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This book is about depression in children and teenagers during their school years, from five to eighteen. It is written primarily for parents, but we hope that teachers, social workers, health visitors and family doctors will also find it useful.
Why do parents need to know about possible depression in their children? All children get sad and miserable from time to time. Sometimes it is difficult to know if such normal unhappiness needs special attention. We aim to help parents in this situation.
Like a plant, depression grows because a particular seed (perhaps psychological, such as a loss, or perhaps physical, such as a viral infection) has been planted in soil that is good for growth. The child’s genes or inherited characteristics, the child’s personality and the child’s early experiences can be seen together as the soil in which the seed is planted. Just as both seed and soil are necessary for plant growth (you won’ t get much plant unless you have both of these), so when we look at depression we need to look at both the seeds – the stresses or triggering events – and the nature of the child at the time these events occur. It would be meaningless to say that one or the other is the cause: both are necessary.
We thought there was something wrong because he was unhappy – he’s normally a very happy cheery boy, outgoing, wants to be with friends, playing with friends. But he didn’t want to see his friends, even on weekends, for example, when he was able to, he didn’t want to. And just looking down and, you know we talk quite often, but there would be lots of tears and that was not like him at all. So, we realized that something was very, very different.
In the previous chapter we discussed some of the things all parents can do to help build children’s resilience and help reduce their chances of developing depression. But there are also some specific stresses that are known to be associated with depression in children and teenagers. When children suffer from depression, it is always important to think of the events that might have triggered the problem. In some children, the stress that has brought on the problem will be obvious; in others it will be far from clear. In this chapter, we focus on six of the most common stresses experienced by children and young people (experiences of loss; parental conflict and separation; academic pressure; bullying and online abuse; gender identity issues; and physical ill health), and discuss what parents can do to help children who face such difficulties.
If you think it is likely that your child or teenager is indeed suffering from depression, you will first want to try to work out why. Often parents are concerned that this is their fault, or that they are somehow to blame for their child’s depression. Or you may be worried that something has happened in your child’s life to cause the depression which they haven’t told you about.
In the United Kingdom, all those involved with supporting the physical and mental health of children and young people are expected to take into consideration the guidelines produced by the National Institute for Health and Care Excellence (NICE). NICE’s most recent recommendations on the treatment of depression in children were published in 2019, and it includes a lot of helpful advice, mostly based on good research evidence.
Although this is a book primarily for parents, we think it right to point out that there is a great deal that governments could do to make it easier for parents and teachers to help children avoid emotional problems. The policy measures we list below would help parents, teachers and children themselves reduce the frequency of clinical depression in the young. Perhaps some parents might use their influence and their votes to bring about changes in these directions.
This chapter summarises some of what we know about depression: how common it is in young people, where it comes from and what are the things that research suggests may increase or decrease the likelihood of a young person developing depression. We also explain what we know about the most likely outcomes for those who do experience depression.
It is at least possible that you have picked this book up because you are wondering if your own child or teenager, or one whom you know, is suffering from depression. Is there any clear-cut indication which will tell you whether what you are noticing is just normal behaviour or a sign of clinical depression? Unfortunately, the answer may not be straightforward and we shall not pretend that it is.
Has your daughter lost her sparkle? Has everyday life become a trial for your son? This book, written by two experts in child and adolescent mental health, describes how to recognise depression and what causes it; and provides guidance on how parents can support their child, including up-to-date advice on seeking professional help. It gives advice on how to tell the difference between normal responses to stress and symptoms that are more concerning. It covers topical issues such as academic pressure, social media, getting a grip on screen time and cyber-bullying. You will also be given information about the different treatment options provided by child and adolescent mental health services, as well as practical advice and information about the support you can give at home.
EPA and DHA are required for normal cell function and can also induce health benefits. Oily fish are the main source of EPA and DHA for human consumption. However, food choices and concerns about the sustainability of marine fish stocks limit the effectiveness of dietary recommendations for EPA + DHA intakes. Seed oils from transgenic plants that contain EPA + DHA are a potential alternative source of EPA and DHA. The present study investigated whether dietary supplementation with transgenic Camelina sativa seed oil (CSO) that contained EPA and DHA was as effective as fish oil (FO) in increasing EPA and DHA concentrations when consumed as a dietary supplement in a blinded crossover study. Healthy men and women (n 31; age 53 (range 20–74) years) were randomised to consume 450 mg/d EPA + DHA provided either as either CSO or FO for 8 weeks, followed by 6 weeks washout and then switched to consuming the other test oil. Fasting venous blood samples were collected at the start and end of each supplementation period. Consuming the test oils significantly (P < 0·05) increased EPA and DHA concentrations in plasma TAG, phosphatidylcholine and cholesteryl esters. There were no significant differences between test oils in the increments of EPA and DHA. There was no significant difference between test oils in the increase in the proportion of erythrocyte EPA + DHA (CSO, 12 %; P < 0·0001 and FO, 8 %; P = 0·02). Together, these findings show that consuming CSO is as effective as FO for increasing EPA and DHA concentrations in humans.
Increasingly, claims are being made by developmental neuroscientists that adolescence is characterised by unique changes to the brain. These changes are said to underlie what are claimed to be unique behavioural features of the teenage years. In this paper, it is argued that the brain changes described begin before the teen years and continue long after them. This is not surprising, as there are no behavioural features that are specific to adolescence.
EPA and DHA are important components of cell membranes. Since humans have limited ability for EPA and DHA synthesis, these must be obtained from the diet, primarily from oily fish. Dietary EPA and DHA intakes are constrained by the size of fish stocks and by food choice. Seed oil from transgenic plants that synthesise EPA and DHA represents a potential alternative source of these fatty acids, but this has not been tested in humans. We hypothesised that incorporation of EPA and DHA into blood lipids from transgenic Camelina sativa seed oil (CSO) is equivalent to that from fish oil. Healthy men and women (18–30 years or 50–65 years) consumed 450 mg EPA + DHA from either CSO or commercial blended fish oil (BFO) in test meals in a double-blind, postprandial cross-over trial. There were no significant differences between test oils or sexes in EPA and DHA incorporation into plasma TAG, phosphatidylcholine or NEFA over 8 h. There were no significant differences between test oils, age groups or sexes in postprandial VLDL, LDL or HDL sizes or concentrations. There were no significant differences between test oils in postprandial plasma TNFα, IL 6 or 10, or soluble intercellular cell adhesion molecule-1 concentrations in younger participants. These findings show that incorporation into blood lipids of EPA and DHA consumed as CSO was equivalent to BFO and that such transgenic plant oils are a suitable dietary source of EPA and DHA in humans.