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Children & Depression

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In any given 1-year period, 9.5% of the population, or about 18.8 million American adults, suffer from a depressive illness5 The economic cost for this disorder is high, but the cost in human suffering can't be estimated.

Depressive illnesses often interfere w/normal functioning & cause pain & suffering not only to those who have a disorder, but also to those who care about them. Serious depression can destroy family life as well as the life of the ill person. But much of this suffering is unnecessary.

Most people w/a depressive illness don't seek treatment, although the great majority - even those whose depression is extremely severe - can be helped. Thanks to years of fruitful research, there are now medications & psychosocial therapies such as cognitive/behavioral, "talk" or interpersonal that ease the pain of depression.

Unfortunately, many people don't recognize that depression is a treatable illness. If you feel that you or someone you care about is one of the many undiagnosed depressed people in this country, the information presented here may help you take the steps that may save your own or someone else's life.

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recent news:
Having a Confidant May Ward Off Kids' Depression
Reuters Health / By Charnicia E. Huggins
Monday, November 15, 2004

NEW YORK (Reuters Health) - Among abused & neglected children who are genetically prone to develop depression, the risk of doing so may be reduced if they have someone to talk to, share good news with & get advice from, new study findings show.

"A lot of people think that maltreatment or having 'bad' genes leads inevitably to bad outcomes, but it doesn't," study author Dr. Joan Kaufman, of Yale Univ. in New Haven, Connecticut, told Reuters Health.

"Positive social supports can help promote resiliency even in the context of maltreatment & a genetic predisposition for psychiatric illness," she said.

Countless instances of child maltreatment occur each year, including nearly 1 million substantiated reports & many other cases that are never brought to the attention of some authority. Although not all abused children are doomed to experience some type of psychiatric problem, depression is among the most commonly reported mental conditions among this group.

Also, genes can be a factor. Previous research in adults has shown that having a short version of the serotonin transporter gene, may increase susceptibility to depression after some stressful event. Among infants reared in stressful environments, those with the genetic variant show increased emotional distress, studies show.

Researchers have also found that the availability of a caring, stable parent or guardian may positively influence the long-term development of a person with a history of abuse.

In the current study, Kaufman & her team looked at 57 children who were removed from their homes due to allegations of abuse &/or neglect & a comparison group of 44 children with no history of maltreatment. The 5 to 15 year-old black, white, Hispanic & biracial study participants were from 67 families.

As in adult studies, children who had a history of significant stress - maltreatment in this case - & were genetically predisposed, seemed to be more vulnerable to depression than their peers, the researchers report in this week's Proceedings of the National Academy of Sciences.

Those from more stable homes, on the other hand, tended to have less signs of depression, regardless of whether or not they were genetically predisposed to the condition, the researchers note.

i.e., among those genetically vulnerable to depression, maltreated children with low social support - i.e. they didn't always have someone to rely on when in need, talk to about personal things, share good news with, have fun with or go to for advice - scored twice as high on a measure of the severity of their depression symptoms than did those with no history of abuse.

Frequent contact with a primary support person, such as a parent, relative, friend or other adult, was associated with lower depression scores.

In fact, among maltreated children with a slight genetic vulnerability to depression, those who were able to see their primary support only semiannually or less frequently had depression scores that were 33% higher than those with more frequent contact.

Altogether, these findings show that the risk for depression "may be modified by both genetic & environmental factors, w/the quality & availability of social supports among the most important environmental factors in promoting resiliency even in the presence of a genotype expected to predispose to psychiatric disorder," Kaufman & her team write.

SOURCE: Proceedings of the National Academy of Sciences, November 15, 2004.

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Generally Speaking: What is a Depressive Disorder?

A depressive disorder is an illness that involves the body, mood & thoughts. It affects the way a person eats & sleeps, the way one feels about oneself & the way one thinks about things.

A depressive disorder isn't the same as a passing blue mood. It isn't a sign of personal weakness or a condition that can be willed or wished away. People w/a depressive illness can't merely "pull themselves together" & get better.

Without treatment, symptoms can last for weeks, months or years. Appropriate treatment, however, can help most people who suffer from depression.

