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Chapter 8
Depression and Other Mood Disorders
Diane Shea, Ph.D.
Holy Family University
History of thinking about depression
• Once thought to only to be strictly an adult
disorder
• Children once considered naturally happy.
– But vulnerable to depression under adverse
genetic and environmental conditions
– Prepubescent depression sufferers rarely suffer
become suicidal
Awareness of childhood depression
• Primary care physicians began to realize that
children could be clinically depressed
• Children’s rights to mental health treatment,
including relief from anxiety and depression,
received increased public recognition
• Research on genetics of emotional disorders
flourished
• Many reliable measures of depression became
available
Types of Mood Disorders
• Major Depressive Episode – may follow
identifiable loss or severe stress, but doesn’t
have to be an obvious preceding event
• Major Depressive Disorder – diagnosed
when two or more major depressive
episodes
• Bipolar Disorder – (manic depressive
disorder) person switches between normal
mood, depressive moods and hyper excited
manic moods
– Manic episodes – inexplicable exhilaration,
tireless activity, sleeplessness, talkativeness,
impulsiveness
– Usually appears in early adulthood
– Rare in childhood
• Minor Depression – (subclinical depression)
– Person feels and appears depressed but doesn’t
meet all diagnostic criteria for major depression
– Typically occurs after stressful events and
usually fades
• Dysthymic disorder – (dysthymia)
persistent mild depression that interferes
with functioning or causes person
significant stress over an extended period
– Can begin in early childhood
– Can develop into more serious depression
Prevalence of Depression
• “Common Cold” of psychiatric illnesses
• Diagnosable depression much less frequent
in children than adults
– Very rare before 6
– Rates gradually climb during childhood
– Rates climb rapidly in adolescence
• Teenagers more likely to experience other
psychological disorders with depression.
Other disorders can mask depression
– Disorders occurring together tend to be more
severe
Age Differences in Depressive
Symptoms
• No separate category for childhood
depression in DSM-IV-TR
• Children don’t know what it is and are
unable to report feelings of depression to
adults
• More likely to express their depression
through somatic or physical complaints
Sex Differences and Depression Rates
• Twice as many women as men suffer from major
depression
• Sex differences in childhood depression not
apparent
• Girls depression rates increase dramatically during
puberty, but boys’ do not
• Boys generally welcome signs of physical
maturation; girls experience more conflict
about their changing bodies
• Differences in coping – Boys expected to
overcome stress on their own – Girls are
expected to need more comforting
Risk Factors for Mood Disorders
• Adverse Family Environments
– Parents own mental health, not able to to
provide adequate emotional support, model
depressive behavior
– Family violence
• Children’s Contributions
– Some infants temperamentally negative and are
management challenge for mothers. Can
undermine parents’ ability to be good caretakers
– When a teen experiences one major depressive
episode (after a romantic break-up for example)
more likely to have recurrence when faced with
even less severe stress in future
Major Theories of Depression
Theory
Predisposing Event
Precipitating Event
Psychoanalytic
Constitutional over reliance on Real or imagined loss or
oral stimulation
rejection
Attachment theory
Attachment insecurity, early
loss
Major loss or rejection
Beck’s Cognitive
theory
Early rejection, loss, or failure
Major loss or
disappointment
Learned
helplessness theory
Unavoidable pain or failure
Major loss or traumatic
event
Social cognitive
theory
Overly demanding parents,
inadequate coping
Threat to self-efficacy
Reinforcement-loss
model
No necessary predisposition
Massive reduction in
reinforcement
Biological Basis of Depression: Genetic, Brain
and Biochemical Functions
• Much research suggests a substantial
genetic contribution to depressive disorders
in adulthood
• Genetic basis less clear for childhood onset
depression
– Heritability has larger role in less severe form
– Environment has stronger influence on severe
forms
• Effectiveness of medications for depression
does not prove biological basis
• Researchers examining sensitive periods in
neural development
Treatment
• Antidepressant medications
– Most developed for adults; effects on children
untested
– SSRI’s prescribed for children before
effectiveness proven
– Little is known about potential hazards
Psychotherapy
• Cognitive behavioral therapy can help
youngsters manage depression and anxiety
• Courses emphasis that depression comes
from life stress; teaches new skills to deal
with stress
• Treatments with long-term effectiveness are
still needed
Prognosis for Depressed Children
• Once established, adolescent depression is
not easy to overcome
• Steps to follow
– Call mental health professional if child feels
miserable for 2 weeks or more
– Show you understand child is suffering and you
understand
– Don’t urge depressed children to cheer up and
use will power to overcome their unhappiness
– Be a facilitator
Prevention in Infants and Children
• Intervention programs for depressed,
stressed single-mothers
• Toddler-parent psychotherapy
• Programs for postpartum depression
Programs for School-Age Children
• The Penn optimism program
– Training in relaxation and assertiveness skills
– Training in cognitive and social problem
solving skills
– Longer term benefits yet to be demonstrated
– Effects stronger in boys than girls
Suicide
• Rare in children under 12; 3rd leading cause of
death in 15-24 year olds
• Warning Signs
–
–
–
–
–
–
Adjustment problems
Past psychiatric disorders
Depressive thought patterns
Inadequate coping styles
School or health problems
Past attempts
• More girls have these risk factors and
attempt suicide more than boys. But, boys
actually kill themselves more often
• Many suicidal youngsters not depressed, but
have different motivations
• Completed suicide more often associated
with depression
Cultural and Social Factors
• In places like Japan, suicide is an honored
tradition; rates are high
• Rate is consistently high on Indian reservations
– Loss of culture, lack of acceptance and opportunity in
majority culture leads to hopelessness
• Rate is high in decaying, violent inner cities
• Rate High among Gay and Lesbian youth
Suicide Prevention
• Removing all means to commit suicide until
person calms down and receives counseling
• Decisive action is required
• Saving a life is more important than
preserving privacy or sparing someone’s
feelings