What is depression in children and teens?

Depression is a serious mood disorder that can take the joy from a child’s life. It is normal for a child to be moody or sad from time to time. You can expect these feelings after the death of a pet or a move to a new city. But if these feelings last for weeks or months, they may be a sign of depression.

Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve. As many as 2 out of 100 young children and 8 out of 100 teens have serious depression.

Still, many children don’t get the treatment they need. This is partly because it can be hard to tell the difference between depression and normal moodiness. Also, depression may not look the same in a child as in an adult.

If you are worried about your child, learn more about the symptoms in children. Talk to your child to see how he or she is feeling. If you think your child is depressed, talk to your doctor or a counselor. The sooner a child gets treatment, the sooner he or she will start to feel better.

What are the symptoms?

A child may be depressed if he or she:

• Is irritable, sad, withdrawn, or bored most of the time.
• Does not take pleasure in things he or she used to enjoy.

A child who is depressed may also:

• Lose or gain weight.
• Sleep too much or too little.
• Feel hopeless, worthless, or guilty.
• Have trouble concentrating, thinking, or making decisions.
• Think about death or suicide a lot.

The symptoms of depression are often overlooked at first. It can be hard to see that symptoms are all part of the same problem.

Also, the symptoms may be different depending on how old the child is.

• Both very young children and grade-school children may lack energy and become withdrawn. They may show little emotion, seem to feel hopeless, and have trouble sleeping. Often they will lose interest in friends and activities they liked before. They may complain of headaches or stomachaches. A child may be more anxious or clingy with caregivers.
• Teens may sleep a lot or move or speak more slowly than usual. Some teens and children with severe depression may see or hear things that aren’t there (hallucinate) or have false beliefs (delusions).

Depression can range from mild to severe. A child who feels a little “down” most of the time for a year or more may have a milder, ongoing form of depression called dysthymia (say “dis-THY-mee-uh”). In its most severe form, depression can cause a child to lose hope and want to die.

Whether depression is mild or severe, there are treatments that can help.

What causes depression?

Just what causes depression is not well understood. But it is linked to a problem with activity levels in certain parts of the brain as well as an imbalance of brain chemicals that affect mood. Things that may cause these problems include:

• Stressful events, such as changing schools, going through a divorce, or losing a close family member or friend.
• Some medicines, such as steroidsor opioids for pain relief.
• Family history. In some children, depression seems to be inherited.

How is depression diagnosed?

To diagnose depression, a doctor may do a physical exam and ask questions about your child’s past health. You and your child may be asked to fill out a form about your child’s symptoms. The doctor may ask your child questions to learn more about how he or she thinks, acts, and feels.

Some diseases can cause symptoms that look like depression. So the child may have tests to help rule out physical problems, such as a low thyroid level or anemia.

It is common for children with depression to have other problems too, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems to help your child get the right diagnosis and treatment.

How is it treated?

Usually one of the first steps in treating depression is education for the child and his or her family. Teaching both the child and the family about depression can be a big help. It makes them less likely to blame themselves for the problem. Sometimes it can help other family members see that they are also depressed.

Counseling may help the child feel better. The type of counseling will depend on the age of the child. For young children, play therapy may be best. Older children and teens may benefit from cognitive-behavioral therapy. This type of counseling can help them change negative thoughts that make them feel bad.

Medicine may be an option if the child is very depressed. Combining antidepressant medicine with counseling often works best. A child with severe depression may need to be treated in the hospital.

There are some things you can do at home to help your child start to feel better.

• Encourage your child to get regular exercise, spend time with supportive friends, eat healthy foods, and get enough sleep.
• See that your child takes any medicine as prescribed and goes to all follow-up appointments.
• Make time to talk and listen to your child. Ask how he or she is feeling. Express your love and support.
• Remind your child that things will get better in time.

What should you know about antidepressant medicines?

Antidepressant medicines often work well for children who are depressed. But there are some important things you should know about these medicines.

