Word: fassler
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Dates: during 1990-1999
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...long ago, many psychiatrists argued that children and young teens could not get depressed because they were not mature enough to internalize their anger. Today, says Fassler, "we realize that depression does occur in childhood and adolescence and that it occurs more often in children than we previously realized...
...psychiatrists pick out kids who are depressed from those who are simply moody? In his book "Help Me, I'm Sad," Fassler lists a number of physical symptoms in three age groups--preschoolers, young school-age children and adolescents. Among preschoolers, the signs include frequent, unexplained stomachaches, headaches and fatigue. Depressed school-age children frequently weigh 10 lbs. less than their peers, may have dramatic changes in sleep patterns and may start speaking in an affectless monotone. Adolescents go through eating disorders, dramatic weight gains or losses, promiscuity, drug abuse, excessive picking at acne, and fingernail biting to the point...
...Fassler cautions that none of these symptoms may ever be present and a whole constellation of more subjective manifestations must be considered. Adults and adolescents share many of the same warning signs--low self-esteem, tearfulness, withdrawal and a morbid obsession with death and dying. Among adolescents, however, depression is often accompanied by episodes of irritability that, unlike mood swings, stretch for weeks rather than days...
There are several other complicating factors. Some psychiatrists believe depression in younger children often appears in conjunction with other disorders. "Many depressed kids," notes Fassler, "are initially diagnosed with ADHD or learning disabilities. We need to separate out the conditions and treat both problems." But there's a chicken-and-egg problem here: antisocial behavior or a learning disability can lead a child to become isolated and alienated from peers and thus can trigger depression. And depression can further interfere with learning or bring on antisocial behavior...
Most psychiatrists, despite their enthusiasm for the new antidepressants, write prescriptions for only six months to a year and taper the dosage toward the end. Even Fassler admits, "We try to use medication for the minimum amount of time possible. And with a younger child, we're more cautious about using medication because we have less research concerning both the effectiveness and the long-term consequences and side effects." Says Michael Faenza, president of the National Mental Health Association: "I feel very strongly that no child should be receiving medication without counseling. Medication is just one spoke in the wheel...