Cerebral Palsy and Depression

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Children with chronic disorders that impair their motor abilities and independence, such as cerebral palsy, are at a heightened risk of developing depression. Depression rates can be twice as high for people with disabilities compared to non-disabled people.[1] Therapy and medication are effective treatments for depression.

About Depression

According to the American Psychiatric Association (APA), depression is a medical condition that affects how someone acts, feels, and thinks.[2]

Depression symptoms range in severity from mild to severe and can lead to many physical and emotional ailments. Common symptoms of depression include:

• Weight loss
• Appetite change
• Feelings of persistent sadness
• No interest in previous hobbies and activities
• Thoughts of suicide, and in severe cases, suicide attempts
• Fatigue
• Feeling hopeless and “empty” inside
• Slower movements, slower speech
• Excessive irritability and outbursts
• Sleeping too little or too much
• Hand wringing
• Pacing
• Excessive crying
• Difficulties functioning in class and school activities
• Feeling guilty, worthless
• Frequent stomach aches or headaches
• Decreased appetite or binge eating

The APA states that the symptoms must be present for at least two weeks for depression to be medically diagnosed. Other medical conditions can mimic depression and should be ruled out first, including brain tumors, vitamin deficiencies, and thyroid problems.

The Link Between Cerebral Palsy and Depression

According to a study published in The Scientific World Journal, children with cerebral palsy or similar neurodevelopmental disorders are prone to psychiatric issues.[3]

The study indicated that around 40% to 50% of school-aged children with cerebral palsy exhibit emotional and behavioral problems. One out of every two children with CP meets the criteria for some form of psychiatric disorder, with attention deficit hyperactivity disorder (ADHD) being the most prevalent.

The study did note that children with cerebral palsy who suffered from depression and anxiety were generally on the same academic functioning level as their peers. The mental health issues resulted more from painful social and classroom experiences than an inability to perform academically.

Problems with peers seem to be a significant factor in children with CP developing depression, specifically bullying issues. Bullying can happen at any age in school, but middle school tends to be the highest association of bullying, name-calling, and ridiculing.

The study also indicated that overlapping conditions were overwhelming in children with CP who developed depression. For example, many children with depressive disorders also had ADHD or oppositional defiance disorder (ODD).

Symptoms of depression can vary significantly according to each child. While one child may exhibit sadness and isolation, another one may become easily irritated and angered. Biochemistry, genetics, personality, and the child’s environmental factors all play a part in how someone with depression will react.

Stress or Depression?

Children with cerebral palsy are also prone to mood swings and stress. Because the signs are similar, it sometimes becomes difficult to discern whether they’re having a bad day or genuinely depressed.

There are a few ways that mood swings differ from depression. Parents should keep in mind that since children display depressive behavior differently, you should always speak with a healthcare provider if you suspect any issues.

Critical differences between stress and depression include the following: 

• Depression lasts for days and weeks, whereas a child having mood swings may have several days without symptoms
• Feeling nervous and anxious periodically but still motivated at school and performing well leans more towards stress or mood swings.
• A feeling of being overwhelmed characterizes stress, but with depression, the overwhelming feelings start to affect the child’s ability to function in school and at home

How Is Depression Treated?

APA reports that around 80% to 90% of people with depression respond favorably to treatment, which is excellent news for parents with children going through daily struggles.

Yet, to be successful, you’ll need to find the right approach. It takes some trial and error, but with effort, persistence, and with professional medical guidance, the odds of beating depression are typically favorable.

In general, most medical professionals recommend three types of traditional treatments. Some children can benefit from just a single treatment modality, while many have the best results from a combination of approaches.

Psychotherapy

Psychotherapy is the mainstay of treatment for mental health disorders and often works well as the only treatment modality for mild to moderate symptoms.

Psychotherapy consists of retraining thought processes or negative patterns of thinking to change the way people process and react to the world around them. This teachable skill can change the way daily interactions or perceived and, therefore, the feelings and behaviors that result.

The American Academy of Child and Adolescent Psychiatry reports that there are numerous types of psychotherapy, some of which can be combined for better outcomes. Sometimes various forms of psychotherapy can be combined with medication, which “may be more effective.”[4]

Some of the common types of psychotherapy for children include:

• Cognitive Behavior Therapy (CBT)
• Family Therapy
• Parent-Child Interaction Therapy (PCIT)
• Play Therapy
• Acceptance and Commitment Therapy (ACT)
• Psychodynamic Psychotherapy
• Supportive Therapy

Medication

If brain chemistry contributes to the child’s depression, certain medications may be beneficial in battling depression. Specific drugs for depression include SSRIs or SNRIs, two types of antidepressant prescription medications.

Common brand names include Prozac, Paxil, Zoloft, Lexapro, and Celexa. It can take up to 4-6 weeks to see accurate therapeutic results after starting a medication.[5]

Medications come with some side effects, which are essential to consider before initiating medication therapy. Among the most common are nausea, dizziness, drowsiness, and dry mouth.

In severe cases of depression, suicidal thoughts may become more frequent before they improve, and appropriate monitoring and safety measures should be implemented.

These medications should also not be stopped abruptly, so always talk to your child’s healthcare provider on how best to taper off medicines if you wish to stop the therapy.

Electroconvulsive Therapy (ECT)

ECT treatment is usually reserved for the most severe cases of depression who didn’t have success with other types of treatment.[6] It involves electrical stimulation of the brain while the patient goes under anesthesia. ECT treatment consists of receiving the stimulation a few times a week for up to 12 treatments.

Although there is a stigma attached to ECT treatments, the Mayo Clinic suggests it comes from older versions of the procedure, before patients were offered anesthesia and when extremely high amounts of electric currents were administered.

If You Need Immediate Help

If you suspect your child will self-harm or is suicidal, or if you just need someone to talk to, contact the National Suicide Prevention Hotline at 1-800-273-TALK. Skilled and trained counselors are available 24 hours, seven days a week. If your child starts to give away prized possessions and sees no hope for the future, the APA suggests seeking immediate help.