• Children who take antidepressants should be watched closely. These medicines may increase the risk that a child will think about or try suicide, especially in the first few weeks of use. If your child takes an antidepressant, learn the warning signs of suicide, and get help right away if you see any of them. Common warning signs include:
  • Talking, drawing, or writing about death.
  • Giving away belongings.
  • Withdrawing from family and friends.
  • Having a plan, such as a gun or pills.
• Your child may start to feel better after 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressants as prescribed and keeps taking them so they have time to work.
• A child may need to try several different antidepressants to find one that works. If you notice any warning signs or have concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child’s doctor.
• Do not let a child suddenly stop taking antidepressants. This could be dangerous. Your doctor can help you taper off the dose slowly to prevent problems

Help is available. For additional information, visit MagellanHealth.com/MYMH

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A child’s mental health affects nearly every aspect of their overall health. Their physical health and their ability to become successful, contributing members of society depends on the state of mind they bring to every situation. Children’s mental health issues are real, common and treatable. An estimated 15 million of our nation’s young people can currently be diagnosed with a mental health disorder. Many more are at risk of developing a disorder due to genetic and environmental risk factors. However, it is estimated that only about 7 percent of youth who need services receive appropriate help from mental health professionals (Department of Health and Human Services, 2001 — Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda).

1) What should I do if I am concerned about mental, behavioral, or emotional symptoms in my child? Keep in mind that every child is different. Even normal development, such as when children develop language, motor, and social skills, varies from child to child. If you are concerned about changes in behavior or other symptoms, talk to your child’s doctor or health care provider. If your child is in school ask the teacher about observed changes in behavior and see if the school system can provide an evaluation. Share this with your provider as well. Be prepared to seek further evaluation by a specialist with experience in child mental health issues. Specialists may include psychiatrists, psychologists, social workers, psychiatric nurses, and behavioral therapists.

2) How do I know if my child’s problems are serious? Many everyday stressors can cause changes in a child’s behavior, however, not every problem is serious. For example, the birth of a sibling may cause a child to temporarily act much younger than he or she is. Behavior patterns that may indicate a more serious issue include:

• Problems across a variety of settings, such as at school, at home, or with peers
• Changes in appetite or sleep
• Social withdrawal, or fearful behavior toward things your child normally is not afraid of
• Returning to behaviors more common in younger children, such as bed-wetting, for a long time
• Signs of being upset, such as sadness or tearfulness
• Signs of self-destructive behavior, such as head-banging, or a tendency to get hurt often
• Repeated thoughts of death.

3) How are mental illnesses diagnosed in young children? Just like adults, children with mental illness are diagnosed after a doctor or mental health specialist carefully observes signs and symptoms. Some primary care physicians can diagnose a child themselves, but many will refer to a specialist for diagnosis and treatment.

• Before diagnosing a mental illness, the doctor or specialist tries to rule out other possible causes for a child’s behavior. The doctor will:
• Review the child’s medical history
• Discuss the issues you have observed
• Review the child’s developmental level
• Ask about any family history of mental health disorders
• Ask if the child has experienced physical or psychological traumas, such as a natural disaster, or situations that may cause stress, such as a death in the family
• Consider reports caretakers and/or teachers

Children are constantly changing and growing and diagnosis and treatment must be viewed with this in mind. While some problems are short-lived and don’t need treatment, others are ongoing and may be very serious. In either case, it is important to see more information so you can understand treatment options and make informed decisions.

3) What are the treatment options for children? The specialist will recommend specific treatment based on the diagnosis. Treatment options may include psychotherapy and/or medication. Talk about the options with the specialist and ask questions. Some treatment choices are a part of standard health care practice while others may be in the experimental stage.

4) Will my child get better with time? Some children get better with time and others children may need ongoing professional help, it all depends on the diagnosis. That is why it is important to consult with a health care providers as soon as possible because treatment may produce better results if started early.

