What is depression?
Psychiatry.org defines depression as a medical illness that causes “feelings of sadness and/or a loss of interest in activities once enjoyed.”
People with autism, particularly teens and adults, are prone to depression. At this stage of their lives, autistic teens and adults have more social experiences. As a result, they can go through phases of depression, depending on several triggers.
Managing autistic behavior can take a toll on mental health, so people with autism can be faced with yet another challenge. It’s important that people with autism have adequate support for coping with the emotional strain of autism.
There are several factors that contribute to the link between mental health and autism. They can be:
- Being victim to bullying
- Realizing he/she is different from peers
- Having a difficult time making and maintaining friendships
- Experiencing challenges in accomplishing academic tasks
Why is ASD Frequently Associated with Anxiety and Depression?
In research published in the Journal of Abnormal Child Psychology, almost half of adults with autism will experience depression at some point in their lives. What is the source of depression in young adults with autism?
There is a multitude of reasons people experience anxiety and depression. What makes people with autism more likely to experience it is often associated with social skill challenges. As a result, they can have a harder time making and keeping friends. They also have unusual, repetitive behaviors others consider unusual or undesirable.
Common symptoms of depression in autism
Depression for people with autism can be a unique scenario. Mood disorders are common for people with autism. As such, some symptoms of depression can overlap with autism itself. Because of this, it’s important to distinguish the significant differences so parents and caregivers can correctly recognize depression in autism.
Parents and caregivers are the first people who should notice a shift in their child’s behavior. It can be possible to misread autism emotions and dismiss the possibility of depression.
Some of the symptoms of depression in autism include:
- Obsessive Behavior
- Social Withdrawal
- Oppositional and Aggressive Behavior
- Sleep Disturbance
- Low Self-Esteem
To fully understand symptoms of depression, we must first know the types of depression. Some types of depression have similar symptoms, while others can have opposite ones.
Different types of depression
There are many types of depression. These classifications apply to everyone, even those without autism.
The six most common types of depression are:
Also called major depressive disorder, this type of depression is felt most days of the week. The signs and symptoms include:
- Lost of interest in things that are usually pleasurable for the person
- Weight gain or weight loss
- Difficulty sleeping
- Feeling restless
- Feeling sluggish (mentally and/or physically)
- Feeling guilty
- A sense of worthlessness
- Difficulty making decisions
- Thoughts of self-harm or suicide
Major depression is diagnosed if symptoms persist for two weeks or more. It is treated with psychotherapy and anti-depressants. Electroconvulsive therapy is sometimes needed for severe cases.
Persistent depressive disorder
Also called dysthymia, this type of depression is milder but lasts longer. People with persistent depressive disorder can accomplish their daily tasks. The problem is they don’t feel joy and are often low in energy most of the time.
Symptoms of persistent depressive disorder include:
- Not eating enough
- Sleeping too much or too little
- Low self-esteem
- Feeling hopeless
- Trouble concentrating
- Trouble making decisions
People with this type of depression are treated with psychotherapy and/or medication.
Bipolar disorder is a type of depression which causes emotions to be on extremes. The highs and lows in emotions are often seen both in autistic and non-autistic people. Diagnosing people with autism bipolar is a possibility.
Signs and symptoms of elevated emotions, also called manic episodes, are:
- Over-the-top thinking
- High self-esteem
- Deliberately avoiding sleep
- Doing tasks at unusual speed
- Pursuit of pleasure
- Taking uncalculated risks
People with bipolar disorder can go through a period of depression after a manic episode. This period can be dangerous as it leads to self-destructive behavior.
Medication for bipolar disorder is different from those prescribed for other types of depression. Studies have shown that typical antidepressants are not effective in treating bipolar disorders. In fact, they can sometimes increase the risk of illness.
The US Food and Drug Administration (FDA) has approved three kinds of medicines for treating bipolar disorder. These medicines are:
- Olanzapine-fluoxetine combination
Seasonal affective disorder
This type of depression happens during the fall and winter when days are shorter and nights longer. Seasonal affective disorder (SAD) is said to alter moods due to the absence of light and/or lower levels of serotonin and melatonin in the body. SAD typically disappears once spring or summer arrives.
SAD is also treated with medication and psychotherapy.
Other mental illnesses that affect people with autism
Other than depression, people on the spectrum might also experience other types of mental health issues. These include:
Around 40 percent of people with autism show signs of anxiety disorder. There is no established explanation for the link between anxiety and autism. Experts believe an autistic person’s vulnerability to stress is one major factor in developing an anxiety disorder.
Some symptoms of anxiety include:
- Trouble focusing
- Negative thoughts
- Trouble sleeping
- Obsession about a particular subject
- Always thirsty
- Tummy Aches
- Loose bowel movements
- Frequent urinating
- A sudden increase in heartbeat
While anti-anxiety medication can be effective to treat anxiety, there are other methods that suit those on the spectrum. For instance, cognitive and behavioral therapy can expose the person to his/her fears one step at a time, until the person learns how to control his/her emotions despite having an emotional trigger.
Parents of younger children can also create a list of situations that cause anxiety and what the child needs to do to get through it.
Obsessive-compulsive disorder (OCD) is a form of anxiety disorder that involves repetitive actions. OCD is more common in people with autism. There are two elements of OCD: obsessions (thoughts) and compulsions (behaviors).
Because of its repetitive nature, OCD can be mistaken as a symptom of autism. It is important that a parent or caregiver is able to discern the difference between the two. If this isn’t possible, then it’s time to get professional help.
