Are anti-depressant drugs the answer for childhood depression? Dr. Achal Bhagat writes

M3 India Newsdesk Oct 10, 2018

On World Mental Health Day, Dr. Achal Bhagat, a noted Psychiatrist highlights the need for recognising and addressing rising mental health issues among the youth in our country, also highlighting the alarming rise of anti-depressant prescription for childhood depression.

 




The youth in India find themselves alone. They feel no one is available to understand their experiences or needs.

Most young people have two significant mental health needs:

  • To search for their own identity or uniqueness
  • To be accepted and understood by someone

For many years overt and covert messages from our society have been that to be accepted you have to be an academic genius and to be unique you have to be more of the same.

In the last ten years or so this has changed and you can be seen to be successful even if you are not an engineer or a doctor but the time frame of success has become shorter. You cannot think of success at twenty-nine you have to prove yourself by the nineteenth birthday and live up to icons like Virat Kohli and Sunder Pichai.

Everyone is not a Pichai. Everyone does not need to be one. Most people are ordinary with their strengths and difficulties. But all people have a right to fulfill their potential and not be prejudged and labelled as a “failure”.


Setting unrealistic goals & wrong definitions of success

In most of their adolescent years rather than forming an identity for themselves the youth in India today chase performance targets set by a narrow definitions of success of academic performance or of social performance.

These targets are so narrow and the young persons’ view of their success is so ‘all or none’ that most of the young people do not see themselves as successful. This constant apprehension of failure contributes to the demoralisation of a generation.


The familial context of young people today is not a happy one. Many a time, they are faced with a family striving hard to survive, poor on communication skills, disempowered women, covert marital discord between parents and with inconsistent and directive parenting skills.

There is also a high incidence of domestic violence, childhood sexual abuse and exploitation of children. All these factors do not allow the young person to explore their potential, they have to survive and keep on seeking approval and assurance about themselves.

This makes the young people vulnerable to mental health problems. For the children who face deselection, ongoing criticism and labelling, mental health difficulties become more prominent. The psychosocial impact of trauma makes their reality difficult to define and cope with.


Mental health issues plaguing today's youth

Then, there are mental health problems that young people face in India apart from the background of demoralisation. These have a biological underpinning. These include:

  • Attention Deficit Disorder
  • Mood Disorders
  • Anxiety Disorders
  • Eating Disorders 
  • Psychotic disorders

About ten to fifteen per cent of the school going population suffers from one or the other psychiatric disorder. These disorders have a biological basis apart from the psycho-social contributions and need to be assessed and treated. There is also high incidence of Specific Learning Difficulties, which remain undiagnosed and without help.

 


Childhood depression

Depression is one of the most common disorders amongst children and young people. It may present as sadness, crying episodes, lack of interest, decreased scholastic performance, developmental delays, school refusal, irritability, withdrawal and many other behavioural changes.

Childhood depression is contributed to by biological changes in neurotransmitters, unhelpful ways of thinking and social stressors like parental discord and educational stress.

A study on school mental health problems in reported that nearly 23 per cent of school going children have mental health problems.


If one were to consider children in need of care and protection: there is an undocumented, but well perceived high prevalence of post-traumatic stress disorder amongst those who need safeguarding. These young people show externalising or internalising symptoms of psychiatric disorders to the extent of more than fifty percent.


All these mental health problems impact the quality of life of the person they affect and their ability to achieve their potential. But these also come in the way of the objectives of the educational system, to create human resources in the country that is able to cope with the ever-changing work environment, is confident and communicative. Human resources that can be in turn good enough parents to the next generation.


The rise of antidepressants

There is a rising trend to prescribe antidepressants to children. While some children do definitely need and benefit from antidepressants many others may experience a negative impact of the same.

Another study says that though there's a steep rise in prescribing of anti-depressants to children over the last decade, more than 40 percent are drugs, which do not work and can even have toxic side-effects.

Over-prescription of these drugs with reasonable fears of the "medicalisation" of unhappiness and the ordinary emotional turmoil experienced by teenagers is fast becoming a reality in India.


