Anxious times: Fear, confusion can mark a child's descent into depression
By Christina Hennessy, Greenwich Time.com
09/23/2008

Looking back, LeAnn realizes her daughter left a trail of evidence, signs that she was slipping away.

"But it was so gradual, I did not notice it was happening," she says of her daughter depression.

LeAnn is not her real name. She is an area resident who has agreed to talk about her daughter's mental illness on the condition that her identity not be revealed. All the people who offered to share their stories requested the same courtesy. They say while the stigma of mental illness has eased, it can be a barrier to gaining employment and keeping a job. Publicizing a person's name also can cause setbacks for those who are fearful about letting others know about their conditions.

LeAnn says her 30-year-old daughter is still under tremendous pressure, even though it has been more than 15 years since she was diagnosed. While therapy and medication have eased the situation, she says there is always a fear that it will reassert itself.

"It may happen because of a trigger or a recurring problem through their life," LeAnn says. "It is a chronic issue."

Her daughter was diagnosed with attention deficit disorder in sixth grade. It took another three or four years before they learned it was depression.

"She never seemed to want to do anything," LeAnn says. "She isolated herself more and more. She just had a lack of interest, a lack of joy about anything in her life."

However, it was difficult for LeAnn to assess whether it was the normal behavioral changes a teenager goes through or something deeper. "A lot of teenage girls keep things so close to themselves, you wouldn't know about it if you ran it over with a truck."
With vigilance, LeAnn was able to see that this was not a fad. It was a genuine health issue that needed medical attention. However, she understands the fine line parents bridge every day, trying to make an accurate assessment of their children's behavior, since most of the time it is a gradual shift rather than a marked change. "Sometimes you don't see the changes because you see this person every day."

Watching for signs
This guessing game often leaves parents bewildered and anxious themselves, as they attempt to seek a cause for their child's change in behavior. Experts say even though mental health professionals once theorized that children could not become depressed or anxious, at least 60 years of research and study have revealed that children younger than 10 can exhibit symptoms of such disorders. This has led to a number of resources and services to help parents give their children the care and attention needed to live better, more productive lives.

It is estimated that one out of every 33 children may have depression, according to the federal Substance Abuse and Mental Health Services Administration. Further, anxiety disorders - anything from generalized anxiety to specific phobias and obsessive-compulsive disorders - affect 13 of every 100 children ages 9-17. Girls are often more affected by anxiety issues than boys. About half of the children and teens with anxiety have another mental disorder, such as depression.

"Depression is often introduced by anxiety," says Dr. Simon Epstein, a Stamford psychiatrist who has been the associate medical director at the Child Guidance Center of Southern Connecticut Inc. in Stamford for more than 40 years.

Whether seeing a child, young teen or an adult, Epstein says mental health professionals always delve deeper to get to the underlying problems, and often they find the patient is suffering from depression.

Some young people may face even bigger dangers. Epstein says parents must be particularly vigilant if their children express suicidal thoughts. Even an inkling of a threat should be addressed and treated immediately, he says, noting that there are many area professionals who work diligently to prevent suicide.

"It can be hard for a parent," he says. "A child does not say, 'I'm depressed.' "

In addition, as children reach 9, 10, 11 and older, they begin to enter the often difficult time of puberty, increased school demands and a desire to explore their independence, all of which makes it difficult for a parent to assess natural changes as compared with those that can occur with the onset of mental illness. But there are always signs, he says.

"You look to see if they have lost their enthusiasm, if they have lost an interest in the things they love," he says. "It is a lack of joy, a lack of pleasure in the things they once found pleasurable."

He says this goes beyond the idea that a child will simply "snap out" of the behavior. "This is not something you can talk yourself out of."

Hereditary link
In Kelly's case, she says her son began showing signs of mental illness when he was a small child - temper tantrums, anxiety, refusing to go to school and other behaviors.

"I bought every parenting book out there, but nothing seemed to apply," she says. By the time she brought him to school, his anxiety and acting out had increased. "It was just a disaster and it only got worse."

She says a school social worker suggested that he get a psychiatric evaluation. At 9, he was diagnosed with general anxiety disorder. Her eldest daughter, who had shown signs of moodiness and anger and had expressed suicidal thoughts, was diagnosed with major depressive disorder at about 12. They are both now in their mid- to late teens.

Kelly cites a mixture of genetics and environmental influence when it comes to explaining her children's conditions.

"I think I have had low-grade depression all my life," she says. "I wasn't diagnosed, however, until I had my son."

Charles P. Alexander, a staff psychiatrist at Hall-Brooke Behavioral Health Services in Westport, says heredity is often a factor with depression, though environment and traumatic events also can have a significant impact.

Particularly in the younger ages, he says an outside event usually brings on the disorder, perhaps triggering a genetic predisposition. At other times, it is hard to decipher why a condition has developed. He says it can be difficult to diagnose a child because most of the attention and research focuses on adult diseases.

"I know it may surprise you that there is no machine that provides the answer," he says. "There is nothing like that in psychiatry."

Instead, medical professionals go to their manuals, review the list of symptoms, then make a diagnosis, even if the symptoms are more geared to adults.

"Our diagnostic tools need to evolve and improve a little bit," he says.

Treatment has evolved
Still, for someone like Abby, who has coped with bipolar disorder for more than 40 years, the fact that there is more research and study into early childhood diseases is a marked improvement from when she was younger.

Initially diagnosed with depression at 8, it wasn't until 1997, when she was in her 40s, that she was told she had bipolar disorder. Marked by swings of highs and lows, she suffers from racing thoughts, insomnia (sometimes being unable to sleep for more than five days) and debilitating depression that makes it hard for her to get out of bed.