Types of Depression

Depressive disorders come in different forms, just as is the case w/other illnesses such as heart disease. This pamphlet briefly describes 3 of the most common types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity & persistence.

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Major depression is manifested by a combination of symptoms (see symptom list) that interfere w/the ability to work, study, sleep, eat & enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that don't disable, but keep one from functioning well or from feeling good. Many people w/dysthymia also experience major depressive episodes at some time in their lives.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) & lows (depression). Sometimes the mood switches are dramatic & rapid, but most often they're gradual.

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When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder.

When in the manic cycle, the individual may be overactive, overtalkative & have a great deal of energy.

Mania often affects thinking, judgment & social behavior in ways that cause serious problems & embarrassment.

i.e., the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms of Depression & Mania

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies w/individuals & also varies over time.

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  • Persistent sad, anxious, or "empty" mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being "slowed down"
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, early-morning awakening, or oversleeping
  • Appetite and/or weight loss or overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

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  • Abnormal or excessive elation
  • Unusual irritability
  • Decreased need for sleep
  • Grandiose notions
  • Increased talking
  • Racing thoughts
  • Increased sexual desire
  • Markedly increased energy
  • Poor judgment
  • Inappropriate social behavior


Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill.

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However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional factors, possibly stresses at home, work, or school, are involved in its onset.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses, or none at all.

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The first step to getting appropriate treatment for depression is a physical examination by a physician. Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression & the physician should rule out these possibilities thru examination, interview & lab tests.

If a physical cause for the depression is ruled out, a psychological evaluation should be done, by the physician or by referral to a psychiatrist or psychologist.

A good diagnostic evaluation will include a complete history of symptoms, i.e.,

  • when they started
  • how long they've lasted
  • how severe they are
  • whether the patient had them before &, if so
  • whether the symptoms were treated 
  • what treatment was given

The doctor should ask about alcohol & drug use & if the patient has thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness & if treated, what treatments they may have received & which were effective.

Last, a diagnostic evaluation should include a mental status examination to determine if speech or thought patterns or memory have been affected, as sometimes happens in the case of a depressive or manic-depressive illness.

Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications & psychotherapies that can be used to treat depressive disorders.

Some people with milder forms may do well with psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants.

Most do best with combined treatment: medication to gain relatively quick symptom relief & psychotherapy to learn more effective ways to deal with life's problems, including depression.

Depending on the patient's diagnosis and severity of symptoms, the therapist may prescribe medication and/or one of the several forms of psychotherapy that have proven effective for depression.

Electroconvulsive therapy (ECT) is useful, particularly for individuals whose depression is severe or life threatening or who can't take antidepressant medication.3

ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. In recent years, ECT has been much improved.

A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses.

The stimulation causes a brief (about 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. For full therapeutic benefit, at least several sessions of ECT, typically given at the rate of three per week, are required.


There are several types of antidepressant medications used to treat depressive disorders. These include newer medications - chiefly:

  • the selective serotonin reuptake inhibitors (SSRI's)
  • the tricyclics
  • the monoamine oxidase inhibitors (MAOI's)

The SSRI's - & other newer medications that affect neurotransmitters such as dopamine or norepinephrine - generally have fewer side effects than tricyclics. Sometimes the doctor will try a variety of antidepressants before finding the most effective medication or combination of medications. Sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the full therapeutic effect occurs.

Patients often are tempted to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication isn't helping at all. It is important to keep taking medication until it has a chance to work, though side effects (see section on Side Effects on page 13) may appear before antidepressant activity does.

Once the individual is feeling better, it is important to continue the medication for at least 4 to 9 months to prevent a recurrence of the depression. Some medications must be stopped gradually to give the body time to adjust.

Never stop taking an antidepressant without consulting the doctor for instructions on how to safely discontinue the medication. For individuals with bipolar disorder or chronic major depression, medication may have to be maintained indefinitely.

Antidepressant drugs aren't habit-forming. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given. The doctor will check the dosage and its effectiveness regularly.

