Treatment of Depression in Children and Adolescents
Although many youth experience transient episodes of sadness, Major Depressive Disorder is marked by pervasive feelings of despair, apathy, irritability, social withdrawal, hopelessness, and poor self esteem, which affect all spheres of a child’s life. The incidence of clinical depression has increased in recent years. The reasons for this increase are uncertain, but the COVID pandemic, effects of social media, and mounting pressures to succeed may all be contributors. Regardless of the cause, the clinicians at The Midtown Practice recognize that any treatment must be individualized for a specific family and child, and is determined by both clinical recommendations, familial culture and circumstances. After a thorough assessment by one of our skillful clinicians, we recommend a comprehensive approach that might include psychotherapy (“talk therapy”), behavioral and lifestyle modifications, family psychoeducation, coping strategies, and at times pharmacological interventions. Although medication is almost never our initial step, there are instances when it can be helpful even on a temporary basis, until a child is able to resume normal activities and functioning.
It is often stated that the best treatment is prevention. Targeted psychotherapy can be used to prevent new onset or recurrent depression. At risk children or teens that have experienced loss, bullying, family conflict, or physical illness can benefit from speaking to a therapist. When a pediatrician, teacher, or caregiver notices subthreshold changes in a child’s mood, early intervention can often prevent a full blown depression. Those with a diagnosis of Major Depression in remission can also benefit from regular support and psychotherapy to make them less vulnerable to recurrent episodes.
Treatment planning should be collaborative with parents, families, and the affected child. At The Midtown Practice, we understand the ways in which your child’s depression has affected your entire family, and how anxiety provoking it is to worry about your child. With education, stigmatization improves and families feel empowered and hopeful about their child’s future. At The Midtown Practice, we believe knowledge is power, and a diagnosis does not determine life course, but is rather a guide for treatment and return to normal function.
Psychotherapy, or talk therapy, is a general term for treating emotional struggles by talking to an experienced clinician, such as a Therapist, Psychiatrist, or Psychiatric Nurse Practitioner (PMHNP). At The Midtown Practice, our skillful clinicians can help you and your child learn to identify their moods and feelings and understand the negative thought patterns and behaviors that might reinforce their depression. Psychotherapy can help your child or adolescent feel less alone, and teach them to respond rather than react to challenging situations. We teach healthy coping skills that your child can apply outside the office in real world circumstances.
There are many types of psychotherapy, each with their own philosophy and approach. At The Midtown Practice, we employ a variety of strategies, drawn from evidence based practice, and tailored to your child’s age, life experience, and personality. The goal of psychotherapy is to reduce discomfort, learn to manage unhealthy or unproductive behaviors, recover from trauma, resolve conflict, and return to a normal productive life.Our clinicians are trained in various specialties such as Dialectical Behavioral Therapy, Cognitive Behavioral Therapy, Psychodynamic Therapy, Supportive Therapy, Acceptance and Commitment Therapy, and Cognitive Processing Therapy. They will use these modalities alone or in combination, depending on the individual needs of your child.
Our goal is to achieve remission of symptoms and tangible improvement in social, academic, and family life. We will also teach the tools to identify triggers and identify signs to prevent relapse. Generally, there is little risk in engaging in psychotherapy, however, it is possible when exploring and/or learning how to manage difficult emotions to be emotionally uncomfortable at times. Sometimes more difficult issues arise, which our experienced clinicians are prepared to address should that occur. We work hard at the Midtown Practice to find a clinician well matched with you and your child, who can provide you with a safe and trusting environment to achieve the best results possible.
At The Midtown Practice, our general philosophy is that less medication is better, especially in the pediatric setting. However, there are instances when medication can be a safe and effective treatment for those suffering from depression. We rarely recommend medication as a first line course, but rather use it in combination with psychotherapy. The decision to prescribe medication depends on the severity of your child’s depression, the extent it interferes with their school work, social life, and everyday functioning or if your child is experiencing thoughts of harming themselves. At times, medication is recommended when psychotherapy or another treatment alone is ineffective. Medication can be prescribed similar to training wheels on a bicycle. In these instances, the medication can be used to temporarily relieve symptoms while a child learns to manage their emotions within the context of therapy, and then is tapered once a child achieves adequate progress in our care.
There are several types of medication that can help with symptoms of depression. Although they often have confusing names, they generally fall into discrete categories. These include antidepressants such as Selective Serotonin Reuptake Inhibitors (such as Zoloft, Prozac, and Celexa), Antidepressants called Selective Serotonin and Norepinephrine Reuptake Inhibitors (such as Effexor XR or Cymbalta), Anti Anxiety medications called benzodiazepines (such as Ativan or Klonopin), Atypical Antipsychotics (such as Abilify or Latuda). After thoroughly discussing and weighing the risks and benefits with you, your clinician at The Midtown Practice will make a recommendation best suited for your child and family, constantly reevaluating to make sure progress is being made.
Behavioral and Lifestyle Modifications
Through self monitoring of daily lives and reactions, your child can learn to identify specific triggers, physical sensations, and thoughts that signal and perpetuate depressed emotions. Perhaps your child can benefit from greater structure, more exercise, or avoidance of certain foods. Your clinician might also teach relaxation and mindfulness techniques, such as diaphragmatic breathing or progressive muscle relaxation. Multiple studies have shown that these methods ease the nervous system, and effectively manage subjective and objective symptoms of depression..
Diaphragmatic breathing involves breathing slowly and deeply from the diaphragm to facilitate a relaxation response. Sometimes we combine this type of breathing with mindfulness exercises, such as counting your breaths, intentionally making your exhalation longer than your inhalation. Progressive muscle relaxation involves tensing and relaxing muscles throughout the body, beginning with the lower extremities and moving upward the length of the body. Other mindfulness exercises, such as focusing on the senses, mindful walking or paying attention to how your body moves when you walk slowly, or taking a 3 breath hug with your child can also help them regulate their emotions. Our skillful clinicians know how to adapt these techniques to your child’s age, symptoms, and temperament in order to achieve the highest level of success.
At The Midtown Practice, we know how important it is to include you and your child in all treatment decisions, and spend whatever time is necessary to ensure success. We are dedicated to helping young people early and comprehensively, so that they can mature into healthy, well adjusted adults living the full and meaningful lives of their own making.