Loss of appetite, insomnia, irritation...We need to focus more on treatment than on parents' guilt
Dec 29, 2024
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Along with Professor Kim Jae-won of the Department of Pediatric Psychiatry at Seoul National University Children's Hospital, we summarized 'Depression', which should not be passed on to simple emotional exhaustion, and the cause and treatment method.
- What is pediatric depression?
▶Depression is a psychiatric disease that has depression and decreased motivation as the main symptoms, accompanies various cognitive, mental, and physical symptoms, and reduces daily function. When this condition occurs in children and adolescents, it is called childhood depression. 60% of childhood depression is environmental factors (academic stress, family and colleagues), and the remaining 40% is genetic.
The incidence of childhood depression in Korea is gradually increasing. According to the National Health Insurance Service, the number of depressive treatments for children (6 to 11 years old) increased by 92% over the five years from 2018 to 2022, and adolescents (12 to 17 years old) increased by 57%. This increase is attributed to the fact that children and adolescents in Korea are exposed to a lot of stress from an early age.
- Risk factors for childhood depression?
▶ Difficulties in peer relations are cited first. Conflict with friends or school violence is an important risk factor for childhood depression, so peer relationships should be maintained well. Even if you have problems with other peer relationships, making and maintaining one or two good friends who you have been constantly interacting with since childhood can help relieve stress.
In addition, when children use SNS, they are often exposed to false information that increases the risk of depression, self-harm, and suicide. Therefore, I think it would be more helpful not to use SNS during childhood and adolescence. In fact, in foreign countries, online child protection laws, including age restrictions, are in effect one after another.
In addition, childhood obesity is another disease that has recently increased incidence. Although the causal relationship has not yet been proven, various studies have shown that childhood obesity and childhood depression affect each other. Both diseases can be said to be important in that they require active prevention.
- What are the symptoms and diagnostic methods of childhood depression?
Similar to adult depression, childhood depression is accompanied by decreased appetite, insomnia, and decreased concentration. In particular, there are many children who complain that they cannot concentrate on studying or lose interest or motivation for previously enjoyed activities. Children who are not aware of depression may experience irritation or sensitivity instead of depression. In addition, unlike adults, childhood depression can be accompanied by attention deficit behavioral disorder (ADHD), behavioral disorder, and anxiety disorder, so systematic diagnosis is important.
Sometimes adolescence and depressive symptoms are confused. Emotional mood swings that often occur during puberty are a natural phenomenon, but emotional changes caused by depression continue to interfere with daily life and are symptoms that require treatment. In particular, in order to diagnose depression, depression or hypersensitivity lasts for more than two weeks, and at least four of the warning symptoms of depression must appear.
To distinguish between puberty and depression, it is necessary to watch the child's changes with interest. For example, if a child who studied well until elementary school is suddenly sluggish in his studies since middle school, the first problem parents are worried about is ADHD, which is likely to be a decrease in concentration accompanied by childhood depression.
Seoul National University Children's Hospital systematically diagnoses childhood depression using 'DSM~5 (American Psychiatric Association Evaluation Criteria)' and 'CDRS~R (Children's Depression Severity Evaluation Tool).' In addition, to diagnose psychiatric diseases other than depression 'K~The interview tool 'SADS' is used.
- How to treat childhood depression?
If left unattended, pediatric depression can develop into chronic depression that affects adults, so accurate diagnosis and treatment are important. As a result of the CDRS~R evaluation, if the score is milder than 40, psychological treatment is performed first, and if the score is more than 40 (moderate or higher), antidepressant treatment is performed.
First, antidepressant treatment is performed.
About 60% of patients respond to antidepressant treatment. In general, the response is assessed at 8 to 12 weeks of the start of treatment and determined whether to continue. The treatment response is based on whether the symptoms evaluated by CDRS~R have decreased by more than 50%, and if there is a response, the treatment will continue for about six months at the same dose, and gradually reduce the dose with the aim of stopping treatment. If there is no response, the type of drug is changed and cognitive behavioral therapy is performed at the same time.
If you take antidepressants for a long time, you are very concerned about the increase in suicidal thoughts as a side effect. However, studies have shown that suicidal thoughts from long-term use do not increase statistically significantly, and the benefits of antidepressant treatment are much greater.
Other treatments may be combined with 'play therapy' or 'emotional regulation training'.
This is because children and adolescents are often immature in their ability to express or control emotions.
However, since the role of guardians participating in treatment is very important, 'family treatment' is sometimes performed together.
In children with childhood depression with physical illness, it is important to maintain physical health to endure the treatment process. To help this, 'behavioral activation therapy' can be implemented to plan and practice exercise or hobbies that can be enjoyed alone.
There are two important factors in the treatment of childhood depression, the first being suicide prevention. This is because even minor depression, which is not severe, can increase the risk of self-harm or suicide. The second is parental help and support. In particular, guardians need to study depression so that they can understand the child well, and they need a posture to support the child without getting tired in the long treatment process.
- How to prevent childhood depression?
The most important preventive rule for childhood depression is to create a healthy environment for the mind and body. Instead of playing games or cell phones, it is important to provide time and space for rest through sound physical activity to prevent depression. However, it is difficult for children to secure enough leisure time in the current educational environment in Korea. Therefore, it is necessary for parents to step up and provide their children with a chance to breathe.
Regular screening is also important for early detection and prevention. In the United States, a depression screening test is recommended once a year for adolescents aged 12 to 18. On the other hand, in Korea, emotional behavior characteristics tests are conducted for first and fourth graders in elementary school, first graders in middle school, and first graders in high school, but regular tests are insufficient. Therefore, it is recommended to perform regular tests every year through evaluation tools such as depression tests (PHQ~9) that can be performed at home.
Professor Kim Jae-won said, `Children and parents who suffer from childhood depression often feel guilty that this situation was caused by their fault. However, depression is a disease that can occur in anyone, so it is necessary to focus on the present and the future rather than trying to find the cause"It is most important not to blame yourself, but to work together for your child's recovery and a healthy future."
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This article was translated by Naver AI translator.