5) How can families of children with mental illness get support? Like other serious illnesses, taking care of a child with mental illness is hard on the parents, family, and other caregivers. Support groups are available for many different types of issues and age groups. By sharing experiences in a safe and confidential setting encourages empathy and a sense of community.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Sources: American Psychological Association, National Institute of Mental Health

If you’re raising children today, it can be easy to focus on the negative, especially with the constant media stream coming from all directions. Helping children see the positive in the world today is more important than ever. Research shows that optimists, who believe they can achieve success, are in fact more able to do so. They are less likely to get depressed, get fewer illnesses, have longer relationships, and live longer.

Here are 12 tips to help your children develop a positive outlook on life.

1. Quit complaining. Focusing on negative thoughts and frustrations is classic pessimism. The more you moan about troubles at work, money problems, etc. the more likely it is that your children will learn to do the same thing. Instead, try talking about things that go right.
2. Have high expectations. Kids won’t develop an optimistic, “can-do” attitude unless they have the opportunity to prove their worth.
3. Encourage reasonable risk-taking. Discouraging your children from doing activities because they might not be as skilled as other children can undermine their confidence.
4. Wait before reacting. Let your children try to solve things without your help. This will boost their sense of accomplishment and also make them more optimistic about what they can do in the future.
5. Be realistic and honest, even in difficult situations. For example, if your child is having a difficult time making friends at a new school, empathize with him/her, but explain that making friends takes time and he/she needs to take active steps to meet other kids and make friends.
6. Show your children you love them. Make time for them every day and use words and affection to show you care.
7. Be a positive role model. Your children will mimic your behaviors, so make sure you show them constructive ways of dealing with life’s challenges and misfortunes.
8. Allow your child to experience success. For example, give them age-appropriate tasks around the house and praise them for their efforts.
9. Teach practical skills with patience and humor. Help your child to keep up with peers – for example, tying shoelaces, using cutlery and managing the toilet.
10. Listen to their problems. Take concerns seriously and be supportive as they learn how to cope with life’s hurts and disappointments.
11. Point out the ‘silver lining’ in every cloud. Get your child into the habit of looking for the positives, even times where it may only seem like the chance to learn from a mistake.
12. Make happy events a regular part of your family life.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Sources: Parents.com, Better Health Channel

If you have, or believe you may have, a mental health problem, it can be helpful to talk about it with others. It can be scary to reach out for help, but it’s often the first step to helping you heal, grow, and recover.

Build your support system
Find someone—such as a parent, family member, teacher, faith leader, coworker or healthcare provider who:

• Gives good advice when you want and ask for it
• Assists you in taking action that will help and doesn’t escalate bad feelings
• Likes, respects and trusts you, and who you like, respect and trust, too
• Allows you the space to change, grow, make decisions, and even make mistakes
• Listens to you and shares with you, both the good and bad times
• Respects your need for confidentiality so you can tell him or her anything
• Lets you freely express your feelings and emotions without judging, teasing, or criticizing
• Works with you to figure out what to do the next time a difficult situation comes up
• Has your best interest in mind

Find a peer group
Find a group of people with mental health problems similar to yours who are taking care of the problems in a positive way. Peer support relationships can positively affect individual recovery because:

• People who have common life experiences have a unique ability to help each other based on a shared history and a deep understanding that may go beyond what exists in other relationships
• People offer their experiences, strengths, and hopes to peers, which allows for natural evolution of personal growth, wellness promotion, and recovery
• Peers can be very supportive since they have “been there” and serve as living examples that individuals can and do recover from mental health problems
• Peers also serve as advocates and support others who may experience discrimination and prejudice

You may want to start or join a self-help or peer support group. National organizations across the country have peer support networks and peer advocates. Find an organization that can help you connect with peer groups and other peer support.

Participate in your treatment decisions
It’s also important for you to be educated, informed, and engaged about your own mental health. Get involved in your treatment through shared decision making. Participate fully with your mental health provider and make informed treatment decisions together includes:

• Recognizing a decision needs to be made
• Identifying partners in the process as equals
• Stating options as equal
• Exploring understanding and expectations
• Identifying preferences
• Negotiating options/concordance
• Sharing decisions
• Arranging follow-up to evaluate decision-making outcomes

Develop a recovery plan
Recovery is a process of change where individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Studies show that most people with mental health problems get better, and many recover completely.