For the small number of people for whom MAO inhibitors are the best treatment, it is necessary to avoid certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles, as well as medications such as decongestants. The interaction of tyramine with MAOIs can bring on a hypertensive crisis, a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the patient should carry at all times. Other forms of antidepressants require no food restrictions.

Medications of any kind—prescribed, over-the counter, or borrowed—should never be mixed without consulting the doctor. Other health professionals who may prescribe a drug—such as a dentist or other medical specialist—should be told of the medications the patient is taking. Some drugs, although safe when taken alone can, if taken with others, cause severe and dangerous side effects. Some drugs, like alcohol or street drugs, may reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer, and hard liquor. Some people who have not had a problem with alcohol use may be permitted by their doctor to use a modest amount of alcohol while taking one of the newer antidepressants.

Antianxiety drugs or sedatives are not antidepressants. They are sometimes prescribed along with antidepressants; however, they are not effective when taken alone for a depressive disorder. Stimulants, such as amphetamines, are not effective antidepressants, but they are used occasionally under close supervision in medically ill depressed patients.

Questions about any antidepressant prescribed, or problems that may be related to the medication, should be discussed with the doctor.

Lithium has for many years been the treatment of choice for bipolar disorder, as it can be effective in smoothing out the mood swings common to this disorder. Its use must be carefully monitored, as the range between an effective dose and a toxic one is small. If a person has preexisting thyroid, kidney, or heart disorders or epilepsy, lithium may not be recommended. Fortunately, other medications have been found to be of benefit in controlling mood swings. Among these are two mood-stabilizing anticonvulsants, carbamazepine (Tegretol) and valproate (Depakote). Both of these medications have gained wide acceptance in clinical practice, and valproate has been approved by the Food and Drug Administration for first-line treatment of acute mania. Other anticonvulsants that are being used now include lamotrigine (Lamictal) and gabapentin (Neurontin): their role in the treatment hierarchy of bipolar disorder remains under study.

Most people who have bipolar disorder take more than one medication including, along with lithium and/or an anticonvulsant, a medication for accompanying agitation, anxiety, depression, or insomnia. Finding the best possible combination of these medications is of utmost importance to the patient and requires close monitoring by the physician.

Side Effects

Antidepressants may cause mild and, usually, temporary side effects (sometimes referred to as adverse effects) in some people. Typically these are annoying, but not serious. However, any unusual reactions or side effects or those that interfere with functioning should be reported to the doctor immediately. The most common side effects of tricyclic antidepressants, and ways to deal with them, are:

  • Dry mouth—it is helpful to drink sips of water; chew sugarless gum; clean teeth daily.
  • Constipation—bran cereals, prunes, fruit, and vegetables should be in the diet.
  • Bladder problems—emptying the bladder may be troublesome, and the urine stream may not be as strong as usual; the doctor should be notified if there is marked difficulty or pain.
  • Sexual problems—sexual functioning may change; if worrisome, it should be discussed with the doctor.
  • Blurred vision—this will pass soon and will not usually necessitate new glasses.
  • Dizziness—rising from the bed or chair slowly is helpful.
  • Drowsiness as a daytime problem—this usually passes soon. A person feeling drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.

The newer antidepressants have different types of side effects:

  • Headache—this will usually go away.
  • Nausea—this is also temporary, but even when it occurs, it is transient after each dose.
  • Nervousness and insomnia (trouble falling asleep or waking often during the night)—these may occur during the first few weeks; dosage reductions or time will usually resolve them.
  • Agitation (feeling jittery)—if this happens for the first time after the drug is taken and is more than transient, the doctor should be notified.
  • Sexual problems—the doctor should be consulted if the problem is persistent or worrisome.
Herbal Therapy

In the past few years, much interest has risen in the use of herbs in the treatment of both depression and anxiety. St. John's wort (Hypericum perforatum), an herb used extensively in the treatment of mild to moderate depression in Europe, has recently aroused interest in the United States. St. John's wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk and herbal remedies. Today in Germany, Hypericum is used in the treatment of depression more than any other antidepressant. However, the scientific studies that have been conducted on its use have been short-term and have used several different doses.

