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"Professor, recently my child does not know what is going on, it has become very easy to get angry, very unhappy all day long, I used to find classmates to play ball games, now I am hiding in my room, I don't like to go out, sometimes I see him, I feel always listless, talk to him, I am also impatient, I always complain that my memory has become poor, I am tired and can't lift my energy, I can't sleep at night, I can't concentrate in class, this monthly exam regressed, I think my performance is too bad, sorry for my parents and teachers." Visiting parents said they didn't know what was going on with their children or what was going on, and speculated that it would be too much pressure to do their homework.
If I say, "Your child has adolescent depression," many parents' reaction will be: when the student is very relaxed, we do not give him any pressure, how can we get depression, will it just be a bad mood for something.
Depression and depression are not exactly equal, depression refers to the origin, severity and duration of depressive symptoms beyond the ordinary, and there will be some different manifestations with different ages and different stages of development. Common depressive symptoms can manifest in four main ways:
One. Mood: for example, sadness, depression, unhappiness, depression, emptiness, worry, irritability.
Two. Cognitive: e.g., loss of interest, difficulty concentrating, low self-esteem, negative thinking, inability to decide, guilt, suicidal ideation, auditory hallucinations, delusions, sense of worthlessness, helplessness, and poor memory.
Three. Behavioral aspects: e.g., psychomotor retardation or agitation, crying, social withdrawal, dependence, suicidal behavior.
Four. Physical aspects: for example, sleep disturbances, fatigue, appetite problems, weight loss or increase, pain, gastrointestinal discomfort, decreased libido.
Children before the age of two may also be manifested by symptoms such as nightmares, night terrors, antagonistic behavior, or excessive fear, and school-age children and adolescents may also be characterized by symptoms such as breaking the law, anger, volatile emotions, confrontation, hyperactivity, substance abuse, and sexual behavior. According to the criteria for the diagnosis of depression set out in DSM-IV (a classification of mental illnesses), it is classified as major depressive disorder, low-falling affective disorder, and other unspecified depressive disorders.
A seizure of hyperdepressiveness refers to the simultaneous appearance of five (or more) of the following symptoms over a period of at least two weeks, with a change from the original function; and at least one of the two symptoms of 1 or 2 points should be present.
(1). Depressed mood, almost all day, almost every day. In children and adolescents can be irritable mood.
(2). At all or almost all activities, interests or joys are significantly reduced, almost all day, almost every day.
(3). Significant weight loss, or weight gain, or daily loss or increase in appetite without being on a diet. In children, the inability to increase the expected weight should be considered.
(4). Almost daily insomnia or drowsiness.
(5). Almost daily psychomotor agitation or retardation.
(6). Almost daily fatigue or loss of vitality.
(7) Almost daily feelings of worthlessness, or excessive or inappropriate feelings of guilt (up to the level of delusion).
(8) The ability to think or concentrate on an almost daily basis is reduced, or there is no decisiveness.
(9) Repeated thoughts of death (not just fear of imminent death), repeated suicidal thoughts without a special plan, suicide attempts, or special plans to carry out suicide.
Low-falling affective disorder refers to an almost all-day depressed mood that has more days than non-depressed moods and can be shown by subjective statements or observations by others for at least two years. In children and adolescents, it may be depressed and irritable for at least one year. And when depressed, two or more of the following symptoms occur:
(1). Poor appetite or eating too much.
(2). Insomnia or drowsiness.
(3). Low vitality or fatigue.
(4). Low self-esteem.
(5). Decreased ability to concentrate or difficulty making decisions.
(6). Feeling hopeless.
And in bipolar disorder for two years (one year for children and adolescents), its symptoms never disappeared for more than two months at a time, and there were no major depressive episodes during this period.
There are some self-scales of depression that can be used as a reference for diagnosis, but a definitive diagnosis must be evaluated by a complete interview and some tests to rule out other possibilities, such as thyroid dysfunction, which cannot be diagnosed on the scale alone. Depression should also be diagnosed with bipolar disorder, schizophrenia, attention deficit hyperactivity disorder, oppositional resistance, behavioral norm disorder, substance abuse reaction, maladaptation and other diseases.
There has been increasing evidence of the causes of depression in recent times related to neurotransmitters and dysfunction in the brain. One report shows that under the MRI examination of the brain, depressed young people have a smaller frontal lobe volume ratio and a larger ventricular volume ratio than young people without depression. Another report, in SPET, found that blood flow to the left prefrontal cortex and left temporal cortex in untreated depressed patients was relatively low, and this abnormality could return to normal after treatment. Current medical research proposes the "monoamine hypothesis", there are too few monoamines (such as serotonin) between synapses in the brain, resulting in the manifestation of depressive symptoms, and if the monoamine between synapses can be improved, these symptoms can be improved.
Genetic studies have shown that the prevalence of affective disorder co-occurrence in identical twins is 67%, and the prevalence rate is 19% for fraternal twins, and if identical twins are raised separately, the comorbidity rate drops to 67%, indicating the influence of genes, but not 100%, indicating that other psychosocial mechanisms are affected. Children with depressed parents have been reported to have more affective disorders (Weissman et al., 1984) and parents and other relatives of children with affective disorders have more affective disorders.
In addition, in terms of psychosocial mechanisms, studies have shown that children with affective disorders have more opportunities to be abused or neglected by their affective disorder parents, while other risk factors include depression in both parents, early onset of parental diseases, divorce, separation or the death of one of the parents. Parental marital conflict is associated with maladaptation of the child. And the depression of the mother is more associated with the psychopathy of the child than the depression of the father.
Treatment of adolescent depression can start from the following aspects:
One. Pharmacotherapy: At present, antidepressants with single-line selective serotonin recovery inhibitors are mainly used, and if the effect is not good, single-line non-SSRI antidepressants, tricyclic antidepressants, monoamine oxidase inhibitors or lithium salts are used as a combination. The duration of drug therapy requires further study, and at present it is used at least six months to one year after the complete disappearance of symptoms before a gradual discontinuation is considered.
Two. Psychotherapy: e.g. hypnotherapy, cognitive behavioral therapy (CBT), exposure therapy, Morita therapy, etc.
Three. Family therapy: The goal is first to reconnect the child's relationship with the family, determine the child's safety, and teach parents positive disciplinary attitudes and methods.
Four. Group psychotherapy: For example, interpersonal orientation group counseling, through group activities, children and adolescents learn and practice interpersonal related topics.
As for the prognosis of depression in adolescents, studies have shown a higher risk of becoming adult depression and a higher rate of bipolar disorder later on. Adolescent depression also has a high suicide rate, which is also a danger that requires attention. I hope that with the efforts of many parties, we can make depressed teenagers embrace the sunshine and have hope as soon as possible.
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