You may want to develop a written recovery plan. Recovery plans:

• Enable you to identify goals for achieving wellness
• Specify what you can do to reach those goals
• Can be daily activities as well as longer term goals
• Track your mental health problem
• Identify triggers or other stressful events that can make you feel worse, and help you learn how to manage them

Help is available. For additional information, visit MagellanHealth.com/MYMH

Source: MentalHealth.gov

This blog post is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Should you require specific help or feel that you are in crisis, you should seek the assistance of an appropriately trained professional.

If you have family, friends or colleagues who live with mental illnesses, you may be unsure of how to speak to them in a respectful way. You want to show you care, but don’t know how to express your concern and not hurt the person at the same time.

Just ask…

1. Can you help me understand what it’s like living with your condition?
2. Is there anything you need from me or something I can do to help you?
3. Can we do something together – get coffee, go for a walk or see a movie?
   Just because the person has mental illness doesn’t mean he/she won’t want to do regular activities
4. What is your diagnosis and how do you feel about it?
5. Do you need to talk?
   Sometimes talking can help make things feel a little better.
6.  What can I do to be there for you, and help you feel supported?
7. How can I support you – can I listen to you, leave you alone, give you a hug?
8.  How has living with this condition shaped who you are today?
9. How are you? You don’t seem like yourself, and I want to know how you’re really feeling because I care about you.

Find Help and More Information Regarding Mental Illness

Help is available. For additional information, visit MagellanHealth.com/MYMH.

For more information on treatment resources, contact:
National Institute of Mental Health
https://www.nimh.nih.gov/health/find-help/index.shtml

NAMI (National Alliance on Mental Illness)
http://www.nami.org/

Substance Abuse and Mental Health Services Administration (SAMHSA) https://findtreatment.samhsa.gov/https://www.mentalhealth.gov/

Mental Health.gov
https://www.mentalhealth.gov/
Help is available. For additional information, visit MagellanHealth.com/MYMH

Read more about Mental Illness from Magellan Health Insights

When a person you care about is going through a difficult time or has been out of sorts for an extended period, it’s hard to watch and is only natural to want to do everything you can to help him or her feel better.

While this person may feel very grateful to have your support, there’s really only so much you can do as a friend, family member, or colleague. There comes a point where the person could really benefit from seeing a professional who can provide some unbiased advice and insight.

Treatments for mental illnesses are highly effective. According to the National Library of Medicine, only one out of three people who need help might actually seek it. Of that, the people who need help the most are typically the least likely to get it. People may worry about appearing weak if they seek therapy, or they may not even realize they really are sick.

Approaching the person and encouraging him or her to seek therapy can be a tricky situation. If done the wrong way, you could aggravate the person or turn him or her against the idea entirely. There is an effective way to have this conversation, but keep in mind that each person is unique, and what works for one person with mental illness may not be the solution for every person.

Nine steps to set up the conversation

1. Let the person know that you need to have an important conversation.
2. Pick a good time and a quiet place without other distractions.
3. Approach the person with empathy and consider using a phrase such as “If I didn’t care about you, we wouldn’t be having this talk.”
4. Be prepared for the person to be upset, but try not to get defensive.
5. Use “I” statements such as “I’m concerned about you.”
6. If the person has expressed concerns or frustrations to you, repeat these back to the person.
7. Avoid using words such as “crazy” or “abnormal.”
8. Offer to help in the process of finding a therapist or counseling service and scheduling an appointment.
9. Remind the person that you care about him or her and are here to provide ongoing support.

As a friend, family member, or close colleague, you have a lot of power in helping the mentally ill person that you care about. Use it. Help is available.

For additional information, visit MagellanHealth.com/MYMH

Source: Psych Central

Q: What is stress?

