 |
|
|
|
|
|
|
Childhood Depression Becoming A Larger Problem On Dr. David Fassler's second visit with seven-year-old Dana, he asked her to draw a picture of a person. She drew a simple stick figure of a girl with two eyes, long hair and a big frown. "Can you tell me what she's doing?" he asked. "She's crying," Dana answered. Then she added tears to the figure's face and printed the words "I'm sad" in uneven letters next to it. "How come the girl in the picture is so sad?" "Because she has no friends." "What does it feel like to be sad?" "Like I'm sadder than anyone in the whole world. I stay in my room and cry. Sometimes I get so sad I want to run away." They talked a little more and then the doctor asked Dana if she had ever thought of hurting herself. "One time I was so sad I wished I would go to sleep and not wake up," Dana said softly, staring down at the drawing in front of her. Then as tears welled up in her eyes, she picked up a crayon and added two words to the top of her picture: "Help me." More and more children each year are diagnosed with severe depression and other mental illnesses. The department of health estimates that nearly 10,000 Vermont children under the age of 18 were receiving mental health treatment in FY2003, up nearly 30% since FY1999. The U. S. Surgeon General's Report states that one child in five suffers from a significant psychiatric illness. Why the increase in diagnoses? "In general, we're getting better and better at recognizing the signs and symptoms of mental illness in children and adolescents," says David Fassler, MD, clinical associate professor in the department of psychiatry at the University of Vermont and clinical director of Otter Creek Associates in Burlington, who is a nationally known expert on pediatric mental illness. "When I was in medical school, we were actually taught that depression didn't occur in childhood. It was thought that children were too 'emotionally immature' to experience 'true depression,'" Fassler notes. "Today, we are well aware that conditions such as depression do, in fact, occur in children and adolescents. We also understand that they are very real illnesses, which can be quite devastating for the child and family. "We see depression (like in Dana's case above), bipolar disorder, anxiety disorders, and even schizophrenia," he explains. "We also understand that some of the significant child psychiatric disorders can persist into adulthood. For example, we used to think that most children with ADHD would 'outgrow' their symptoms by the end of adolescence. Today, however, we realize that as many as half of all children with ADHD continue to have signs and symptoms of the disorder well into adulthood," he adds. "Still, the majority of children with psychiatric problems aren't receiving the comprehensive treatment they need and deserve," Fassler relates. "This is really a tragedy, since we can help most children with these illnesses," says Fassler. "We can't fix or cure all the problems, but we can almost always make a significant difference in how these problems interfere with patients' lives." Are children more at risk if they have family members who suffer from mental illness? "Yes, there are genetic factors involved with many of these illnesses and parents should be aware of them. The odds of a child suffering from depression are at 25 percent if one parent suffers from depression. If both parents suffer from depression, the child has a 75 percent chance of suffering also," Fassler relates. "There are certain steps you can take to reduce the risks for a child with a family history of mental illness – one of which is carefully monitoring potential signs and symptoms. Teach your children about their elevated risk; it's no different than knowing that high blood pressure or diabetes runs in a family," he asserts. What does pediatric treatment of mental illness entail? Is medication the best way to go? "Based on a comprehensive evaluation, we can develop a treatment plan individualized to the needs of the child and family," Fassler says. "Treatment will often include individual therapy or counseling. It might also include work with the family. In some cases, the school may also be involved in the child's treatment plan. "Medication can also be an important component of child psychiatric treatment, but medication alone is rarely a sufficient intervention for complex child psychiatric disorders. It should only be used as part of a comprehensive, individualized treatment plan," he states. What about recent news regarding SSRIs (selective serotonin uptake inhibitors) and their link to suicide? Are these drugs safe? "SSRIs are generally well-tolerated and quite helpful for a significant number of children; of course, plenty of children don't seem to respond to them," Fassler answers. "There are several good studies that show that Prozac (or its generic equivalent) is effective in treating the core symptoms of depression in children. For the other SSRIs, we don't have such good research. "As to the question of whether SSRIs can be linked to suicidal behavior, I think that physicians are being appropriately cautious in deciding to monitor the risks. Of course, depression itself is associated with a high risk of suicidal behavior--about 30 percent of depressed children will attempt suicide," he notes. "I recently testified for the Food and Drug Administration about this issue. While there is a lot of data currently available, it's clear just how complex the question is. Studies use different criteria to measure suicidal thinking, so comparisons are tricky. Also, in some studies, it looks like the risk of suicidal thinking may have been slightly elevated with use of SSRIs; in others, it looked like the risk was higher with use of placebos. "The FDA approved a program through which Columbia University will analyze the data from various studies and make the data more comparable. In the meantime, I think it's still appropriate for doctors to use Prozac for children in conjunction with other treatment as long as the children are closely monitored and the parents are informed about the treatment," he explains. "It's important that parents be advocates for their kids," Fassler stresses. "I worry that media reports about the hearings regarding SSRIs may unintentionally frighten parents about these medications or even treatment in general. The good news is-- we can do so much to help most kids who suffer from psychiatric disorders. The real tragedy is that so many young people still aren't receiving the help which they need and deserve." |
|||
|
|
|
|
|
 |
|
|