Navigating a Depression Diagnosis: A Short Guide
About the Author:
Emma Bartley is a senior at the University of Notre Dame majoring in Neuroscience and Behavior and minoring in Education as well as Art History. Emma is a part of the Development and Psychopathology Lab and is involved in projects studying parent-child interactions and their impact on typical child development. She is especially interested in education reform, childhood adversity, and connecting the general public with scholarly information.
Like the authors of Asking the Right Questions about ADHD did, I have written this article to provide parents and others with valuable information so that you will be able to ask the right questions when talking to your child’s teachers, doctors, and therapists about depression. This is not professional advice for your child, nor should it be construed as such. Our goal instead is to facilitate the discussion when you are collaborating with those who know your child best.
A diagnosis of “depression” can be met with an onslaught of different emotions. You might feel a sense of calm, thinking, “Everything finally makes so much sense,” or, alternatively, you may feel a sense of anxiety, fear, and guilt, thinking, “What does this mean?” or “What do I do now?” No matter what you may be feeling, we are here to support you as you navigate this process and the information available to you. In this article, we will answer in easy-to-digest terms what depression is and what resources and treatments are available. All of this information has been collected from academic sources which will be provided if you want to learn more.
What is Depression?
Depression is a mood disorder with sadness as the predominant symptom. While sadness typically is a transient feeling that everyone experiences as a natural reaction to situations that cause emotional upset, with depression it is sometimes more extreme and more persistent. Depression is longer-term and can result in other changes in behavior. There are many symptoms of depression, which may include:
- Feelings of sadness
- Loss of interest or pleasure in activities once enjoyed
- Irritability
- Changes in appetite, which can be both weight loss or weight gain
- Dysregulated sleeping, which can be both troubles sleeping or sleeping too much
- Loss of energy
- Feelings of worthlessness or unwarranted guilt
- Difficulty thinking or concentrating
- Thoughts of death and suicide
To diagnose depression, symptoms must persist for at least two weeks and represent a change from previous functioning.
Depression is one of the most commonly diagnosed mental disorders in children. Even more, depression has the highest rate of comorbidity with other mental disorders; about 3 in 4 children with depression also have anxiety, and about 1 in 2 have behavioral problems. In fact, in community sample studies, the estimates of prevalence of depression among those with ADHD range anywhere from 13 to 27%, with some clinical samples reporting estimates as high as 60%.
https://www.psychiatrictimes.com/view/comorbid-depression-and-adhd-children-and-adolescents
https://psychiatry.org/patients-families/depression/what-is-depression
What Causes Depression?
There is no singular known cause of depression, and it is believed to instead be the result of a combination of genetic and environmental factors.
The primary hypothesis for depression surrounds the monoamine neurotransmitters serotonin (the “feel-good” chemical) and norepinephrine (the “energy” chemical). This hypothesis posits that those with depression may have lower levels of serotonin and/or norepinephrine caused by any variety of genetic mutations, such as a polymorphism in the serotonin transporter or receptor gene, or the norepinephrine transporter or receptor gene (see articles below for more information).
Another potential contributor might be altered levels of brain-derived neurotrophic factor, which makes the part of the brain called the hippocampus hypersensitive to stress. Dopamine is also increasingly thought to play an important role in the onset of depression.
Yet another cause may be structural differences in the brain. Neuroimaging studies have shown that those with depression often have a smaller hippocampus and other abnormalities in areas of the brain called the amygdala and ventral striatum.
Stress is a common precipitating factor for depression, but inflammatory diseases and high altitudes are also associated with depression. It is clear that depression is a complicated, multi-factor psychiatric disorder that may be caused by any number of interactions between genetics and the environment.
https://pubmed.ncbi.nlm.nih.gov/19188629/
How Do I Support my Child with Depression?
First and foremost, help your child get professional support. If they are at all hesitant about getting help, try talking with a school counselor or family pediatrician to help them feel more comfortable with the idea.
At home, be sure to offer compassion. Avoid minimizing their pain and instead offer validation. If and when your child opens up, be an active listener, setting aside everything else you might be doing.
It can also be helpful to promote positive lifestyle changes. Perhaps you can help your child build a daily schedule which includes an activity they enjoy and a physical activity of some sort, which can naturally boost serotonin levels. Emphasize the importance of healthy eating and a regular sleep schedule. And try to do these behaviors yourself! Seeing a family member engage in these behaviors helps make healthy habits routine and commonplace. Plus, regardless of whether you’re experiencing depression yourself, these types of lifestyle changes can help you feel better.
Does A Diagnosis Mean My Child Needs Medication?
Not necessarily. Because depression is such a complex disease with no singular cause, there is no one treatment that will work for all individuals. That being said, the most common forms of treatment for depression are cognitive-behavioral therapy (CBT) and antidepressant medications, with research showing that a combination of the two have historically worked best.
Deciding what treatment is best for your child is something to discuss with your doctor. What’s most important to know, though, is that no matter what treatment you choose, you must stick with it to see its effects. It’s not something that happens overnight. When choosing a treatment, make sure it is something that you can and will stick to while consulting with your physician if you believe adjustments to treatment are necessary.
If My Child Starts Therapy, What Can I Expect?
CBT is a form of psychological treatment which works to change thinking patterns and behavioral patterns. Treatment will involve building a “toolbox” of strategies to change thinking patterns, like learning to recognize distorted thought processes and using problem-solving skills to cope with difficult situations. In this way, individuals are taught to be their own therapists, learning skills to take outside the session.