Because of the widespread interest in St. John's wort, the National Institutes of Health (NIH) conducted a 3-year study, sponsored by three NIH components—the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, and the Office of Dietary Supplements. The study was designed to include 336 patients with major depression of moderate severity, randomly assigned to an 8-week trial with one-third of patients receiving a uniform dose of St. John's wort, another third sertraline, a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, and the final third a placebo (a pill that looks exactly like the SSRI and the St. John's wort, but has no active ingredients). The study participants who responded positively were followed for an additional 18 weeks. At the end of the first phase of the study, participants were measured on two scales, one for depression and one for overall functioning. There was no significant difference in rate of response for depression, but the scale for overall functioning was better for the antidepressant than for either St. John's wort or placebo. While this study did not support the use of St. John's wort in the treatment of major depression, ongoing NIH-supported research is examining a possible role for St. John's wort in the treatment of milder forms of depression.

The Food and Drug Administration issued a Public Health Advisory on February 10, 2000. It stated that St. John's wort appears to affect an important metabolic pathway that is used by many drugs prescribed to treat conditions such as AIDS, heart disease, depression, seizures, certain cancers, and rejection of transplants. Therefore, health care providers should alert their patients about these potential drug interactions.

Some other herbal supplements frequently used that have not been evaluated in large-scale clinical trials are ephedra, gingko biloba, echinacea, and ginseng. Any herbal supplement should be taken only after consultation with the doctor or other health care provider.


Many forms of psychotherapy, including some short-term (10-20 week) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist, sometimes combined with "homework" assignments between sessions. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression.

Two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome.

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Preschool Depression May Mirror That of Adults
Reuters Health

By Amy Norton

Tuesday, November 23, 2004

NEW YORK (Reuters Health) - Research has shown that even preschool children can suffer from depression & now new evidence suggests their symptoms can be divided into subtypes in a way that reflects what's seen in adults.

A study of 156 children between the ages of 3 & about 5 1/2 found that among the 54 diagnosed w/depression, two groups emerged. One group had characteristics similar to those of adults diagnosed w/a subtype of depression known as "melancholic" depression

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In adults, melancholic depression is considered to be more severe than some other types of depression & research has shown it to be distinct from a more "reactive" depression that arises in response to a traumatic event.

From the new study findings, it does appear that depressed preschoolers can be broken into two groups along the lines used for adults, the study's lead author, Dr. Joan L. Luby of Washington University in St. Louis, told Reuters Health.

The children in the study whose depression mirrored adult melancholic depression tended to have more severe symptoms & a strong family history of depression & all of them suffered from so-called anhedonia - a lack of interest in the things that normally occupy young children, including play.

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These children also appeared to be "slowed down" or "restless" more often than the other depressed children in the study.

57% of the depressed children in the study fell into the group with anhedonia.

The second group -- which Luby & her colleagues refer to as "hedonic" -- was distinct in that the children's moods did brighten at times & they were able to take pleasure in things like play. They also had a higher rate of stressful life events, which is consistent w/the "nonmelancholic" type of depression seen in adults, Luby & her colleagues note in the report.

It's possible, Luby said, that some young children may suffer from depression in reaction to a stressful situation, while for others -- those w/anhedonia -- symptoms are biologically based.

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Research in adults has suggested that anhedonia may have genetic underpinnings & possibly be related to dysfunction in the brain's "reward system."

If it's the case that preschoolers can be separated into melancholic & nonmelancholic groups, it's important to make the distinction, according to Luby. Adults w/melancholic depression have been shown to respond to therapy differently than those w/other types of depression, she pointed out.

Currently, young children w/depression are treated w/forms of psychotherapy geared for their age group, such as "play" therapy, but more research is needed to judge the effectiveness of such treatment, Luby said.

SOURCE: American Journal of Psychiatry, November 2004

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Smaller Baby Girls at Risk for Depression

Ivanhoe Newswire

Girls who weigh less than about 5.5 pounds at birth may be at significant risk for depression in their teenage years.

Duke University researchers who followed nearly 1,500 girls and boys from 9 years old through 16 found nearly 40 percent of girls with low birth weights were affected by depression at some point between ages 13 and 16. That compares to just more than 8 percent of girls who were born with higher birth weights.

