Depressive Disorders Health Article

Psychotherapy

Psychotherapy, or talk therapy, involves analyzing a child's life to bring to light possible contributing causes of the present depression. During treatment, the therapist helps the patient to become aware of his or her thinking patterns and how they came to be, and works with them to develop healthy problem solving and copying skills. In very young patients, a therapist may use toys, games, and dolls as a vehicle for helping a child express her emotions. This type of therapy, sometimes referred to as play therapy, is useful in children who may not have the developmental capacity or language skills to express the thoughts and feelings behind their depression.

Cognitive-behavioral therapy assumes that the patient's faulty thinking is causing the current depression and focuses on changing the depressed patient's thought patterns and perceptions. The therapist helps the patient identify negative or distorted thought patterns and the emotions and behavior that accompany them and then retrains the depressed individual to recognize the thinking and react differently to it.

Electroconvulsant therapy

Electroconvulsive therapy (ECT) is only considered after all therapy and pharmaceutical treatment options have been unsuccessful, and even then it is a treatment of last resort, typically employed when a patient has become catatonic, suicidal, or psychotic as well as depressed.

The treatment consists of a series of electrical pulses that move into the brain through electrodes on the patient's head. ECT is given under anesthesia, and patients are administered a muscle relaxant to prevent convulsions. Although the exact mechanisms behind the success of ECT therapy are not known, it is believed that the electrical current modifies the electrochemical processes of the brain, consequently relieving depression. Headaches, muscle soreness, nausea, and confusion are possible side effects immediately following an ECT procedure. Memory loss, typically transient, also has been reported in ECT patients.

Alternative treatment

St. John's wort (Hypericum perforatum) isused throughout Europe to treat mild depressive symptoms. Unlike traditional prescription antidepressants, this herbal antidepressant has few reported side effects. Despite uncertainty concerning its effectiveness, a 2003 report said acceptance of the treatment continues to increase. A poll showed that about 41 percent of 15,000 science professionals in 62 countries said they would use St. John's wort for mild to moderate depression. The usual adult dose is 300 mg three times daily and may be lowered for children and adolescents.

In several small studies, S-adenosyl-methionine (SAM, SAMe) was shown to be more effective than placebo and equally effective as tricyclic antidepressants in treating depression. In 2003, a U.S. Department of Health and Human Services team reviewed 100 clinical trials on SAMe and concluded that it worked as well as many prescription medications without side effects of stomach upset.

Parents and caregivers of children who suffer from depression should consult their child's physician before administering any herb or dietary supplement. Some supplements can interfere with the action of other prescription and over-the-counter medications. In addition, some supplements may not be appropriate for use in children with certain medical conditions.

A report from Great Britain published in 2003 emphasized that more physicians should encourage alternative treatments such as behavioral and self-help programs, supervised exercise programs, and watchful waiting before subscribing antidepressant medications for mild depression.

Nutritional concerns

Poor nutrition, especially eating habits that lead to overweight or obesity in children, can also contribute to depression. A 2003 study in the journal Pediatrics found that children who are substantially overweight for long periods of time are more likely to suffer from depression. Whether the depression causes the weight problem or the weight issue triggers the depression was not completely clear.

Prognosis

Untreated or improperly treated depression is the number one cause of suicide in the United States. Proper treatment relieves symptoms in 80 to 90 percent of depressed patients. After each major depressive episode, the risk of recurrence climbs significantly: 50 percent after one episode, 70 percent after two episodes, and 90 percent after three episodes. For this reason, patients need to be aware of the symptoms of recurring depression and may require long-term maintenance treatment of antidepressants and/or therapy.

Prevention

Good nutrition, proper sleep, exercise, and family support are all important to a healthy mental state, particularly in children. Extended maintenance treatment with antidepressants may be required in some patients to prevent relapse. Early intervention for children with depression can be effective in avoiding the development of more severe psychological problems later in life.