Overview
It is normal to experience depressed mood and anxiety occasionally, often dictated by sad or stressful situations (ex. important presentations, job interview, moving to a new city). However, depression and anxiety disorder are conditions that are more pervasive and chronic and can interfere with daily functioning in school, work, and relationships.
What Is Anxiety Disorder?
It is a condition in which children and adolescents have frequent, persistent, and excessive worry and fear about everyday situations. They engage in frequent “what if” line of thinking and often anticipate negative outcomes which can intensify their worry about a particular situation, place, or person. These fears are difficult to control and often out of proportion to the actual threat or concern. Just like with depression, anxiety disorders can also manifest with physical and cognitive symptoms such as disturbance of sleep and energy, agitation/restlessness, difficulty focusing/concentrating, and muscle tension/aches.
There are different types of anxiety disorder: generalized anxiety disorder, panic disorder, social anxiety disorder, separation anxiety disorder. People can suffer from one or more of these disorders.
Generalized Anxiety Disorder
Presence of excessive anxiety and worry about a variety of topics that are difficult to control and accompanied by one or more physical or cognitive symptoms.
DeletePanic Disorder
Recurrent, unexpected panic attacks and significant apprehension of such attacks that may lead to avoidance of certain situations, people, or places.
DeleteSocial Anxiety Disorder
Persistent or intense anxiety about specific social situations due to fear of judgment, embarrassment, or humiliation that may lead to avoidance of certain situations, people, or places.
DeleteSeparation Anxiety Disorder
Recurrent and excessive fear of being away from home or loved ones or anticipation of it and/or frequent apprehension of harm coming to loved ones leading to refusal to be separated from them and/or avoidance of certain situations or places.
DeleteHow Do We Treat Anxiety?
The good news is that depression and anxiety disorder can be treated effectively and sustainably. It takes a multidisciplinary approach including the following:
Develop Helpful, Healthy Coping Strategies
This can be learned with a help of a therapist/counselor/psychologist. Cognitive behavior therapy (CBT) and/or dialectical behavior therapy (DBT) are the most effective psychotherapy approaches.
CBT
Helps patients identify and become better aware of negative thinking and inaccurate perceptions. Helps them develop ways to steer their negative thinking towards a more positive, hopeful, and realistic direction which helps clarify their perception of a stressful situation.
DeleteDBT
Helps patients identify their strengths as well as unrealistic thoughts, beliefs, and expectations that may be hindering their ability to be happy with who they are. Helps them establish more reasonable expectations leading to better contentment in themselves and their abilities.
DeleteFinding a therapist/counselor/psychologist: Demand for a good therapist is high but supply is low. It takes patience and persistence but don’t give up!
- https://www.psychologytoday.com/us
- https://www.findcbt.org/FAT/
- Ask your doctor for some local recommendations.
Work on Self-Care 🔗
When the body is healthy, the benefit overflows to the mind and emotions. These include healthy, regular eating, adequate sleep, regular exercise, moderation in screen/social media use, building strong support systems, and improvement of personal skills/capabilities. Taking care of oneself takes intentionality and time but this is one area that is largely under the patient’s control.
DeleteMedication
Not everyone needs medication but it can provide additional support to get patient back on their feet to start working on self-care or going to therapy. The goal of medication is not to eliminate all feelings of depression or anxiety but to lessen the intensity overall to make the hard moments more tolerable. The goal will always be to use the least amount of medication that is helpful with the least amount of side effects.
Selective serotonin reuptake inhibitors (SSRIs) are the first line of medication for children and teens struggling with depression and anxiety disorder. Examples include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro). These medications help by increasing the amount of serotonin (the “feel good” chemical) available in the brain but it is not a serotonin pill. What naturally increases serotonin in the body include working on coping strategies, taking care of your physical health, investing in important relationships, and gaining confidence from a sense of accomplishments from a task completed and well done, however small. Therefore, SSRIs are most effective when combined with psychotherapy and improvements of self-care.
Side effects of SSRIs are uncommon, mild, and often transient and include: abdominal pain, nausea/vomiting, headache, sleep disturbance (either difficulty falling asleep or feeling drowsy). These typically resolve within a few days with continued use. Rare side effects include mania/hypomania (feelings of euphoria, impulsivity/hyperactivity, disinhibition, irritability) and self-harm thoughts and behavior. The latter may happen due a phenomenon in which physical symptoms of depression and anxiety (ex. energy, motivation, clarity of thinking) often improve before the patient’s mood and/or anxiety. Such a state of “disconnect” can lead some people to consider or attempt ways to hurt themselves. However, these medications will not “control” a patient to act against their will and these feelings are completely reversible upon discontinuation of the medication. It is important for patients to discuss these thoughts and urges with their doctor, even if they are confident that they will not act upon them.
DeleteHow Can Parents Help Their Child? 🔗
Supporting and validating their child’s difficulties is the first step. Unfortunately, significant stigma still surrounds mental health diagnoses and those who struggle with them are perceived as “weak” or “crazy.” It is important to acknowledge to their child and to those around them that the emotions that their child is experiencing are as real and potentially dangerous as any other symptoms of a physical illness (ex. asthma, diabetes). They should educate the patient and those around them that mental illnesses are often chronic but help is available.
Parents can help their child find a therapist/counselor/psychologist who is a good fit. It is a painstaking job involving repeated calls and messages but well worth the effort.
Parents should help their child establish reasonable self-care goals and encourage him/her to participate in these routines. They can volunteer to set similar goals for themselves as to provide support and accountability.
Parents should remind their child to take his/her medication and check in frequently (but not pester) to assess for potential side effects. They should listen to their child’s self-reflections about whether the medication seems to be helping or not.
Having a child struggling with depression and/or anxiety can be difficult for parents and other family members. It is important that parents also take time to care for themselves. As these illnesses can be hereditary, it is important for parents to take inventory of their own mental health state and seek help from their doctor if needed.
Books and Apps
Children (< 12 years)
- What to Do When You Worry Too Much (for anxiety)
- What to Do When You Grumble Too Much (for negativity)
- What to Do When Your Temper Flares (for anger)
- What to Do When Your Brain Gets Stuck (for OCD)
- What to Do When Bad Habits Take Hold (for nail biting and more)
- Coping Cat Workbooks (for 7 yo or older)
- App: Finch Self Care Widget Pet (for 4 yo or older)
Adolescents
- Fighting Invisible Tigers
- Cognitive Behavioral Therapy Workbook for Anxiety
- App: Mindshift CBT-Anxiety
- App: Mindfulness Coach
- App: My3
- App: Woebot - CBT, DBT & mindfulness skills
- App: Finch Self Care Widget Pet
- App: Headspace (meditation)
- App: Calm (meditation)
- App: CalmHarm (self-harm)
Parents
- Parenting a Teen Who Has Intense Emotions: DBT Skills to Help Your Teen Navigate Emotional and Behavioral Challenges
Online Resources
https://www.healthychildren.org/english/healthy-living/emotional-wellness/pages/default.aspx
https://childhood101.com/managing-big-emotions-best-resources-to-use-with-kids/