By Sanjay Chugh August 2001 Each year thousands of teenagers commit suicide in India. It is because depression is now increasingly bedeviling both children and adolescents Depression is not a disease limited to the adult population. Teenagers also suffer depression, which is a treatable illness. Depression in adolescence could best be understood as an illness when the feelings of depression persist and interfere with a child or adolescent’s ability to function. A significant percentage of children and adolescents suffer from depression at any given time. In my practice, I have seen this number growing at a rapid pace over the last few years. Children who are stressed, have experienced loss, or those who have attention-related learning, conduct or anxiety disorders, are at a higher risk for depression. Depression also tends to run in families. The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters. SIGNS OF DEPRESSION If one or more of the following signs of depression persist, parents should seek help for their children: • Frequent sadness, feeling low or weepy • Hopelessness • Decreased interest in previously favorite activities • Persistent boredom, low energy • Increased social isolation, poor communication • Worthlessness, low self-esteem • Feelings of guilt • Extreme sensitivity to rejection or failure • Increased irritability, anger, or hostility • Difficulty with relationships • Frequent complaints of headaches and stomachaches • Frequent absences from or poor performance in school • Poor concentration • Major change in eating and/or sleeping patterns • Talk of or efforts to run away from home • Thoughts or expressions of suicide or self-destructive behavior A child who often played with friends may now spend more time alone and without interests. Things that the teenager enjoyed now bring little joy. Children and adolescents who are depressed may say they want to die or may talk about suicide. Depressed children and adolescents are at increased risk of suicide. Depressed adolescents may abuse alcohol or other drugs as a way to feel better. Children and adolescents who cause trouble at home or at school may actually be depressed. Because they may not always seem sad, parents and teachers do not realize their behavior is a sign of depression. When asked directly, these children sometimes state they are unhappy or sad. SUICIDAL SYMPTOMS Suicide among young people nationwide has increased dramatically in recent years. Each year in India, thousands of teenagers commit suicide. Shockingly, suicide is one of the leading causes of death for 15 to 24 year olds. Adolescents experience strong feelings of stress, confusion, self-doubt, pressure to succeed and financial uncertainty, besides other fears while growing up. For some teenagers, parental divorce, starting a new family with stepparents and siblings, or even moving to a new place can be very unsettling, intensifying self-doubt. In a lot of these cases, suicide appears to the teenagers as a ‘solution’ to the problem they are currently facing. Many symptoms of suicidal feelings are similar to those of depression. Parents should be aware of the following behavioral and emotional symptoms in adolescents who may attempt to kill themselves: • Change in eating and sleeping habits • Withdrawal from friends, family and regular activities • Violent actions, rebellious behavior, or running away • Drug and alcohol use • Unusual neglect of personal appearance • Marked personality change • Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue • Loss of interest in pleasurable activities • Not tolerating praise or rewards. A teenager who is planning to commit suicide may also: • Complain of being a bad person or feeling ‘rotten inside’ • Give verbal hints with statements such as: ‘I won’t be a problem for you much longer’, ‘Nothing matters’, ‘It’s no use’, and ‘I won’t see you again’ • Put his affairs in order, for example, give away favorite possessions, suddenly clean his room, throwing away important belongings. • Become suddenly cheerful after a period of depression • Have signs of psychosis (hallucinations or bizarre thoughts) If a child or adolescent says: ”I want to kill myself” or ”I’m going to commit suicide”, always take the statement seriously and seek evaluation from a child and adolescent psychiatrist or another physician. People often feel uncomfortable talking about death. However, directly asking the child or adolescent whether he or she is depressed or thinking about suicide can be helpful. Rather than ‘putting thoughts in the child’s head’, such a question will provide assurance that somebody cares and will give the young person the chance to talk about problems. If one or more of these signs occur, parents need to talk to their child about their concerns and seek professional help when the concerns persist. With support from family and professional treatment, children and teenagers who are suicidal can heal and return to a healthier path of development. MANAGING THE PROBLEM Depression and suicidal feelings are treatable mental disorders. The child or adolescent needs to have his or her illness recognized and diagnosed, and appropriate treatment plans developed. When parents are in doubt whether their child has a serious problem, a psychiatric examination can be helpful. Early diagnosis and medical treatment are essential for depressed children. This is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy, including the use of antidepressant medication. For help, parents should consult a qualified psychiatrist, who can diagnose and treat the depression. It is not a condition that can be wished away or ignored. It is real and very frightening for the person suffering it, and can prove fatal if proper and timely management is not ensured.
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