such as conflict, that are
associated with onset and perpetuation of
depression
Other therapies:
• Phototherapy
• ECT
• Play therapy
• Psycho education
Coping with depression:
A) what to avoid
B) Creating a balance(neither over responsive or
under responsive)
C) Taking care of self and family members other
than the patient, skills for self preservation
D) Coping with special problem
Nursing diagnosis:
• Impaired verbal communication
• Ineffective coping to situation
• Anticipatory grieving/ dysfunctional grieving
• Hopelessness
• Powerlessness
• Low self esteem
• Disturbed sleep pattern
• Spiritual distress
• Risk for suicide
• Risk for self directed violence
• Anxiety related to surroundings