Abby believes she began exhibiting signs before she was first diagnosed. As to the cause of her illness, she says she believes it was brought on by molestation at a young age by people she knew. She suppressed the memory, recovered many years later, and in turn developed a rage. "I had a temper to beat the band."

Initially, she was put on tricyclides, a class of antidepressant drugs, "which were probably the least invasive," she says.

It really wasn't until the late '50s and early '60s that medicine was prescribed to children as part of a treatment for mental illness. Epstein says that wasn't always successful and it wasn't until the late 1980s, with the arrival of Prozac and later Zoloft, that medical professionals began to see results with a mix of medication and therapy with younger patients.

Prozac and other drugs that help to increase the brain's supply of serotonin may help balance the chemistry in the brain and ultimately control the symptoms of depression and some anxiety disorders.

Still, prescribing antidepressants to children and teens is controversial. And Epstein and Alexander say the decision should not be taken lightly, noting it should always be in conjunction with therapy. Previous studies have suggested that antidepressants can increase the risk of suicidal behavior in young adults. However, untreated depression is a risk factor for suicide, too.

Balancing act
For Kelly and her children (she also has a younger child who so far has not exhibited signs of mental illness) it has been a constant struggle to find the right mix of treatment. Both teens have been hospitalized over the years and have attended different school programs. They appear to be achieving some balance and normalcy in their lives, but the path has not been easy and will likely remain difficult, Kelly says.

For Abby, who takes Lamictal, it also has been a lifetime of finding the right mix of therapy treatments and medication. Even the treatment has improved, she says, further easing her anxieties. She recalls being treated in the psychiatric ward of an area hospital, where patients were kept in locked rooms.

She says the stigma is easing, but those suffering from mental illness still often feel "broken, damaged and ashamed." She says she finally had to feel compassion for herself.

"I have an illness, so do a lot of other people, emotional and physical," she says. "That doesn't mean I am a second-class citizen. I am entitled to have a life."

She encouraged those coping with mental illness to find things that make them feel safe and give them pleasure. Abby records her thoughts in a journal, something she has done since she was a girl.

"Go to a bookstore, take a walk, talk to friends," she says, adding that by recognizing her triggers she is often able to head them off.

"The message I'd like to send is that this is not a death sentence," she says. "I have an illness, but the illness doesn't have me."

The experts and women interviewed say parents who are worried about their child's behavior should talk with their pediatrician, or a social worker or guidance counselor at school.

Epstein says the risk of staying silent is that someone who could have been treated may go through many years of unnecessary suffering.

LeAnn is grateful that she was able to get her daughter the help she needed, but knows that even the best parent does not always see the signs.

Her advice: "Follow your intuition. ... You know your child better than anyone else.

"The human spirit is remarkably robust," she says. "You can't let go of the fact that it is resilient. Never, ever let go of hope. You just can't."

Reading the signs
Children and teenagers who may be suffering from depression and anxiety often show certain symptoms and behaviors. Here is a list of some of them:

  • Feign sickness or develop physical ailments for which there are no causes.
  • Develop feelings of helplessness and hopelessness.
  • Evidence a major change in eating or sleeping habits.
  • Exhibit increased irritability or a bad temper. They can become easily annoyed.
  • Experience a change in personality or behavior.
  • Lose interest in activities that once brought them pleasure.
  • Become withdrawn and isolate themselves from others.
  • Express fearful or anxious behavior.
  • Exhibit a marked loss of energy.
  • Exhibit an unending sadness.

What parents can do:

  • Keep a record of your child's developmental history, emotional and physical, over the years. It should reflect his or her behavior at home, in the community and at school.
  • Seek counsel from a trusted adviser, whether it be a family physician or school social worker or guidance counselor.
  • Talk to your child. Experts and those who have mental illness say rather than approaching the change as a problem, suggest that you want to work with them so they can get back to enjoying those things that once brought them happiness.
  • Visit the National Mental Health Information Center at SAMHSA's National Mental Health Information Center or the American Academy of Child & Adolescent Psychiatry at American Academy of Child & Adolescent Psychiatry.

Help is out there
National Alliance on Mental Illness is a grass-roots group that was founded in 1979 by families affected by mental illness who sought to learn from and support one another.

The group's Connecticut affiliate has a number of local chapters, including one for Stamford and Greenwich, which provides free services, including support groups, resources, education and advocacy. Through these efforts, it is hoped that the lives of people living with mental illness will be improved, according to Peter Case, the executive director.

"In a lot of cases, they have already seen a doctor and the onset of the disease has already started. The symptoms are already there," he says of those who call the affiliate. "They have been dealing with it for some time and they are at their wit's end and need some other folks to talk to."

The current programs include family support groups, which are open to any family member, caregiver or friend of a person with mental illness. Case says participants share stories and practical information about resources. They are held at the Tully Health Center in Stamford on the first Wednesday of the month. There also are meetings at Silver Hill Hospital in New Canaan on other days of the month.

Another program, "In Our Own Voices," attempts to lessen the stigma of mental illness by offering personal testimonials from people who live with their mental illness; and NAMI Basics, a program for parents and caregivers of children and adolescents who have a mental illness.

The affiliate also runs a Family to Family educational program - a free, 12-week course with a NAMI-developed curriculum. The current session is under way, but the group expects to offer it again in the spring. It requires pre-registration.

"There is never a reason to give up hope," Case says.

Visit NAMI Stamford Greenwich or call 388-1603.