Stigma & the lack of recognition of mental health issues in childhood

Parallel to the increased prescription of antidepressants, there is stigma attached to mental health problems and there is a lack of trained human resources for mental health. Children thus do not have access to appropriate mental health services leading to significant delays in providing much needed help. Sometimes this delay is not days and months, but years.

Educational systems do not recognise mental health problems early and child gets labelled as truant or dysfunctional. Children and young people are also experimenting with addictive substances. There is parental criticism, information overload from the Internet and competitive deselecting environment. Not surprisingly there are reports of rising suicide rates amongst the young people in India.


Five key steps need to taken immediately

  1. Children, young people, teachers and parents need to know more about Depression to recognise it early and seek treatment.
  2. Schools need to invest in the Mental Health of children.
  • Every child should have access to mental health services from the portals of education and these should include life skills and development of resilience in the curricula for children
  • The skills for managing difficult feelings, negative thoughts, difficult relationships and experiences should be taught and there should be an opportunity for practising and clarifying these skills
  • There should also be access to phone and app based services which children can approach in case they need to seek help through counselling

Mental Health, unfortunately, is not on the top of agenda for the educational policy makers. There is ignorance regarding the need. Services are few and provided by inadequate number of counsellors. The teachers have a poor acceptance of these services and referral to these is still seen as a way of chastising the difficult students. The services are also stigmatised.

The schools hire “career counsellors” as a token and organise some workshops on parenting or personality development. The training of the counsellors is incomplete. Even the training of the psychiatrists and other mental health professionals does not reflect the enormity of the need that exists.

The recent efforts of CBSE to start hotlines or including the grading system or including the extra-curricular in the mark sheets of the students are surface changes and not shifts of attitude.

  1. Parents need to be supported to learn communication skils to be non-judgemental and supportive as opposed to critical and directive.
  2. Health systems need to invest in making mental health services to be child appropriate.
  • Mental Health services should not be focussed only on medical interventions but should have psychological services like cognitive behaviour therapy as mainstay
  •  All psychiatrists need to be trained in Child and Adolescent Psychiatry for at least a period six months during their training
  • All psychologists should have training in psychotherapy skills through supervised training
  • Technology can be used to make this training available in places where there are no teachers and supervisors available for mental health training
  1. Mainstreaming of mental health needs in to the child care and protection system is another important task if far-reaching changes have to be achieved.

Equally accessible & affordable care for all

  1. Mental Health Services should not be seen as add on fanciful things, those only frightfully expensive schools think about. Mental Health Services should also be available to all not only the difficult student or the poor scholastic performer.
  2. It should not only be the school counsellor who delivers the mental health services. The stakeholders of the complete development of a child, the parents and the teachers have to be informed and made partners in furthering the mental health goals of the young people.
  3. A range of mental health services should be available to all students from the peer counselling services, mentoring services, preventive communication skills and referrals to child and adolescent psychiatry teams.
  4. Similarly, in the child protection environments mental health needs to be seen as right and not a luxury. The milieu of child protection processes has to focus on the mental health and developmental needs of the young person. There has to be easy non stigmatised access to counselling. Choice and dignity have to the goals of any child protection program.

Need of the hour?

The emphasis of Mental Health Services should be to increase access to psychosocial interventions. Psychiatric medicines should be used less often only after psychological treatments have failed or there is an urgent need to due to the severity of the problems being faced by the child. Anti-depressant use amongst children unfortunately could paradoxically increase the agitation and negative thinking for some children and should be regularly supervised by a psychiatrist.

The need is for there to be universal preventive and promotive mental health services for children which lead to an early recognition of some psychiatric disorders but more importantly build the skills of the child and the parents to cope with the changing context, mitigate the risk of using substances, overwhelming influence of Internet and need for shortcuts to gratification.

Children are the mental capital of a society. Loss of children’s mental health is a loss of this mental capital. Not focussing on the mental health of children is a lost opportunity for a society that is so focused on performance and success.

 

Disclaimer- The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of M3 India.

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