No increase in depression was found for boys -- about 5 percent of boys in both the low birth weight and normal birth weight groups ended up with depression. Other psychiatric disorders were similar in both girls and boys, including anxiety disorders.

Why would low birth weight girls be more susceptible to depression in their teens? The authors believe a complicated interplay of hormones and psychology may be responsible and call for more study to tease out the causes. In the meantime, they say parents and doctors should be more vigilant in looking for signs of depression in girls who were born weighing less than 5.5 pounds.

"For the present, the findings suggest that pediatricians and parents of girls who were of low birth weight should pay close attention to their mental health as they enter puberty," they write.

This article was reported by Ivanhoe.com, which offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.healthscout.com/external/redir.asp?

SOURCE: Archives of General Psychiatry, 2007;64:338-344

Poverty: The next generation

By Heather Ziegenbein, Black Hills Pioneer / July 14, 2006

NORTHERN HILLS - It's not easy for poor kids to fit in with others at school. But, they can't just leave their family's financial issues behind when they step thru the school's doors. A reminder that they're indeed different, is an ongoing cycle that continues to threaten the innocence & youthfulness of our children.

Students visit counselors on a daily basis at area schools because they struggle with issues at home caused by the stresses of living in poverty.

Lead-Deadwood Elementary Counselor Greg Calabro sees 40 children on a regular basis as a direct result of parents living in poverty. Some are seen to discuss misbehavior issues while other children discuss the onset signs of depression.

At the high school level, Spearfish High School counselor Marcia Price said her students are mostly dealing with peer pressure.

"In some instances we hear from students who are being made fun of because they're poor, because they have body odor or because of the car they drive," Price said of just some of the problems her students face.

"There's a common feeling of hopelessness with these kids. I hear comments like 'What is the point? And how can I ever get out of this?' & I just try & build a relationship with them. I'm non-judgemental & have empathy for their situation."

Calabro sums it up in one statement; "I listen." He continued by saying a substantial part of his job is giving his kids permission to be sad or angry. Usually the withdrawn little ones are reserved in expressing their own thoughts and Calabro just takes his time.

"I use Legos or tinker toys & let them play & just talk to them while they're immersed in this diversion. I build a relationship with them & when they come back I use a more aggressive form of communication."

Calabro said some of the toughest situations for kids are during vacation time when school isn't in session because they're forced to stay at home where things aren't going so well. "Thankfully this year was pretty good, but often there are times when abuse will surface.

Sometimes in the summer & on holidays kids come in after a referral by another teacher or adult has been made. If there's tension at home, these kids have school as a venue of escape.

They're also fed 2 meals a day (at school) & sometimes that's the most solid meals they'll have."

Sometimes others have the unrealistic impression that all poor families can qualify for the federal Food Stamps program or other government subsidies & that simply isn't the case for all families.

Some may make a bit more than the defined poverty levels but still not earn enough to meet daily living requirements with higher fuel costs & other pressures on family budgets. There are situations of disability or other medical crisis that can plunge families into extreme hardship with few safety nets.

For children who are younger, these money issues can be tough to understand. So, most kids hear fighting among adults or seldom see parents because they're working 2 jobs to support the family.

What kids do understand, Calabro says, is the fact they don't have that certain toy.

"I've had kids come in & they see what other kids have & they don't - some can get quite aggressive. You know, it's hard to explain to them about why this is the way it is," Calabro said.

Price said her kids are the same way. "In some instances we probably don't see as many of the students as we should because a lot of them have a great deal of pride & they don't want people to know.

When they do, most are angry at their peers, their situation & sometimes they're shy & withdrawn."

Price noted she sees a few students who are an exception to the rule & are pushing themselves toward a better life.

Behavior Management Caseworker Jenny Sand of Spearfish said there's a definite cycle when it comes to poverty. She works on a daily basis with families in Lawrence County dealing with emotional problems that are a direct result of financial anxiety.

She also sees several patients that are living in poverty because of their mental disabilities.

Counselors see up to 225 clients per year in Lawrence County. A lot of times, caseworkers will visit the individuals at home to make it easier & more comfortable for them.

