Depression Across the Lifespan
Although depression is usually first noticed during the teen or early adult years, a person can have an episode of depression at any age. Without treatment, an episode can last six months or longer.
Children and Adolescents
Depression may have a slightly different set of symptoms when a child or teen has it. Children and adolescents may be more likely to have symptoms like unexplained aches and pains, irritability and social withdrawal. On the other hand, symptoms more likely to affect adults include slowed speech and activity, sleeping too much and believing things that aren't true (delusions).
Depression in children may co-occur with anxiety, disruptive behavior disorders or attention deficit disorder. Children should be treated by a physician with knowledge and experience in treating children with mood disorders. Parents, teachers and health care professionals should be familiar with symptoms of mania, including:
- Increased irritability
- Increased self-esteem
- Decreased need for sleep
- More talkative than usual
- Racing thoughts; lots of ideas at once
- Being eaisly distracted
- Increase in goal-directed activity or physical activity
- Excessive involvement in pleasurable activities
Medication choices for people under 18 years old should be made and monitored carefully. Ask children who take antidepressants often how they are feeling and encourage them to be honest with someone about any major mood changes, especially thoughts of suicide. Educate children in age-appropriate ways about symptoms that mean trouble and need to be reported right away. Make sure they have several phone numbers of support people they can call if they have trouble with worsening symptoms.
Parents should also know the signs of suicidal thoughts such as:
- Giving away possessions or making plans for a future when they are gone
- Talk of unbearable feelings or situations
- New or more thoughts of suicide or death
- New or worse depression
- New or worse anxiety
- Feeling very agitated or restless
- Panic attacks
- Difficulty sleeping (insomnia)
- New or worse irritability
- New or more social isolation
- Attempts to commit suicide
- Acting aggressive, being angry or violent
- Acting on dangerous impulses
- Increased use of alcohol or substances
- Being extremely hyperactive in actions and speech
- Other unusual changes in behavior, including a sudden sense of calm as if a final decision has been made
Health care providers, parents and their children must weigh the risks of treating depression compared to the risks and lifetime impact of untreated depression and suicidal ideation. They should discuss all treatment choices, not just the use of antidepressants. All adults who interact with the child should become familiar with all suicide warning signs, regardless of what treatment the child is receiving. In addition, parents should educate teachers about what behavior they must report.
Depression is not a normal part of growing older.
Older adults may be going through changes such as children moving away, illness, moving to assisted living facilities or the death of loved ones. All of these things can cause feelings of sadness or grief. But when feelings of sadness last for a significant length of time and keep older adults from enjoying life the way they used to, it may be a sign that they should seek treatment.
Depression treatment is especially important for older adults because they may have a greater risk of suicide. Loved ones should watch for signs such as preoccupation with death, increased visits or calls, hopeless statements or refusal to follow doctors' recommendations for medication or diet plans.
Other illnesses may also be an issue for older adults with depression. Older adults should have complete physical examinations and their health care providers should be informed about all medications they take for all illnesses. Some medications for other illnesses may trigger symptoms of depression or have side effects that look and feel like depression.
It can help older adults have a group of people to talk to who have had similar experiences and can understand and offer support. They may feel apprehensive or ashamed at first, and not want anyone to know they are coping with a mood disorder. Most people of all ages in DBSA support groups also struggled with these feelings at first and can offer insight and support.
Older adults are also encouraged to start support groups for older adults that meet earlier in the day, are accessible to people with disabilities, are closer to people's homes or meet other special needs. DBSA Support Groups [link] are confidential and free of charge.
After more than 60 years living with depression, I was able to find relief. Though I've recently had some setbacks in my recovery, I've worked hard to keep to a normal routine as much as possible - a healthy diet, medication, electroconvulsive therapy (ECT), talk therapy, volunteer work and DBSA support groups. The most important thing I've needed to get me through the hard times has been the support of my friends. Though it can be very tempting to isolate myself, it's so helpful to be reminded that I'm loved and of value and that my depression will pass.
I'm grateful for so many things that have happened on my way to recovery: the perspective I've gained from keeping a journal of my progress, the persistence of my doctors when I didn't respond to conventional treatments, the support of the people who care about me, and the many opportunities I've had to learn and grow---most recently attending the DBSA Conference. I learned a great deal and came in contact with many responsive and understanding people.
Another thing that's important to me today is encourageing others who have depression or another mood disorder to keep fighting and never give up hope. Today I try to reach out to others any way I can. In helping them, I also help myself.
Depression Across Cultures
Different cultures interpret the symptoms of depression in different ways. In Latino and Mediterranean cultures, people may report symptoms such as nervousness or headaches. In Asian cultures, depression may be described as tiredness, physical weakness or imbalance. In Middle Eastern and Native American cultures, depression may be described as heart problems or heartbreak.
It is important for people with symptoms of depression to tell their health care providers if they feel their unique personal or cultural experience is not being understood. Health care providers should learn something about the background and beliefs of each patient. This can help with diagnosis as well as treatment.