Wellness & Fitness

Phases of depression in the family and age

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“Why does depression manifest itself more strongly in the elderly? Is there a link between age and effects of depression?”

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You have asked two questions. The first is hard to answer while the second is answered by a simple yes! There is indeed a link between age and the effects of depression.

It is true that many non-communicable diseases have this age effect. A good example is diabetes where one is classified as having juvenile and the other as having adult onset diabetes.

The former is diagnosed in childhood and is usually treated with injections of insulin while the latter is managed to a large extent by lifestyle changes including weight loss, exercise and diet. Sometimes insulin and medication to lower blood sugar is also used.

In a very similar way, depression has different faces (and treatments) depending on the age of onset. It is critical for us to point out that the first episode of depression usually occurs in childhood or in adolescence. Many experts believe that paediatricians should be made more aware of depression in childhood if only because it causes so much pain and suffering to the young, parents, teachers and siblings. We work with one university to train paediatricians to recognise mental illness in children.

Two years ago, we saw a 15-year-old boy who had been expelled from a local high cost school where he had been found in the girls’ sleeping rooms. Two weeks earlier he had “stolen” a girl’s bra and “hidden” it in a place where all could find it. For this, a stern warning letter was written, with the school prescribed punishment of withdrawal of privilege.

These two offences were excusable but when his parents and head teacher asked him to apologise for this very bad behaviour, he refused. Not even his mother’s tears would get him to change his mind. He went home with his very angry parents, who soon got him yet another school. He was in trouble again and was expelled for the fourth time in three years!

A letter to his mother got him the attention he had craved all along. In it, he told her of his unhappiness since the age of eight. He explained how he had not experienced a single day of happiness for as long as he could remember. He confessed of having killed the family cat in a state of anger and desperation. He also told his mother of days he tried to kill himself by suffocation as well as the number of times he tried to commit suicide.

The many fights he was in at school were on account of irritability and frustration that he experienced, as other boys and girls seemed so happy. He had stolen many things from home including money, hoping to bribe other children to become his friends. He explained how giving gifts to other children did not seem to buy him the friendship he craved so much.

He hated himself. He was too short, was ugly and other children called him “piggy”. The teachers called him lazy because he did not finish his class work.

The letter to his mother told her of his love for her and he promised to be a better son in the next world. He was found unconscious on his bed after he had taken a large number of tablets prescribed to his mother for her own depressive illness. The alcohol he swallowed the drugs with belonged to his father who later explained that he needed alcohol to help him live in a home where both the son and the mother seemed to have “problems”.

During subsequent family sessions, it became clear that the mother had also experienced her first depression as a child, while the boy’s grandfather had recently been diagnosed with depression. For the boy, the problem was poor school performance, the mother loss of interest in her husband and family while the grandfather also had depression presenting as memory loss.