"I think a lot of it (poverty) is passed down from generation to generation. Sometimes we see this kind of situation when someone came from money, but most of the time families who have always struggled & pinched pennies are simply stuck in the system," Sand said.

As for the average diagnosis, most individuals seen at Behavior Management suffer from stress, anxiety & depression.

"Many of the patients I see on a regular basis have an overwhelming feeling of being judged & looked down upon because of circumstances that are uncontrollable," Sand said of their feelings of shame.

Price said in the end talking & listening to those struggling with these issues can be the most important. Also, she said, teaching them coping skills can be very beneficial.

"It's also very important to let them know that they can improve the quality of life & letting them know that you don't have to make 6 digits & have a house on the hill to be happy.

The tough thing is explaining it to a young person who doesn't have food & shelter that they can be the best that they can be," Price said. "How can you even get there if you don't have the basics?"

Anxiety Disorders & Depression in Children
what is attention deficit hyperactivity disorder?

Attention Deficit Hyperactivity Disorder (ADHD)Attention Deficit Hyperactivity Disorder, ADHD, is one of the most common mental disorders that develop in children. Children w/ADHD have impaired functioning in multiple settings, including home, school & in relationships w/peers. If untreated, the disorder can have long-term adverse effects into adolescence & adulthood.

Depression in Children

Only in the past 2 decades has depression in children been taken very seriously. The depressed child may:

  • pretend to be sick
  • refuse to go to school
  • cling to a parent
  • worry that the parent may die
  • older children may sulk
  • get into trouble at school
  • be negative
  • grouchy
  • feel misunderstood

Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going thru a temporary "phase" or is suffering from depression.

Sometimes the parents become worried about how the child's behavior has changed, or a teacher mentions that "your child doesn't seem to be himself." In such a case, if a visit to the child's pediatrician rules out physical symptoms, the doctor will probably suggest that the child be evaluated, preferably by a psychiatrist who specializes in the treatment of children.

If treatment is needed, the doctor may suggest that another therapist, usually a social worker or a psychologist, provide therapy while the psychiatrist will oversee medication if it's needed.

Parents shouldn't be afraid to ask questions:

  • What are the therapist's qualifications?
  • What kind of therapy will the child have?
  • Will the family as a whole participate in therapy?
  • Will my child's therapy include an antidepressant? If so, what might the side effects be?

The National Institute of Mental Health (NIMH) has identified the use of medications for depression in children as an important area for research. The NIMH-supported Research Units on Pediatric Psychopharmacology (RUPPs) form a network of 7 research sites where clinical studies on the effects of medications for mental disorders can be conducted in children & adolescents.

Among the medications being studied are antidepressants, some of which have been found to be effective in treating children with depression, if properly monitored by the child's physician.8


Depressive disorders make one feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

  • Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
  • Break large tasks into small ones, set some priorities, and do what you can as you can.
  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
  • Participate in activities that may make you feel better.
  • Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help.
  • Expect your mood to improve gradually, not immediately. Feeling better takes time.
  • It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition—change jobs, get married or divorced—discuss it with others who know you well and have a more objective view of your situation.
  • People rarely "snap out of" a depression. But they can feel a little better day-by-day.
  • Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
  • Let your family and friends help you.
How Family and Friends Can Help the Depressed Person

The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication. The depressed person should be encouraged to obey the doctor's orders about the use of alcoholic products while on medication. The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person's therapist. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it." Eventually, with treatment, most people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.


If unsure where to go for help, check the Yellow Pages under "mental health," "health," "social services," "suicide prevention," "crisis intervention services," "hotlines," "hospitals," or "physicians" for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for an emotional problem, and will be able to tell you where and how to get further help.

Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services.

