Depression; It is a syndrome characterized by depression, deep sadness, sometimes both a sad and depressing emotional state, as well as slowness and stagnation in thought, speech, movement and physiological processes, as well as worthlessness, smallness, weakness, reluctance, pessimism, feelings and thoughts. Depressive disorders, similar to other psychiatric disorders, occur as a result of the interaction between genetic, familial and environmental factors. Past traumas, losses, sadness and difficulties, ongoing problems, newly emerged challenging life events, low education level, and poverty can also cause depression. Depression is mood depression that lasts at least 2 weeks. Temporary low mood during the day is not called depression
. Things to see in the two-week period:
1. Depressed mood lasting nearly all day almost every day 2. Decreased interest or desire in all or most activities 3. Significant weight loss or weight gain or significant decrease or increase in appetite 4. Sleeping too much or inability to sleep 5. Psychomotor agitation or retardation 6. Fatigue, exhaustion, or loss of energy 7. Excessive or inappropriate feelings of worthlessness or guilt 8. Difficulty thinking, focusing, or making decisions 9. Recurrent thoughts of death and suicide
The risk of depression increases from childhood to adolescence and reaches its highest level in adolescence. There is no difference between genders in the risk of depression until adolescence, but according to studies conducted in adolescence, girls are found to be at greater risk than boys. Events that negatively affect a child's life, such as the loss of a relative, an accident, sudden life changes, deterioration of the family's socio-economic situation, natural disasters, parents' divorce, separation, school failures, loveless environments, diseases, and dependence on someone else, can lead to depression. Marital conflicts between parents, perceptions of rejection by parents, and poor family relationships increase depressive symptoms. Significant relationships have been identified between parental depression and mental disorders and the depression level of children and adolescents. In some studies, low A relationship has been found between school success and depression. It is found to be more common in individuals with low socio-economic levels
Depression in Infancy
It is a normal developmental stage that occurs between the ages of 1-2. In later years, Spitz defined the situation that occurs in 6-8 month old babies who are suddenly separated from their mothers as introversion and indifference to the environment, following crying and examination, as "anaclitic depression" (Spitz, 1945; Spitz, 1965). The most important feature of this period is the limitation of communication and externalization of emotions due to the absence of speech at all and its inadequacy when it occurs. Therefore, as the child is younger, somatic expressions such as sleeping and eating disorders and skin symptoms (eczema) will come to the fore. These babies look exhausted, stagnant, dull-eyed and indifferent to their environment. They do not perform age-appropriate vocal games (googling, etc.) and hand games, nor do they show curiosity and exploration of the environment. Instead, they exhibit stereotypical patterns of behavior aimed at self-stimulation. In cases where the situation becomes more severe, the baby's psychomotor development may slow down.
Depression in Childhood
Unhappy, dysphoric temperament and depressive appearance (or both) in children persist for a period of days to weeks. is the situation. Depression in children can also be defined as a constant state of unhappiness and a state of joylessness that reduces the child's joy and creativity (Tüzün, 1993). The depressive mood is conveyed by expressions such as "I can't do it", "I don't know", "I'm tired". However, attitudes such as aggressive and impulsive behavior, stealing, lying, running away from school or home may be used to counteract depressive emotions. School failures are present in almost every case. Depression in school-age children can also be seen as withdrawal, deterioration in peer relationships at school, academic failures, decrease in interest and activities, and inability to concentrate. Disorders such as enuresis, encopresis, and somatic complaints such as headaches and abdominal pains can also be considered among the depressive symptoms of this period.
A child may have long-term depression or Dysthymia is diagnosed when the person becomes irritable. The difference between dysthymia and major depression depends on the severity and persistence of symptoms. Major depression is more severe but subsides after a few months. Dysthymia has less obvious symptoms but is chronic. In short, it is a bored mood that causes long-term chronic depressive behaviors. Major depression is an important disorder that should be taken into consideration, with significant impairments in social and school functionality.
Depression in Adolescence
Adolescence is a transition period in which sexuality awakens and the body becomes sexualized due to the development of secondary sexual characters. . During this transition period, the spiritual structure must also keep up with these physical changes and cope with new conflicts as well as old conflicts that flare up with the change. The decompensation that may occur when the psychological structure cannot cope with these conflicts may also be depression.
It is the period that most overlaps with adult depression. Adolescents experience sudden changes in their emotions, thoughts and relationships depending on the period they are in. Depressed adolescents may experience these changes more quickly, and similar to adults, they may show symptoms of depression such as social withdrawal, decrease in interest and activity, deterioration in friendships, decrease in school success, escaping from school and home, tendency to use substances and alcohol, and suicidal thoughts and attempts. A tendency to wear black clothing, write gloomy poetry, or engage in music with depressive themes can be common depressive symptoms. Sleep problems may include watching television all night, difficulty waking up for school, or sleeping throughout the day. It can usually be seen as a lack of interest in pleasurable activities, withdrawal from friends, or being alone in the bedroom. Boredom may be a result of depressed mood. Unhappiness becomes uneasy and anxious, a state of uncontrollable anger is experienced, and a sense of guilt prevails (Morgan, 2000). Depression in adolescence can also be seen together with behavioral disorders, substance use or eating disorders.
The rate of major depressive disorder in school-age children is 1.5%-2.5%, and in adolescents, this rate is between 15%-20% (Graber and Sont ag, 2009). By the age of 15, female adolescents are twice as likely to experience depression as male adolescents. Some of the reasons for this gender difference are:
1. Women tend to think over and over again about the consequences and causes of their depressive mood and tend to exaggerate it. 2. Women's self-image, especially their body image, is more negative than men's. 3. Women experience more stress than men regarding weight-related issues. 4. Women are exposed to discrimination more than men. 5. Hormonal changes may increase susceptibility to depression during adolescence, especially among girls.
Treatment
The path to be followed in the treatment of child and adolescent depression should be parallel to the path followed in clinical evaluation. That is, it should take into account the child's age and developmental level. In choosing mother-child therapy, family therapy, individual therapy and antidepressant treatment, the severity of the condition and other accompanying pathologies should be taken into consideration, as well as the age of the child. Antidepressant treatment in adolescents has a special feature due to the possibility of depression hiding the underlying psychotic structure.
Cognitive Behavioral (BD) approaches and interpersonal psychotherapy strategies are effective for the treatment of depression. The aim should be to reduce negative cognitions, increase the adolescent's participation in positive activities, support an optimistic perspective, and manage interpersonal and psychosocial stressors. In this context, practices aimed at adolescents include coping training, social problem solving, social skills, communication skills training, cognitive behavioral therapies for stress management, in order to change irrational beliefs and pessimistic attributions, negative self-perception and improve interpersonal skills, and to reduce variable reactions in response to stress. It includes emotional regulation strategies. It is also reported that family-based psychoeducation initiatives are also effective and that it would be appropriate to implement them in a school-based way.
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