Study finds even preschoolers can be depressed

Children can and do suffer from depression, however, even very small children can suffer from depression a new study has found. The researchers discovered that preschoolers who suffer from depression are also likely to experience a recurrence of their depressive symptoms throughout childhood.

Most childhood depression studies carried out to date have focussed on school age children of around 6 years old and older. Now, according to this recent study by L. Luby et al, from the Department of Psychiatry, Washington University School of Medicine, even 3 year olds can show signs of suffering from major depression.

The study published in the American Journal of Psychiatry involved around 250 preschool children between the ages of 3 and 5 who were regularly assessed for signs of depression over a period of 6 years.

Of the 74 children diagnosed with depression at the start of the trial, around 50 percent went on to meet the criteria for depression 6 years later compared to only 24 percent of those who were not depressed at the start of the study.

The study also involved evaluating the relationship between the child and their parents/caregivers through two way mirrors and asking the children’s’ parents/caregivers questions on the child’s moods, emotions, playtime activities, and appetite and sleep patterns.

Children whose mother’s suffered from depression were more likely to suffer from depression themselves later on. However, the biggest risk for suffering from depression in childhood was being diagnosed with depression as a preschool child.

“Preschool depression predicted school-age depression over and above any of the other well-established risk factors” Luby said.

“Those children appear to be on a trajectory for depression that’s independent of other psychosocial variables.”

Difficult and Challenging

However, diagnosing depression in very young children is a lot more difficult and challenging than diagnosing depression in older children or adults, mainly because very young children either cannot articulate exactly how they are feeling or they find it difficult to find the words to express themselves accurately. Diagnosing depression is extremely important though because the earlier it is identified the more successful the treatment.

The biggest challenge with childhood depression is really recognising it in the first place. This is because not all children who are suffering from depression appear sad and unhappy and not all children who are sad and unhappy are suffering from depression. The symptoms may also differ depending on the age of the child and whether the child is able to speak or not.

Symptoms of depression in older children

Although it is still challenging diagnosing depression in older children, it is still easier than recognising it in very young children. The following is not an exhaustive list but these symptoms can be an indication of depression.

  • Poor performance at school
  • Self depreciating and feeling unworthy
  • Think they are unlovable and unloved
  • May speak of or be preoccupied with themes of death or dying
  • May intentionally hurt themselves
  • Frequent bouts of unexplained illness
  • Low moods and appears sad most of the time
  • No longer enjoying activities they used to
  • Sensitivity to criticism
  • Anxiety and excessive worrying
  • Emotional outbursts and crying frequently
  • Permanently bored
  • Defiant behaviour
  • Poor conduct
  • Major changes to appetite with weight gain or weight loss
  • Major changes to sleep patterns with sleeping to much or too little

Symptoms of depression in preschool children

This is much more difficult, not just to correctly diagnose depression but also because a lot of mental health professionals don’t acknowledge that depression can exist in a very young child as it still isn’t accepted in mainstream psychiatric circles. According to Luby it definitely does exist although she recognises that it isn’t common at about 1 or 2 percent.

Luby says an exceptionally ‘good’ child may actually be a depressed child as kids as young as this “are not disruptive in their environment” and she described them as “the wheel that’s not squeaky.”

A young child who is suffering from depression may also look sad and generally unhappy and show an inability to enjoy activities that most other preschool children are able to enjoy.

Guilt is another indicator, in that if something goes wrong, the child feels as though they are somehow to blame and it is their fault.

If these sorts of symptoms persist for longer than a week or two, then it is time to seek help says Luby.

Treatment for preschool depression

Medication combined with cognitive therapy is the standard treatment for children and adults suffering from major depression, however, this isn’t the case for very young children. Luby recommends psychotherapy in the form of play therapy and she is currently developing a treatment that will involve parent/child interaction therapy.

Medication is absolutely not the way forward she says as the drugs given to older children haven’t been tested in very young children.

 

TMS for when drugs don’t work

Most people suffering from depression are likely to be offered Antidepressants as a first treatment when they visit their doctor for help. Although this isn’t ideal, sometimes it is the only option available as lengthy waiting lists along with a lack of resources means that other types of therapies such as cognitive therapy might not be immediately available.

Although antidepressants are effective for many, one of the main problems with them is that any relief they do offer, comes with the price of suffering some unpleasant side effects, including nausea, dizziness, sleep disturbances, headaches, loss of libido, agitation, and erectile dysfunction in men.  Another problem is that in some people, antidepressants will have no effect on the symptoms of depression whatsoever. No one really understands why this is the case and it isn’t possible to predict which people will benefit and which won’t.