  • Family doctors
  • Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
  • Health maintenance organizations
  • Community mental health centers
  • Hospital psychiatry departments and outpatient clinics
  • University- or medical school-affiliated programs
  • State hospital outpatient clinics
  • Family service, social agencies, or clergy
  • Private clinics and facilities
  • Employee assistance programs
  • Local medical and/or psychiatric societies

Following is a list of organizations that may be able to provide additional information and/or assistance about mental health topics:


Ctr. for Mental Health Services
Substance Abuse & Mental Health Services Admin.
Rm 12-105 Parklawn Building
Rockville, MD 20857
Phone: 301-443-8956
Fax: 301-443-9050
URL: http://www.samhsa.gov/

National Institute of Mental Health
Office of Communications
6001 Executive Blvd., Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513
Fax: 301-443-4279
TollFree: 1-866-615-NIMH (6464)
TTY: 301-443-8431
Email: nimhinfo@nih.gov
URL: http://www.nimh.nih.gov

American Psychiatric Assoc. (APA)
1000 Wilson Blvd., Ste. 1825
Arlington, VA 22209-3901
Phone: 703-907-7300
URL: http://www.psych.org/index.cfm

American Psychological Assoc.
750 1st Street, NE
Washington, DC 20002-4242
Phone: 202-336-5510
TollFree: 1-800-374-2721
URL: http://www.apa.org

Depression After Delivery, Inc. (DAD)
91 East Somerset St.
Raritan, NJ 08869
TollFree: (800) 944-4773
URL: below


Depression & Bipolar Support Alliance (DBSA)
730 N. Franklin St., Ste. 501
Chicago, IL 60610-7224
Phone: 312-642-0049
Fax: 312-642-7243
URL: http://www.DBSAlliance.org

Depression & Related Affective Disorders Assoc. (DRADA)
2330 West Joppa Rd., Ste. 100
Lutherville, MD 21093
Phone: 410-583-2919
Email: drada@jhmi.edu
URL: http://www.drada.org/

National Alliance for Research on Schizophrenia & Depression (NARSAD)
60 Cutter Mill Rd., Ste. 404
Great Neck, NY 11021
Phone: 516-829-0091
TollFree: 800-829-8289
Email: info@narsad.org
URL: http://www.narsad.org

National Foundation for Depressive Illness, Inc. (NAFDI)
PO Box 2257
New York, NY 10116
TollFree: 800-239-1265
URL: http://www.depression.org

Irritability in Children With Mood Disorders Has Varying Sources
By Neil Osterweil, Senior Associate Editor, MedPage Today
BETHESDA, Md., Feb. 1 -- The extreme irritability in children with bipolar disorder appears to spring from different wells of frustration than the irritability in children with severe mood dysregulation, NIH researchers reported.

In a study comparing children with bipolar disorder or severe mood dysregulation with unaffected controls, extreme irritability sparked by a task designed to induce frustration revealed distinctly different brain activity patterns, according to Brendan A. Rich, Ph.D., and colleagues here and at the University of Maryland.

"Our results indicate that there may be different psychophysiological mechanisms and behavioral correlates associated with frustration between children with narrow-phenotype bipolar disorder and those with severe mood dysregulation," the investigators wrote in the February issue of the American Journal of Psychiatry.

The findings, if borne out by further research, could lead to better differentiation and treatment of mood disorders in children, said the study's authors.

"If future research indicates that bipolar disorder and severe mood dysregulation are two separate disorders, this could guide parents and physicians toward the right treatments," said Dr. Rich. "A good example is that medication prescribed for symptoms seen in severe mood dysregulation, such as stimulant medication, might be inappropriate for a child with classically defined bipolar disorder."

To assess whether irritability could be a diagnostic indicator for pediatric mania in bipolar disorder, the investigators looked for behavioral and psychophysiological correlates of irritability among 21 children with severe mood dysregulation, 35 with narrow-phenotype bipolar disorder, and 26 unaffected controls.

Severe mood dysregulation was defined as non-episodic irritability and hyperarousal without episodes of euphoric mood, and narrow-phenotype bipolar disorder was defined as a history of at least one manic or hypomanic episode with euphoric mood.

The children were evaluated with electroencephalography with electrodes recording signals from temporal, frontal, central and parietal sites as they performed the Posner task.

The task involved three tests in which children were asked to press a button on a screen corresponding to the location of a target. After a baseline run, the participants were told they could win or lose 10 cents for each correct or wrong response. On the third test run, the results were rigged so that the children were told they would lose 10 cents on slightly more than half of their correct responses, thereby manipulating emotional demands and inducing frustration.

