DEPRESSION – A CHILDREN’S HEALTH SCANDAL.

 

Children as young as two are being prescribed powerful mood-changing drugs such as Prozac and other anti-depressants.   Although usage usually begins at the age of six and then carried on until the age of 19, the number of two to four year olds taking stimulants such as Ritalin, antidepressants such as Prozac, antipsychotics such as clonidine (used to treat adult high blood pressure and insomnia in hyperactive children has skyrocketed.

Data from America show that over the last 20 years antidepressant use in children increased 400 per cent.   Today around 2 per cent of all youths are taking antidepressants.

I one review carried out in France, 12 per cent of children beginning school were receiving psychotrophic medicines, mostly phenothiazines ; 76 per cent of these had started treatment by age four.  Last year UK doctors wrote 170,000 prescriptions of anti-depressants for children.  Of all the antidepressants, the increased use of selective serotonin reuptake inhibitors (SSRIs) among children has been the most dramatic with a 10 fold increase.

Only eight per cent of GPs and paediatricians have received adequate training in the management of childhood depression.  Yet that has not stopped 72 per cent of them from prescribing SSRIs (such as Prozac) to children under 18 (Paediatrics,2000;105;e82).

In addition 57 per cent of these physicians acknowledged having prescribed an SSRl for a diagnosis other than depression in an under 18 year old patient.

These included children diagnosed with attention-deficit and hyperactivity disorder (ADHD), obsessive-compulsive disorder, aggression/conduct disorder and even enuresis (bed wetting).

Once a drug is approved and on the market, further studies to determine its safety and efficacy in infants and children are rarely conducted (CurrrOpin Pediatr 1995;7:195-8).  So, many medicines used for children are not licensed (have marketing authorisation) or are used ‘off-label’ (outside the terms of the product Licence).  Such prescriptions depend on little more than ‘educated guesswork’ and ‘experiences of peers’ they are not supported by scientific evaluation.

With children, the picture of adverse drug reactions is complicated, as they often react to drugs in a completely different way to adults.  Consider the paradoxical responses to phenobarbital in children to adults.  Phenobarbital acts like a sedative in adults, yet produces hyperactivity in children.

Conversely, Ritalin, a cocaine-like drug, is used as an antihyperactive in children, but produce a stimulating effect in adults.

RECOGNISING CHILDHOOD DEPRESSION.

How do we really know when it is emotionally abnormal for a two-year-old  to cry, or a four-year-old to be fussy and argumentative.  What exactly is childhood depression?

The signs and symptoms of depression in children are notoriously difficult to detect accurately and are dependant on a multitude of other, usually external factors.  In a patient-information sheet produced by the Mayo Foundation for Medical Education and Research, the authors note that “Depression is more difficult to diagnose in children because many behaviours associated with depression can be normal behaviours in children.  In evaluating a child for depression, a therapist considers the number, duration and severity of signs and symptoms.

Fair enough, but the factsheet then goes on to list symptoms such as listlessness, irritability, crying easily, complaints of boredom, arguing with parents,  a lack of interest in schoolwork and even ‘looking sad’ as signs of childhood depression.

What parents can put their hands on their heart and say their child has never experienced any of these states?

What emerges in the evidence is that a child’s mental stability is highly dependent on that of its parents and surroundings.  A recent study by researchers at Columbia University in New York City, for instance reports that poor parenting may put children at a higher risk for anxiety and depression.   The investigators interviewed nearly 600 parents and their children, and concluded that poor parental behaviours, such as verbal abuse, inconsistent rules, parental arguments in front of children and a lack of supervision can all increase the chances of childhood anxiety or depression.

Many studies show that if the mother is depressed the child will be too.

There is, likewise evidence that we are using drugs to make bigger problems such as social inequality, go away.

HOW DIET CAN LEAD TO DEPRESSION.

Drug treatment for depression usually focuses on ‘normalising’  serotonin.  Manipulation of neurotransmitters, however, is poorly understood, difficult to regulate and unlikely to have long-lasting effects.

Recently, nutritionists have turned their attention to morphine-like substances derived from the incomplete digestion of proteins in cereal grains and dairy products as a possible cause of depression.  These substances called ‘exorphins’ were first recognised in the late 1970s (J Biol Chem,1979; 254:2446-9) Further research has identified five distinct exorpins in the pepsin digests of gluten and eight other exorphins in the pepsin digests of milk.

Exorphins act as depressants and are believed to be responsible for the reported psychiatric symptoms, including ‘brain fog’ that often accompany immune reactions to these foods.

Depression is a common symptom of coeliac disease, a disorder where the inner lining of the small intestine (the mucosa) is damaged after eating wheat, rye oats or barley (Am J Gastroenterol, 1999;94:839-43) as well as allergies.  Investigations into the the abnormal electrical brain activity seen in more than two thirds of untreated children with coeliac disease has shown that, in most cases, such activity returned to normal when dairy and grain were removed from the diet.  Abnormal brain activity may be an indication of neurological dysfunction associated with depression.

Clearly not every child who is depressed will have coeliac disease, but, for some cutting out wheat and other grains, or avoiding dairy, may mean the difference between a normal life  and a life on drugs.

OTHER OPTIONS WHEN YOUR CHILD IS SAD.

One of the most common responses on hearing that a child has depression is “But what does he/she have to be depressed about”?  While it is possible that depression is overdiagnosed in young children, some children do suffer from depression.  Recognising and tackling the problem early may be more important than whether or not you use drugs.  Indeed brain scans of children with mood disorders have shown that electrical activity in the brain can return to normal whether or not drugs are used.  The key appears to be finding the right treatment for the given child and supporting the recovery.

Talking works better than drugs. – Unlike treatment with medication, psychotherapy requires a significant commitment by both parents and children.  Nevertheless studies show it is more effective and produces longer lasting improvement than drugs.

Low Self-esteem – is a major contributor to childhood depression.  Parents can improve self esteem in their children by improving communication, setting clear expectations and limits and nurturing a sense of responsibility.

Physical activity – can help relieve or manage depression.  Exercise also has the benefit of improving body image in adolescents.  Non-competitive activities such as swimming are more appropriate than those with ‘winners and losers’.

Teach your kids to cope with stress – This may mean going on a course yourself and sharing what you have learned with your child. Similarly speak to your child’s teachers and ask them to consider initiating a school programme that teaches coping and social skills.

Companion illnesses. – Depression often goes hand in hand with other mental illness or disorders including attention-deficit and hyperactivity disorder and especially in teenage girls eating disorders and self-injury.   Thyroid imbalances, parasites and candida overgrowth can also cause depression.

Ask questions about proposed drugs – Ask your physician and pharmacist about possible interactions and adverse effects.   Remember drugs that are not medically appropriate can make the condition worse.

Reactions to medications – such as antibiotics, asthma medicines heart drugs, anticancer drugs, pain relievers,  immunosuppressants and cough medicines can all cause depression.

Maintain a regular and nutritious diet.  Don’t let your child skip meals and so avoid foods that are high in sugar and artificial sweetners as well as preservatives .  A deficiency in certain vitamins and minerals can be associated with depression, b vitamins essential fatty acids and some minerals.

A regular sleep cycle – this maintains energy.