Now, a new study has highlighted an innovative therapy that is fast gaining recognition as a possible maintenance treatment for major depression in people who either couldn’t tolerate antidepressants or found that the antidepressant drugs didn’t work.

Magnetic pulses

Transcranial magnetic stimulation or TMS as it is known is a treatment involving magnets placed on the head to send magnetic pulses to the parts of the brain responsible for regulating mood.

Neurostar Inc is the company that has come up with Neurostar TMS machine which apparently carries very few, if any, side effects. The most common is a mild headache after treatment.

Pilot Study

In a pilot study carried out by Neurostar, the researchers treated half of the patients with TMS for a period of six weeks and the other half were observed monthly. After the six week period they found that 61.2 percent of those treated with TMS had experienced a remission of depression symptoms and after three months the figure was 62.5 percent compared to 43.8 percent of those who didn’t receive TMS therapy.

“This pilot study supports the notion that maintenance TMS may be useful in the prevention of recurrence of major depression and is an important step in learning what the optimum treatment parameters will be” said Dr. Scott Aaronson, director of Clinical Research Programs and associate medical director at Sheppard Pratt, in a statement.

“This preliminary information will help define an approach to TMS as a maintenance therapy as we extend our understanding of the long-term usefulness of TMS in the treatment of people with this debilitating illness.”

Neurostar Inc revealed the results of their study at the 167th American Psychiatric Association Annual Meeting in New York. According to the company, the treatment is safe.

Unlike ECT (Electroconvulsive therapy) patients do not require sedating prior to treatment. TMS can be carried out in the doctor’s surgery and is typically given daily for a period of four to six weeks.

Effective for more than 50 percent

The results of another study released in May 2014, showed that after one year, more than 50 percent of patients suffering from major depression and treated with Neurostar TMS either had no symptoms of depression or very mild symptoms. After the same period of time the figure is only 38 percent for antidepressants.

Dr Amit Anand from the Center for Behavioural Health at Cleveland Clinic thinks that TMS could be a useful addition to the treatments already available at the Clinic.

“It’s a way to treat depression directly, with few side effects” said Anand, who was not involved in the Neurostar study.

“Other research has shown only a small percentage of people respond to it, but I think if even a quarter of those people respond, it’s a benefit.”

 Expensive

One disadvantage, however, is that TMS is more expensive than drugs, costing between 7,000 and 10,000 dollars. However, if you consider that the treatment isn’t likely to be ongoing in the same way that medication is, then the cost is more viable. Some insurance companies in the US are starting to fund TMS treatment.

TMS in the UK

In the UK and indeed in Europe, TMS is available in very few places. The National Institute for Health and Clinical Excellence (NICE) says that doctors can only offer this treatment in the UK on the NHS as part of a research study.

Conflicting results

Not much is currently known about the way it works and indeed there have been conflicting results as to whether it works as well as some reports have indicated. In one analysis of 11 studies involving 197 people, there was an improvement after two weeks but not after that.  In another analysis of 33 studies involving 877 patients there was no real difference between TMS and a placebo. In yet another study comparing TMS with ECT, 10 out of 20 people having TMS responded to the treatment with 2 of them cured compared to 6 out of 15 having ECT where 3 were cured.

Anything that helps alleviate the symptoms of depression is welcome and TMS could well find its place as a further option, especially where previous treatment has failed.

 

New Study finds Depression is as deadly as smoking

The results of a brand new study carried out by researchers at Oxford University is telling us that mental health problems can be just as deadly as smoking twenty or more cigarettes a day. This is shocking news considering that one in four of us will experience a mental health problem at some point.

Shortened life expectancy

 According to the researchers, people who smoke twenty cigarettes a day shorten their lives by about eight to ten years, and if we compare this to what the Oxford study found, people with recurrent depression have a shortened life expectancy of between seven and eleven years. It’s worse for other types of mental illness. People with Bipolar disorder have a reduction in life expectancy of between nine and twenty years, and between ten to twenty years for Schizophrenia. By far the worst result was for people with drug and alcohol problems; their life expectancy was reduced by up to 24 years.

The report stated that people with mental health problems in the UK have a similar life expectancy to people living in North Korea or Bangladesh. So why is this?

Ineffective Care

Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust suggests that people with mental health problems may not be getting access to the care they need.

“People with mental health problems are among the most vulnerable in society” said Dr Williams.