A: Stress is how the brain and body respond to the demands of life, such as family, work, school, life changes and traumatic events. How you respond affects your health, and it is important to understand how to handle these stressful events in a productive and positive way.

There are four different kinds of stress:

Eustress is positive or good stress. This type of stress can feel pleasant and/or rewarding after the stressful situation subsides.

Distress is negative stress. Most people attribute their own stress to distress. Negative stress can be acute or chronic.

Acute stress is extremely intense stress when it occurs but disappears after the event passes. An example of acute stress is being pulled over by a police officer and your heart rate goes up and you begin to sweat.  Once the situation is resolved you begin feeling normal again.

Chronic stress is less intense stress that usually lasts for a long period of time. An example of chronic stress is if you are dealing with pressure from credit card debt. You may feel an increase in headaches and have difficulty sleeping at night. These physical changes take a toll on your health and well-being.

Q: Who does stress affect?

A: Everyone feels stressed from time to time. Some people cope with stress more effectively or recover from stressful events more quickly than others. There are different types of stress–all of which carry physical and mental health risks. A stressor may be a one time or short term occurrence, or it can keep happening over a long period of time.

Q: Is all stress bad?

A: No. Stress can motivate people to prepare or perform, like when they need to take a test or interview for a new job. Stress can be life-saving in response to danger as your body prepares to face a threat or flee to safety. In these situations, your pulse quickens, you breathe faster, your muscles tense, your brain uses more oxygen and increases activity–all functions aimed at survival.

Q: Can stress cause me to gain or lose weight?

A: Yes. Stress can wreak havoc on your eating habits.

When you are under stress, the balance of hormones in your body can change, leading to cravings, increased appetite or a lack of appetite. Limited time, energy and motivation can also affect your physiological approach to food, as well as what types of food you eat and when you eat. Changes in weight vary greatly from person to person depending on how they respond to stressful situations.

Q: Does stress affect my blood pressure?

A: Stress has not been shown to directly cause high blood pressure, but it can lead to unhealthy lifestyle choices that are associated with high blood pressure. Chronic stress can weaken your immune system and cause uncomfortable physical symptoms like headaches and stomach problems.

Q: Can medications help me lower my stress level?

A: Medicines are helpful for many things, but usually not for stress. Some people take tranquilizers to calm them down immediately, but it’s far better in the long term to learn to manage your stress through relaxation or stress management techniques. Be careful not to confuse stress with anxiety. If you suffer from anxiety, speak with your doctor a treatment or management plan including whether you need medication.

Q: What is Post Traumatic Stress Disorder (PTSD)?

A: PTSD develops in some people who have experienced a shocking, scary, or dangerous event. It is natural to feel afraid during and after a traumatic situation. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD because they may continue to feel stressed or frightened even when they are not in danger.

Q: What causes stress?

A:  A lot of things can cause stress–from personal problems to job and social issues including:

• Health–especially if you have a chronic illness such as heart disease, diabetes, or arthritis
• Emotional problems–anger you can’t express, depression, grief, guilt, or low self-esteem
• Relationships–having problems with your relationships or feeling a lack of friendships or support in your life
• Major life changes–dealing with the death of a parent or spouse, losing your job, getting married, or moving to a new city
• Family–such as having a child, teen, or other family member who is under stress, or being a caregiver to a family member who is elderly or who has health problems
• Conflicts with your beliefs and values–you may value family life, but you may not be able to spend as much time with your family as you want
• Environment–living in an area where overcrowding, crime, pollution, or noise is a problem can create chronic stress
• Social situation–not having enough money to cover your expenses, feeling lonely, or facing discrimination based on your race, gender, age, or sexual orientation can add stress to your life
• Employment–being unhappy with your work or finding your job too demanding can lead to chronic stress. Losing your job or not being able to find work is also very stressful

Q: What can I do to reduce my stress?