You can get a referral from a doctor, friend, or health insurance plan to find a therapist. Before starting therapy, find out what coverage your health insurance offers for psychotherapy (if you have it). Remember, treatment does not just happen in a day. Your child will need multiple sessions to build the skills needed. It is also important to find a therapist that is a good fit for your child. This may require visiting multiple therapists before finding the therapist that is most effective.
If My Child Is Prescribed Medication, What Can I Expect?
There are many different classes of medication that can be used to help treat depression, each working on different systems in the brain. The most popular are SSRIs (selective serotonin reuptake inhibitors), which combat low levels of serotonin by keeping serotonin longer in the brain before it is reabsorbed by a cell. SNRIs (serotonin-norepinephrine reuptake inhibitors) and NRIs (norepinephrine reuptake inhibitors) work similarly, but instead slow the norepinephrine reuptake rate. MAO inhibitors are another popular class of antidepressants, which prevent the breakdown of serotonin, norepinephrine, and dopamine to keep the neurotransmitter in your system for longer.
The two most common antidepressants used to treat youth are fluoxetine (Prozac) and escitalopram (Lexapro), both SSRIs. The evidence base for fluoxetine is the strongest and most supported by pediatric registration trials, data from TADS (the Treatment of Adolescent Depression Study), and TORDIA (the Treatment of SSRI Resistant Depression Study).
It is important to ask questions to understand what the medication process will look like. Some experience symptoms, generally flu-like, as they start medication. Here are some questions that you can ask that might help guide you through this process:
How does this medication work?
What side effects may occur?
Do any foods/drinks/other medications need to be avoided if my child takes this one?
How long will it take before we should expect to see changes?
How often should we see the doctor for a medication check-up?
What might be the benefits of this medication over our current regimen?
Is the price worth the added benefit?
Are there any drawbacks to this medication?
Do we know about any long-term issues that could result from this medication use?
If a child is resistant to medicine, they can try therapy and/or switch medications. As aforementioned, depression is a complex disorder, so some may react better to one medication compared to another.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340601/
Will My Child Have To Be On An Antidepressant Their Entire Life If They Start? What Are The Side Effects Of Starting Or Coming Off A Medication Anyway?
Your child might not need to be on an antidepressant their entire life, but it is a possibility. Just like any other disease, depression needs to be treated in the way that works best. If your child had diabetes, you wouldn’t encourage them to stop taking their insulin after a few years. Time of treatment depends on the individual and the severity of their depression. If discontinuing medication is an option, though, you still want to pursue other forms of wellness to promote healthy thinking and behaviors.
If your child discontinues the antidepressant, there may be some symptoms similar to the depressive behaviors before taking the medicine that resurface. Additionally, they may experience some flu-like symptoms, though every person’s reaction to antidepressants is different. Doctors work to minimize these symptoms, though, by slowly weaning off the medicine rather than going cold turkey.
Ask your doctor about what may happen: If we decide to discontinue this medication, how does this happen and how long is the medication in my child’s body? What symptoms might they experience?
https://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants
What is pharmacogenetic testing, and when could this be helpful?
Pharmacogenomics is an up-and-coming field in research. It’s a type of genetic testing which looks not just at a specific causative gene but instead many genes and their interactions with different medicines. It’s not used like molecular diagnostic testing - which detects whether an individual is affected with a specific disease and diagnoses them - but instead looks at genes associated with medication responses and analyzes their sensitivity to them, which predicts the amount of gene-drug interaction. For example, pharmacogenomic testing might reveal a genetic mutation which lowers the efficacy of a specific type of antidepressant medication.
There are a plethora of genetic mutations that may be involved in depression and/or that can impact one’s ability to metabolize a medication. Furthermore, the different classes of antidepressants work on different neural systems which may be more affected than others. Pharmacogenomic testing can be used to reveal which medicines may or may not work better for an individual based on their genetics and the way in which the medicine works.
Rebecca M. Allen, MD, says, “For my patients, getting information about drug metabolism from the genetic panels helped me build a therapeutic alliance and/or choose which drug to try next when the first drug I prescribed was not effective. One patient’s results showed slow metabolism for every psychotropic she had ever tried. She found this validating, as she had experienced an unusual amount of adverse effects, and we were able to pick a new option from the short list of medications she metabolizes well. Another patient felt reassured when his panel indicated that his metabolism was normal for almost everything. Thereafter, he expressed fewer concerns about trying new medications. A third patient felt validated that her testing supported her intolerance of and lack of response to SSRIs, and she was more willing to try other classes of antidepressants.”
Pharmacogenomic testing could be a potential resource to use if your child is struggling to find a medication that works best for them. GeneSight and Genomind are the two most popular tests; the majority of users pay under $400 for the test, and it can be used from home and sent into the lab for results. Both must be ordered by a healthcare professional, so talk to your doctor if you think this may be a useful tool as you are navigating your child’s treatment.
It is important to remember that this is not an alternate intervention or a new way of diagnosing an individual. It is instead additional information. Pharmacogenomic testing, while not a diagnostic test, can be a useful tool, especially if one is struggling with treatment.
Depression is a difficult disorder to navigate, but there are resources and individuals out there to help you. When in doubt, ask questions! Utilize the support of your teachers, doctors, and other trusted professionals, and trust that you will find treatment that works for your child.