“This work emphasises how crucial it is that they have access to appropriate health care and advice, which is not always the case. We now have strong evidence that mental illness is just as threatening to life expectancy as other public health threats such as smoking.”

The researchers looked at data from 20 separate studies covering all sorts of mental health problems as well as drug and alcohol abuse. The information came from data on more than 1.7 million people and included approximately 250,000 deaths. This information was then compared to data on heavy smoking.

The author of the Oxford study, Dr Seena Fazel of the Department of Psychiatry at Oxford University explains why there might be a drop in life expectancy.

“There are likely to be many reasons for this. High risk behaviours are common in psychiatric patients, especially drug and alcohol abuse, and they are more likely to die by suicide.”

Dr Fazel also highlighted the need for appropriate care.

“The stigma surrounding mental health may mean people aren’t treated as well for physical health problems when they do go to see a doctor” said Dr Fazel who explained that one problem is the tendency to separate mental illness from physical illness.

“Many causes of mental health problems also have physical consequences and mental illness worsens the prognosis of a range of physical illnesses, especially heart disease, diabetes and cancer. Unfortunately, people with serious mental illnesses may not access healthcare effectively” said Fazel, who also believes that it doesn’t have to be like that.

“All of this can be changed” explained Fazel.

It can be done

“There are effective drug and psychological treatments for mental health problems. We can improve mental health and social care provision. That means making sure people have straightforward access to health care and appropriate jobs and meaningful daytime activities. It’ll be challenging, but it can be done”.

No one would deny that smoking is a huge health problem and that many measures have been put in place by governments and media campaigns to reduce the number of people smoking and that these have been on the whole quite effective. Currently it is estimated that around twenty percent of the population smoke and statistics are starting to show that smoking related deaths are on the decline. However, just under half of the people who smoke have some sort of mental health problem.

The study does show how important it is that professionals pay particular attention to the physical health of people with mental health problems and not to focus on the mental health symptoms alone.

“Psychiatrists have a particular responsibility as doctors to ensure that the physical health of their patients is not neglected” said Dr Fazel.

“De-medicalization of psychiatric services mitigates against that” he added.

“What we do need is for researchers, care providers and governments to make mental health a much higher priority for research and innovation. Smoking is recognised as a huge public health problem. There are effective ways to target smoking, and with political will and funding, rates of smoking-related deaths have started to decline. We now need a similar effort in mental health”.

The study was funded by the Wellcome Trust and has been published in the Journal World Psychiatry.

 

 

Antidepressant Link with Preterm Birth and Autism

According to research published online ahead of print in March 2014, women who take antidepressants during pregnancy are more likely to deliver their babies prematurely than women who don’t take them.

Increased fourfold

Lead author of the study Krista Huybrechts, MS PhD from the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital and Harvard Medical School said the number of women using antidepressants whilst pregnant has increased over the past twenty years.

“Preterm birth is a major clinical problem throughout the world and rates have been increasing over the past two decades. At the same time, rates of antidepressant use during pregnancy have increased approximately four-fold,” said Dr Huybrechts.

41 papers studied

According to senior Author Dr Adam Urato, they found a link between antidepressants and preterm birth.

“We studied 41 papers on this topic and found that the available scientific evidence is becoming clearer that antidepressant use in pregnancy is associated with preterm birth”.

Could depression be the culprit?

Apparently not!

“The complication of preterm birth does not appear to be due to the maternal depression, but rather it appears likely to be a medication effect” said Dr Urato.

SSRIs and autism link

A study by John Hopkins Bloomberg School of Public Health revealed that when antidepressants called SSRIs are taken during pregnancy, there is a higher risk of autism and developmental delays.

SSRI’s or Selective Serotonin Reuptake Inhibitors work by increasing the levels of Serotonin (a feel good hormone) in the brain by inhibiting the mechanisms that naturally absorbs serotonin.

The autism link, which was published in the online Journal Pediatrics, involved researchers looking at almost 1,000 children, most of them boys, who had Autism and developmental delays and also children with typical development.

Boys affected more

 The researchers found gender differences in the effect of prenatal exposure to anti depressants with boys being more likely to be affected than girls.

“We found prenatal SSRI exposure was almost three times as likely in boys with autism spectrum disorders relative to typical development, with the greatest risk when exposure is during the first trimester,” said study co-author Li-Ching Lee, an associate scientist in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, in Baltimore.

Should women stop taking their meds?

