Pay attention when your child shows signs of anxiety, depression

More than 1 in 10 children ages 12 to 17 suffered from at least one episode of major depression in 2014, according to the National Institute of Mental Health.

As such, the American Academy of Pediatrics suggests that all children should be screened yearly for depression to catch symptoms as early as possible.

“I want to emphasize the importance of seeking out treatment earlier. There are many time where I have said to adult patients, ‘I wish I had them as patients when they were teenagers and maybe we wouldn’t be sitting here today,’ ” said Dr. David Rube, medical director of child and adolescent psychiatry at Joe DiMaggio Children’s Hospital in Hollywood.

Depression is categorized by sadness, feelings of hopelessness, decreased energy and loss of interest in hobbies and activities that persist for more than two weeks. Although anxiety is a separate disorder, patients with depression also often suffer from anxiety as well.

“The earlier that the symptoms get noticed and brought to attention, the better the children will do,” said Dr. Nicole Mavrides, medical director of child psychiatry consultation at UHealth-University of Miami Health System.

STARTING A CONVERSATION

Talking to an adolescent about depression or anxiety may be a difficult conversation. It’s important not to make adolescents feel like they’re in trouble or did something wrong.

“The parent needs to use the magic words, ‘I’m really concerned that’ and ‘I feel that maybe we need to help you more with,’ ” said Gilda Moreno, Psy.D., a clinical psychologist at Nicklaus Children’s Hospital. “An open statement rather than accusing them.”

Often, depression or anxiety can be coupled with low performance in school or extracurricular activities. Because of that, parents should try to understand what is affecting their child’s performance instead of scolding them.

“Being as honest as possible is really helpful and making it something that isn’t a stigma — sitting down and making sure that they know there isn’t anything wrong with them and that they’re not in trouble,” Mavrides said.

Establishing open lines of communication with teenagers is essential. Parents should know their children well enough to be able to notice if they’re just having a bad day or if they’re experiencing symptoms of depression or anxiety.

“A lot of parents will say, ‘Let them stay in their room’ or ‘They need their space’ but sometimes that causes more distance and kids then don’t feel as comfortable talking to their parents about their issues. If they don’t try and have the conversations, then children start to think that their parents don’t care,” Mavrides said.

TREATMENT

According to experts, the most effective way to treat depression and anxiety disorders is to use a combination of talk therapy and medication.

“Therapy alone is not enough. Medication alone is not enough,” Moreno said.

In terms of medications, depressive and anxiety disorders are treated with selective serotonin reuptake inhibitors (SSRIs), which work by increasing levels of serotonin in the brain, a neurotransmitter associated with stabilizing moods.

“Looking at medications that are used for the treatment of depression, Prozac [the brand name for Fluoxetine] seems to be the one that keeps ringing the bell in terms of its effectiveness,” Rube said.

For mild cases of depression, clinical psychologists often try to treat the episode with therapy alone and then evaluate if further treatment, such as medication, is necessary.

There are multiple levels of behavioral therapy used to treat depression and anxiety, including cognitive, interpersonal and dialectical therapies. Psychologists also recommend talking to family members to evaluate whether there are family issues that may contribute to the mental illness.

Cognitive behavioral therapy focuses on changing negative thoughts, such as “nobody likes me,” “I’m ugly,” or “I don’t have any friends,” Moreno said. In the past, dialectical behavior therapy, which helps people learn about the triggers that cause their behavior and develop coping skills to help avoid these situations, was used solely with adults. In recent years, however, there has been a push to use the therapy on adolescents.

“There’s a big push to involve some people who are at higher risk or have had multiple episodes in dialectical behavior therapy. It’s a group-based program that involves the parents, the teenagers, and it provides more individualized therapy,” Mavrides said.

LIFESTYLE CHANGES

Along with treatment, psychologists recommend lifestyle changes such as improving exercise and diet.

“I like to add in the component of health, like mind and body working together, eating better, sleeping better and doing exercise,” Moreno said.

Because depression and anxiety may cause adolescents to lose interests in hobbies, it’s important for parents to pay attention to their child’s interests.

“There’s a certain pressure for adolescents to succeed. One has to be attuned to their child and what that child’s needs are. We don’t want to take a child who’s meant for the arts and push them toward sports and vice versa,” Rube said.

This story was originally published July 21, 2016 at 3:48 PM with the headline "Pay attention when your child shows signs of anxiety, depression."