Holistic Management of Depression in Children and Adolescents
"Self-esteem is as important to our well-being as legs are to a table. It is essential for physical and mental health and for happiness." - Louise Hart
Holistic management of depression in children and adolescents can be achieved through psychotherapy, good nutrition, proper sleep, exercise, and creativity.
It’s surprising but true – up to 8.9 percent of children and adolescents suffer from childhood depression and 80 percent of childhood depressions continue into adulthood.
Just as in adult depression, depression in children and adolescents are characterized by negative thoughts regarding themselves, others, and the future. This is associated with the feelings of powerlessness and low self esteem.
How will you recognize depressive symptoms in children and adolescents?
- Toddlers – loss of appetite, sleeping problems, failure to thrive, stomach pain or developmental disorders for which no organic cause can be established. These children become passive and apathetic after initial screaming and crying.
- Pre-school children – reduced psychomotor activity, listlessness, mood swings, aggressiveness and irritability.
- School age children – sadness, fear of failure, guilt or ideas of guilt, anxiety, withdrawal from social contacts, and sometimes suicidal ideation.
- Adolescents –underachievement or performance problems, fear for the future, low self esteem, withdrawal, loss of drive and interests; sometimes, violent temper, histrionic behavior and low tolerance and even suicidal tendencies can manifest.
The cause of depression in children and adolescents can be attributed to:
- Loss of a parent or both parents
- Dysfunctional interaction between parents and children
- Relationship problems between the parents
- Divorce of parents
- Single parenthood
- Deprivation or long -term separation in the first year of life
- Low social status
- Migration
- Lack of friends and attention
- Insufficient or excessive demands at school or change in school
- Learning disorders
Psychosocial treatment is the main therapy for mild or moderate depression in children and adolescents. Severe depression would, however, require drug intervention. Parents are given advice with regard to more sensitive style of upbringing and also on how to eliminate stress factors in their child.
Psychotherapy looks at modifying negative thought patterns and increasing self confidence and self esteem. Psychotherapy also helps children and adolescents with depression reduce stress factors, increase positive activities, and learn problem solving strategies.
Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) are commonly used psychotherapies for children and adolescents. The National Institute for Mental Health (NIMH) conducted a clinical trial for adolescents with major depression to compare CBT with Prozac. Prozac is the only anti-depressant approved by FDA for use in children and adolescents. The clinical trial found that at 12 weeks the combination of Prozac with CBT was the most effective treatment.
Apart from psychological treatment, holistic management of depression in children and adolescents includes:
- Eating balanced and wholesome diet – Junk food is a strict no-no for children with depression. Vitamin E and C, coenzyme Q10 and alpha lipoic acid are anti-oxidants that are not found in junk food. Nor do omega-3 fatty acids, zinc and selenium. These are vitamins and supplements that help in brain development and proper functioning of the brain. And these are found in fresh fruits and vegetables, whole grains, nuts, yogurt, home - cooked chicken and fish. Small proportions of each of these foods constitute the balanced diet for children and adolescents with depression.
- Getting sufficient sleep – There is a strong association between depression and sleep problems. Depression may cause insomnia in children and adolescents, on the other hand, children with depression who have insomnia are more likely to have longer - lasting depression. A study shows that among adolescents who are depressed, 73 percent reported not sleeping enough at night. [21] Addressing sleep problems is crucial to recovery from depression. Light therapy may be one of the options for treating insomnia in children and adolescents with depression. It may involve exposure to light from the sun or treatment with a light box. Light therapy is considered safe for children and adolescents. However, evidence to support its effectiveness is limited.
- Exercising and outdoor activities – A brain chemical, phenylethylamine, is produced naturally by the body and is known for its depression- relieving action. This chemical is low in children and adolescents suffering from depression. Studies have shown that exercise raises phenylethylamine levels and helps reduce episodes of depression. This has been confirmed by a Cochrane review which suggested that although there wasn’t sufficient evidence to draw conclusions, exercise was found to be effective in reducing depression and anxiety in children and adolescents. The intensity of exercise, whether high of low, makes little difference. [22] The child may not be interested in the forms of exercise such as treadmill or walking. Dance, yoga, gymnastics, kickboxing, martial arts or any form of outdoor sports and games could be a good start. Moreover, getting out and playing with other children may open up his social blocks and help improve depressive symptoms.
- Getting creative – A creative outlet for children and adolescents with depression can turn negative thoughts into positive ones. Art, poems, cartoons and all other creative forms can be a place to explore their inner selves. Many psychologists feel that depression can be fought by focusing on what makes a person unique. This could be art, poetry, music, or any other hobby. As a parent, encourage your child to take up some form of creative art.