No, say some experts, as the risks are low and it’s important to treat depression in pregnant women. Others aren’t so sure. Although medication may be the only option for severe depression, other safer alternatives may be a better option for milder cases.

What about whilst breastfeeding?

Research presented at the 18th Perinatal Society of Australia and New Zealand annual conference in Perth, explained that women are more likely to continue breastfeeding if they continue taking their antidepressants.

Research carried out by Adelaide University found that 67 percent of women stopped taking antidepressants before becoming pregnant or when they started to breastfeed. The remaining 33 percent continued to take their antidepressant medication throughout pregnancy and while breastfeeding and they breastfed for longer.

“These women were much more successful at maintaining breastfeeding up to and beyond the recommended 6 months” explained Dr Luke Grzeskowiak who led the research.

Dr Grzeskowiak and his colleagues maintain that women should be supported and encouraged by health care providers, as well as family and friends to continue with their medication.

Conflicting information

Unfortunately there isn’t an exact science to weigh up the benefits of taking antidepressant medication during pregnancy and whilst breastfeeding, against the risks to the baby.  Of the numerous studies carried out, many carry conflicting results leaving women and even some doctors unsure of whether medication is really safe.

According to a research study by Filomina Fortinguerra et al and published in Pediatrics in October 2009, the main concern about taking SSRIs whilst breastfeeding, is whether long term exposure may have long term neurobehavioural effects as most of the studies carried out so far have been short term studies.

This research report also said that Fluoxetine (Prozac) was contraindicated whilst breastfeeding. However, another research study by Professor Louis Appleby et al and published in the British Medical Journal found Prozac to be an effective treatment for women with Post Natal Depression.

Just to confuse the matter even more, NICE (National Institute for Health and Care Excellence) advises that Prozac is not recommended whilst breasting unless a woman has already been taking it without any problems during pregnancy.

Best for baby

The most important thing for anyone suffering from depression or considering medication options whilst pregnant or breastfeeding is to discuss their case and all their symptoms with a qualified health care provider. Some women with severe depression will almost certainly need to take medication to keep their depression under control and in these cases this would be in the best interests of the baby too.

However, for many, particularly those with mild depression, it may be that with support and possibly alternative treatments like psychotherapy or natural remedies that the depression is completely manageable without antidepressants and this would be ideally be the best option for baby.

 

Issues Surrounding Infant, Child and Youth Mental Health Problems

First of all, mental health problems can affect anyone of any age, even young children. Indeed, around 10 percent of children between the ages of 5 and 16 have a mental health problem according to the Office of National Statistics and around 4 percent are suffering from some form of anxiety and stress.

One of the main difficulties surrounding infant, child and youth mental health problems is that it can be more difficult to diagnose a mental health problem in a younger person. There are several reasons for this but the main ones are that younger people, particularly very young children, can have difficulty expressing their feelings and are not as able to tell us exactly what’s going on in their minds. Another reason that diagnosing mental health problems in younger people is difficult is because the symptoms can quite often be attributed to something else and not to a mental health problem.

For example, it is perfectly normal for teenagers to go through a period of turmoil; we can all understand that, however, differentiating between what is a normal part of growing up and what could be a mental health problem is not so straightforward.

So what are the main symptoms of mental health problems in children and young adults and how can you recognise them?

The signs and symptoms of a mental health problem in children and young adults are similar to the mental health symptoms displayed in older adults.

  • - Persistent sadness and melancholy
  • - Vague aches and pains with no obvious physical cause
  • - Performing badly in school (or work related problems in the case of adults)
  • - Having low self esteem and confidence
  • - Losing interest in activities they used to enjoy
  • - Changes in eating patterns leading to weight loss or weight gain
  • - Disrupted sleeping patterns where the young person finds it difficult to go to sleep or is sleeping too much
  • - Outbursts of anger and emotion
  • - Showing excessive fearfulness, clinginess and insecurity
  • - Becoming overly concerned about how they look
  • - Avoidance of social activities and social contact
  • - Constant fidgeting, agitation and restlessness
  • - Poor concentration
  • - Displaying obsessive behaviour
  • - Acting in a destructive manner
  • - Inability to follow simple instructions and carry out tasks

An older child may also express feelings of being out of control of their lives, show disorganised behaviour, experience delusions or hallucinations, or indulge in drugs or alcohol or may even talk about suicide.

If you have the slightest doubt that your child is suffering from a mental health problem of any sort then don’t delay, speak to your doctor who will be able to advise you or if necessary refer you to a more specialised professional.