After each task the children were asked to rate their responses to that task, reward, and punishment using the Self-Assessment Manikin with line-drawings showing extremes of happy or unhappy (to assess valence), or calm or aroused (to assess arousal).

The authors measured the children's mood response, behavior (reaction time and accuracy), and brain activity (event-related potentials).

They found that both the children with severe mood dysregulation and narrow-phenotype bipolar disorder reported significantly more arousal than controls when they were frustrated, but that the arousal resulted in different behavioral and psychophysiological performance between the patient groups.

For example, when frustrated, children with bipolar disorder had lower signal amplitude in the parietal lobe (P3 lead) than either children with severe mood dysregulation or controls. This difference indicates that the children with bipolar disorder have impairments in executive attention, the authors wrote.

In contrast, children with severe mood dysregulation had lower N1 (auditory evoked) event-related potential amplitude than children with narrow-phenotype bipolar disorder or controls, regardless of the emotional context. This difference reflected impairments in the initial stages of attention in the children with severe mood dysregulation, the investigators stated.

In post hoc analyses, the investigators determined that in the children with severe mood dysregulation, the N1 deficits were associated with the severity of symptoms of oppositional defiant disorder.

"Whereas the deficits in the narrow-phenotype subjects indicated impaired allocation of attention in the context of frustration, those in the severe mood dysregulation group indicated impairments in the initial stages of attention across emotional and non-emotional tasks," the investigators wrote.

"Finally, whereas the deficits in the narrow-phenotype cohort are consistent with those seen in mood disorders, deficits in children with severe mood dysregulation may reflect concurrent oppositional defiant disorder. The current study is the first to provide evidence of behavioral and psychophysiological differences between possible phenotypes of pediatric bipolar disorder," they concluded.

The investigators acknowledged that the results were confounded by the fact that the majority of children in the study with bipolar disorder were on medication, whereas most of the children with severe mood dysregulation were not medicated. There have been no studies showing that medication decreases P3 amplitude, however, suggesting that medication could not have accounted for the differences they saw in children with bipolar disorder, they wrote.

the following web links are provided for your convenience in visiting the source sites of the information displayed on this page:



1 Blehar MD, Oren DA. Gender differences in depression. Medscape Women's Health, 1997;2:3. Revised from: Women's increased vulnerability to mood disorders: Integrating psychobiology and epidemiology. Depression, 1995;3:3-12.

2 Ferketick AK, Schwartzbaum JA, Frid DJ, Moeschberger ML. Depression as an antecedent to heart disease among women and men in the NHANES I study. National Health and Nutrition Examination Survey. Archives of Internal Medicine, 2000; 160(9): 1261-8.

3 Frank E, Karp JF, Rush AJ (1993). Efficacy of treatments for major depression. Psychopharmacology Bulletin, 1993; 29:457-75.

4 Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF, Alexopoulos GS, Bruce MI, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, Parmelee P. Diagnosis and treatment of depression in late life: consensus statement update. Journal of the American Medical Association, 1997; 278:1186-90.

5 Robins LN, Regier DA (Eds). Psychiatric Disorders in America, The Epidemiologic Catchment Area Study, 1990; New York: The Free Press.

6 Rubinow DR, Schmidt PJ, Roca CA. Estrogen-serotonin interactions: Implications for affective regulation. Biological Psychiatry, 1998; 44(9):839-50.

7 Schmidt PJ, Neiman LK, Danaceau MA, Adams LF, Rubinow DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. Journal of the American Medical Association, 1998; 338:209-16.

8 Vitiello B, Jensen P. Medication development and testing in children and adolescents. Archives of General Psychiatry, 1997; 54:871-6.

Having A Confidant May Ward Off Kid's Depression

Preschool Depression May Mirror That of Adults

both articles above from medline.com - check their index gor articles En Espanol! - click here!

Poverty - The Next Generation

Smaller Baby Girls at Risk for Depression

Irritability in Children With Mood Disorders Has Varying Sources

click here!

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