No Child’s Play – Coping with depression and anxiety — (The Hartford Courant)

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The Hartford Courant

Five-year-old Alex Crawford worries about everything. He frets that dogs might hurt him; that if his sister touches his plate, he’ll get germs; that his family’s car might run out of gas.

His mother, Sue, knew he needed help and took him to a psychiatrist who thought Prozac might help him.

But after two weeks on the medication, his behavior went from anxious to angry. He began to disobey and to have squabbles with friends. On a shopping trip, the normally reserved and compliant child became so frustrated, he fell to the floor in a screaming tantrum and then pulled down a rack of clothes.

“I was very concerned,” said Sue Crawford, who along with her husband adopted Alex several years ago. “I could live with an anxious child, but I couldn’t live with an angry one. It was very scary to have a child go from one extreme to another.”

The doctor took him off Prozac, but it took so long for the angry behavior to disappear, they began to wonder if it would. After several weeks, the anger subsided and the old Alex returned. When the doctor suggested another medication for Alex, his parents were hesitant to go that route again.

For many parents, just getting the news that a child has anxiety or depression can be crushing; having to decide among treatment options is not only confusing but frightening.

On the one hand is the fear that if they don’t find a good treatment, the situation might deteriorate, and at worst, a child could become suicidal.

On the other is the fear – inspired by the “black box warning” slapped on antidepressants two years ago – that medication could lead to an increase in suicidal thoughts. And then there are any number of lesser side effects ranging from headaches to agitation to stomachaches.

Not so long ago, parents almost never faced these questions. Dr. David Fassler, a child-and-adolescent psychiatrist in Burlington, Vt., said that when he was in medical school in the 1980s, textbooks had no chapters on depression in youngsters.

“We were actually taught that kids didn’t get depressed because they weren’t emotionally mature enough to experience depression,” said Fassler, who is the author of “Help Me, I’m Sad: Recognizing, Treating and Preventing Childhood and Adolescent Depression.”

But in the past two decades, the understanding of mental illnesses in children has greatly expanded, as has the numbers of children and adolescents being treated for depression and anxiety.  [This is not accurate; what has expanded is the number of diagnoses invented to label and medicate kids.  As Ales’s story demonstrates, drugs do not improve behavioural challenges – Ed]

The American Academy of Child and Adolescent Psychiatry says about 5 percent of American children under age 18 are seriously depressed. The prevalence of anxiety is 13 percent for children ages 9 to 17.

Fassler said that after reviewing research on children and teenagers, he believes the figures on depression are higher, that one in four children will experience a serious episode before they turn 18.

In any case, the numbers of kids needing psychiatric help far exceeds the services available. There simply aren’t enough child psychiatrists, child psychologists, treatment centers and hospital beds for children with mental disorders. Often kids have to spend weeks or months waiting for help.

At the Wheeler Clinic in Plainville, which offers mental health services to children and adults, Susan Walkama, director of children’s outpatient services, said the demand for services increases at a rate of about 20 percent each year.

She estimates that 30 percent to 45 percent of the 500 or more children receiving services in the outpatient clinic have an emotional problem related to depression or anxiety.

Kids with more severe problems who require hospital or residential care often must spend days in an emergency room while awaiting an open bed in a psychiatric hospital.

Even worse are the kids who never get help. Researchers estimate that 80 percent of children with emotional or mental disorders never receive appropriate treatment. More than 70 percent of children with significant mood disorders such as depression remain undiagnosed or under-treated.

Sean, who asked that his real name not be used, is a well-spoken youth near the top of his 10th grade class in a Hartford-area high school. But as a young child, he was the kid the others picked on all through elementary school. He’d cry, and that would only encourage the teasing.

By the time he was in fifth grade, his precocious writings began to center on only the dark and dismal. Death was a frequent theme. His English teacher was concerned and called his mother, Donna, who also asked that her real name not be used.