By Eman Basil EL SabbaghProf. Dr Hesham Safouh unit

Are they sad or Are they depressed?

If a child or teenager’s symptoms become

persistent, disruptive, and interfere with social

activities, interests, schoolwork and family life,

he or she may be depressed.

Depression is one of the most common

complications of chronic illness.

It is estimated that up to 1/3 of individuals with a

serious medical condition experience symptoms of

depression.

Common chronic diseases

associated with depression Cancer e.g. leukemia, lymphomas

Respiratory e.g. Asthma, Cystic fibrosis

Renal e.g. Chronic renal failure

Hematological e.g. Hemophilia, Thalasemia

Rheumatology: e.g. SLE, Rheumatoid artheritis, FMF

Endocrine e.g. Diabetes

Neurological e.g. Epilepsy, myopathy

Cardiology e.g. Heart failure, Rheumatic heart disease

HIV, HBV, HCV

Metabolic diseases e.g. wilson, gaucher, niemannpick

It is very tricky to diagnose

depression in a chronically ill child

Some of the symptoms of depression

may overlap the symptoms of the

chronic disease e.g.

Tiredness

Lose of interest in activities

eating more,

Difficulty to concentrate.

if child feels sad or gloomy most of the time, has lost

interest in his usual activities for 2 or more weeks, and

shows some of the other symptoms listed, he may have

depression.

Symptoms of depression in a child

1. Grumpy, irritable or sad mood

2. Loss of interest or enjoyment in activities that she typically finds fun

3. Inappropriate feelings of guilt, worthlessness, inadequacy, or incompetence

4. Poor or increased appetite; weight gain or loss

5. Insomnia, or sleeping more than usual

6. Low energy or exhaustion after doing simple tasks

7. Feelings of hopelessness

8. Decrease in productivity (e.g., being absent from school more than usual, cutting classes, or a drop in grades)

9. Trouble thinking or making decisions

10. Outbursts of shouting, complaining or crying

11. Excessive boredom

12. Loss of interest in friends and poor communication with people

13. Fear of death

14. Sensitivity to rejection or failure

15. Acting recklessly

How is a child's life affected

by a chronic disease?

Discomfort or loss of energy

Restriction of activities

Disruption of his life due to medical

treatment

Isolation from family and friends

Feeling self-conscious, embarrassed, or

stigmatized if his disease makes him

different from other people

1) The symptoms of the

chronic disease.

The symptoms that are caused by the chronic

disease may be stressors that lead to

depression.

2) Treatments for chronic

disease

How a child's chronic disease is

treated medically may lead to

depression in two ways:

1. The medications for the chronic

disease may cause depression e.g.

prednisone and phenobarbital

2. The treatment regimen may be

difficult to follow. Or needs relying on

other people to help him with her

treatment

3) The sporadic nature of the

chronic disease

Most chronic diseases have symptoms

that come and go e.g. SLE.

The uncertainty can be very upsetting.

The child may feel helpless and out of

control, which may result in depression.

4) Loss of social contact with

people A child's chronic disease may cause

him to lose contact with people for many reasons:

1. He may have less energy or less time to do things he finds pleasurable.

2. Healthy friends may assume that he cannot act like them so they spend less time with him.

3. In immune deficient children, parents tend to isolate their children to protect them from any possible source of infection

5) The chronic disease may

be stressful to the family Family members may have to take on new roles

they may be disappointed that they can no longer participate in activities that they all used to enjoy together.

They might feel some how blamed for their child illness which can be reflected in form of overprotection or negligence

6) Chemicals in the brain

For example, pain from a child's chronic

disease may be related to too little

serotonin. Lack of serotonin also causes

depression

Why is depression a problem

for children with a chronic

disease?

Depression is harmful whether or not a child

has a chronic disease

However, if a child has a chronic disease

and is also depressed, the problems are

compounded

Why is depression a problem for

children with a chronic disease? (

Cont.)

1- Chronic disease symptoms may increase or get worse.

2-The risk of dying from the chronic disease is increased when the child is depressed.

3-Child may be hospitalized more frequently and for longer durations.

4-The child may not be motivated to take good care of himself if he is depressed.

Role of parents Parents can help by being present for all procedures,

staying with their child (when possible) during hospitalizations and interacting with them as much as possible

Parents can help by allowing children to help in the management of their illness (with supervision), as this increases compliance.

Parents should also reassure their children that the illness is not their fault

Parents should help facilitate their child’s participation in school or other activities to the extent allowed by the child’s doctors. Parents should avoid being over protective

Role of Physicians Develop new coping strategies for the chronic disease e.g.

1- positive reappraisal (reassessing the disease in a positive light)

2-putting in perspective (making a rational assessment of the impact of illness)

3- positive refocusing (shifting one’s thoughts to pleasant matters)

4-focusing on planning (using one’s energy to plan for the future, and make the best of the situation)

Change the medication used to treat the chronic disease if depression is a side-effect of the drug

Enroll the child or family in a support group

Have the child seen in individual psychotherapy or begin family therapy

Change the child's lifestyle to reduce stress levels e.g. healthy food and enough sleep

Take medication for the depression

Role of society

Awareness campaigns for children at

schools

Funding psychotherapy centers that

treat chronically ill children for free

Arranging events for the sick children to

meet and have fun