Childhood Depression

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Dysphoria

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a state of prolonged bouts of sadness

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Anhedonia

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feel little joy in anything they do and lose interest in nearly all activities

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Mania

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abnormally elevated or expansive mood

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Euphoria

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exaggerated sense of well-being

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Bipolar D/O (BP)

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an ongoing combination of extreme highs and extreme lows

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Overview of Mood Disorders

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- children with mood d/o suffer from extreme, persistent, or poorly regulated emotional states- for example, excessive unhappiness or swings in mood from deep sadness to high elation
- Mood d/o are common and among the most persistent and disabling illnesses in young people
- There are two major types of mood d/o: depressive disorders and bipolar disorder

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Major Depressive Disorder (MDD)

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- has a minimum duration of 2 weeks and is associated with: depressed mood, loss of interest, other symptoms, and a significant impairment in functioning

Hint 7

Five or more of the following with at least one being 1 or 2:
1) depressed mood
2) markedly diminished interest/anhedonia
3) significant weight loss or weight gain
4) insomnia or hypersomnia
5) psychomotor agitation or retardation
6) fatigue
7) feelings of worthlessness or excessive/inappropriate guilt
8) diminished ability to think or concentrate
9) recurrent thoughts of death or suicidal ideatioin

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Dysthymic Disorder

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- has a longer duration (1 year) and less severity of symptoms associated with MDD

Hint 8

depressed mood for most of the day on most days for at least 1 year
Presence of 2+ of the following:
- poor appetite or overeating
- insomnia or hypersomnia
- low energy or fatigue
- low self esteem
- poor concentration or difficulty making decisions
- feelings of hopelessness

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Overview of Depression

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- Depression in young people involves numerous and persistent symptoms, including impairments in mood, behavior, attitudes, thinking, and physical functioning
- For a long time, it was mistakenly believed that depression didn't exist in children in a form comparable to depression in adults
- it is now known that depression in young people is prevalent, disabling, and often under-referred.
- The way in which children express and experience depression changes with age
- It is important to distinguish between depression as a symptom, syndrome, and disorder
- Depressive d/o come in two types: MDD and dysthymic

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Overview of MDD

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- The key features of MDD are: sadness, loss of interest or pleasure in nearly all activities, irritability, plus many specific symptoms that are present for a duration of at least 2 weeks
- The overall prevelence of MDD for 4-18 is 2-8%, with rates that are low during childhood but increasing dramatically during adolescence
- The most frequent accompanying d/o in youngsters with depression are: anxiety d/o, dysthymia, conduct problems, ADHD and substance use
- Almost all youngsters recover from their first depressive episode; but about 70% have another episode w/in 5 years and many develop bipolar d/o
- Depression in preadolescent children is equally common in boys and girls; but, the ratio of girls to boys is about 2:1 to 3:1 after puberty
- the relationships among depression and race and ethnicity during childhood is an uderstudied area

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Double Depression

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where a major depressive episode is superimposed on the child's previous dysthymia, causing the child to present with both d/o

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Overview of DD

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- children w/ DD display depressive symptoms on most days for >1year
- about 5% of children and adolescents have an episode of dysthymia by the end of adolescence
- the most common accompaning d/o w/ DD are: sumperimposed MDD, anxiety d/o, CD, and ADHD
- the most common age of onset for DD is 11-12 w/ an average episode length of 2-5years
- almost all youngsters eventually recover from DD, but many develop MDD
- children who recover from DD differ mainly from other children on measures of psychosocial functioning

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Overview of Associated Characteristics of Depressive D/o

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- youngsters w/ depression have normal intelligence, although certain symptoms (i.e. difficulty concentrating, loss of interest, slowness of thought) may negatively affect intellectual functioning
- perform more poorly in school, score lower on standardized achievement tests, and have lower levels of grade attainment
- often experience deficits and distortions in their thinking, including negative beliefs, attributions of failure, and self critical automatic negative thoughts
- almost all youngsters with depression experience low or unstable self-esteem
- have few friends and close relationships, feel lonely and isolated and feel that others dont like them
- they experience poor relations and conflict with their parents and siblings who in turn may respond in a negative, dismissing, or harsh manner
- most report suicidal thinking and 16-30% attempt

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Psychodynamic Theory of Depression

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introjection of the lost object; anger turned inward; excessive severity of the superego; loss of self esteem

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Attachment Theory of Depression

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insecure early attachments; distorted internal working models of self and others

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Behavioral Theory of Depression

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Lack or loss of reinforcement or quality of reinforcement; defecits in skills needed to obtain reinforcement

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Cognitive Theory of Depression

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Depressive mindset; distorted or maladaptive cognitive structurs, processes, and products; negative view of self, world, and future; moor problem solving ability; hopelessness