A: There are countless quick, easy, and cost-free actions you can take to reduce your stress. Here’s a few to consider: meditate, exercise, create a support network, think positive, avoid excess caffeine, laugh, focus on you.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Sources: American Heart Association, National Institute of Mental Health, WebMD

Numerous studies show that job stress is far and away the major source of stress for American adults and that it has escalated progressively over the past few decades.* Negative work stress can come from a variety of factors including having little control but lots of demands, fear of being laid off or fired, working additional overtime due to budget cuts or pressure due to constantly rising expectations.

Start your day off right

After scrambling to get the kids fed and off to school, dodging traffic and combating road rage, and gulping down coffee in lieu of a healthy breakfast, many people arrive at work stressed, and become more reactive to stress at work. In fact, you may be surprised by how much more reactive to stress you are when you have a stressful morning. If you start off the day with good nutrition, proper planning, and a positive attitude, you may find the stress of the workplace rolling off your back more easily.

Be clear about your role

One of the factors that contributes to job burnout is unclear requirements. If you don’t know exactly what’s expected of you, or if the requirements keep changing with little notice, you may find yourself much more stressed than necessary. If you find yourself falling into the trap of never knowing if what you’re doing is enough, it may help to have a talk with your supervisor and go over expectations, and strategies for meeting them.

Stay away from conflict

Interpersonal conflict takes a toll on your physical and emotional health. Because conflict among co-workers is so difficult to escape, it’s a good idea to avoid conflict at work as much as possible.

That means staying away from gossip, not sharing too many of your personal opinions about religion and politics, and steering clear of colorful office humor. Try to limit contact with those who don’t work well with others. If you do have to deal with conflict try these conflict resolution strategies.

Stay organized

Even if you’re a naturally disorganized person, taking the time to plan ahead to stay organized can help you decrease stress at work. Being organized with your time results in less rushing in the morning to avoid being late and being able to leave at the end of the day with a clear mind.

Get comfortable

Another surprising stressor at work is physical discomfort. You may not notice the stress you experience when you are in an uncomfortable chair for a few minutes. But if you practically live in that chair when you’re at work, you can have a sore back and be more reactive to stress because of it. Even small things like office noise can be distracting and cause low-grade frustration. Do what you can to ensure that you’re working from a quiet, comfortable and soothing workspace.

Form positive relationships

While the negative effects of stress are very real, much of the stress we experience can be alleviated simply by talking about it. That’s why positive relationships at work are so important. Even if they can’t solve your problems, the simple act of verbalizing your stress with someone you trust can actually reduce the severity–or clear it up altogether.

Start exercising

Many people are feeling ill effects from leading a sedentary lifestyle. One way you can combat that, and manage stress at work at the same time, is to get some exercise during your lunch break and perhaps take short exercise breaks throughout the day. This can help you blow off steam, lift your mood, and get into better shape.

Keep perfectionism in check

Being a high achiever can help you feel good about yourself and excel at work. Being a perfectionist, on the other hand, can drive you and the people around you a little nuts. Especially in busy, fast-paced jobs, you may not be able to do everything perfectly. But striving to just do your best and then congratulating yourself on the effort is a good strategy. Your results will actually be better and you’ll be much less stressed at work.

Don’t lose sight of your purpose

Each of us is more than the work we do. Taking the time to understand what motivates us and makes us happy is time well spent.  When we starve our purpose—by not engaging with our work, suppressing our creativity, or ignoring our relationships (including the one with ourselves)—we trigger our stress response. When our life is full of nothing but work and obligations, we begin to feel bitter, resentful, depressed, and even angry. The antidote to these feelings is to infuse your life with a sense of purpose and gratitude for what you have every day.

Establish boundaries

In today’s digital world, it’s easy to feel pressure to be available 24 hours a day. Develop some work-life boundaries for yourself. That might mean making a rule not to check email from home in the evening, or not answering the phone during dinner. Although people have different preferences when it comes to how much they blend their work and home life, creating clear boundaries between these realms can reduce the potential for work- life conflict and the stress that goes with it.

For additional information, visit MagellanHealth.com/MYMH

* The American Institute of Stress, Workplace Stress, January 12, 2018. Retrieved from https://www.stress.org/workplace-stress/