Autism, Depression and Suicidal Tendencies
A study published in Autism Research reveals the risk of suicide in autistic people has increased compared to neurotypical peers. In the study, 49 people with autism died by suicide in Utah from 1998 – 2017.
Another research by Autistica.org states that autistic adults who don’t have a learning disability are nine times likely to die from suicide compared to their neurotypical peers. children with autism are 28 times more likely to have suicidal thoughts or a suicide attempt.
Autism and depression and self-injurious behavior – when to seek professional help
The best way to know if an autistic teen or child is suicidal is to simply ask. It might be hard for a person with autism to communicate, so it’s important to also look at the non-verbal cues.
Other strategies for helping an autistic person on the verge of suicide are:
- Just be with the person even if he/she refuses to talk
- Tell others (friends, teachers) about the situation
- Listen closely to their stories to help identify a trigger
- Don’t dismiss him/her when telling you about negative thoughts
- Remind him/her you are always there, ready to talk and/or listen
- Take a trip together
- Teach him/her the number to call when he/she have suicidal thoughts when you are not around
If your child does not want to talk about it but you feel he/she is contemplating suicide, then you need to initiate the conversation. Make your child feel loved and valued and assure him/her that every problem, no matter how heavy, has a solution.
In severe cases wherein the child is clearly doing self-harm, a more aggressive approach might be needed. Crisis intervention might be necessary when you have tried all means of prevention.
Suicide intervention includes:
- Psychiatrist treatment
- Moving the person to a less stressful environment
- Family and community involvement
Autism and depression treatment
Treatment for depression for people with autism is no different from those who are not on the spectrum. However, this may not be the best approach.
In a study conducted by a group of researchers from the Cochrane Collaboration, antidepressants like Prozac, Luvox, and Celexa should be used on a case-to-case basis for depression in autistic patients. The study found no evidence these medicines are effective in treating depression in children.
Dr. Desmon Kaplan, founding service chief at Sheppard Pratt Hospital, says it’s not a good idea to use medication as the first method of treatment. “It’s not good enough to say to a parent, ‘Your child’s depressed, and we’ll give him Prozac,'” Dr. Kaplan said. He recommends a complete evaluation of the child’s medical and social history before taking any action.
While medication for depression is considered safe for most people, there are doubts if these are also safe for autistic people. Unfortunately, there is no solid research on the possibility that anti-depressant medication might work differently for people with autism.
Dr. Christopher McDougle, director of Massachusetts General Hospital reports, “To date, we don’t have a single published systematic clinical trial of antidepressant medication for the treatment of depression in individuals with autism.”
What you can do about depression
As a parent or caregiver, you want to provide the best care and treatment to manage your child’s depression. Learning how to help your child with autism cope with their emotions is the first step towards preventing full-blown depression.
When a child is depressed, he/she feels he/she is worthless. You can assure your child this is not true. Assure your child he/she is loved by friends and family.
Communicate in a way your child feels secure and safe. Here are some ways to communicate so your child feels supported:
- Active listening
- Meaningful eye contact
- Rephrase what they are saying (“It sounds like you’re not feeling great today.”)
- Asking permission
Natural remedies for depression
Some autism health care providers don’t recommend medication for treating depression in children with autism. They believe that people with autism, particularly children, will benefit more from therapy and other activities that help lessen signs and symptoms of depression and anxiety.
Cognitive-Based Therapy (CBT) is known to be effective in treating depression and anxiety in children with autism. CBT is a technique of training the mind to think positively. As a result, anxiety and depression are reduced.
Keep a diary
For older children and adults with autism, writing their thoughts in a diary can help ease anxiety. Writing about their experiences help them reflect on their actions and might help with their anxiety.
Creative arts therapy
Creative therapy treatments involve activities where participants make art in a therapeutic setting. A trained professional guides the students in each activity.
The therapy’s goals are:
- Give a safe time and place with someone who won’t judge you
- Help make sense of things and understand yourself better
- Help resolve complicated feelings or find ways to live with them
- Help communicate and express yourself, which might include feelings or experiences you find hard to put into words
Exercise, sports, and outdoor activities can help manage anxiety and depression in autistic people. Rigorous movements can help release tension and lessen anxiety.
Team sports activities can also “force” your child into communicating with others, which is great for improving his/her social skills.
Mental health is important to everyone, especially to children with autism. However, autistic children might not always tell you how they are feeling. It’s up to parents and caregivers to be observant and recognize the signs as soon as they appear. With proper strategies in place and the right support from experts, children with autism are capable of breaking through their mental health challenges, one day at a time.
Diagnosis: Depression, Now What? (2016, Aug 11) retrieved from: https://iancommunity.org/depression-treatment-autism
Anxiety in autistic adults retrieved from https://www.autism.org.uk/about/behaviour/anxiety.aspx
Mental health and autism retrieved from https://www.autism.org.uk/about/health/mental-health.aspx
Depression Hits 20% of Young Adults With Autism (2018, Aug 31) retrieved from https://www.webmd.com/brain/autism/news/20180831/depression-hits-20-of-young-adults-with-autism#1
The Link Between Suicide and Autism (2019, Feb 10) retrieved from https://www.psychologytoday.com/intl/blog/caring-autism/201902/the-link-between-suicide-and-autism
Suicide and autism retrieved from: https://www.autistica.org.uk/what-is-autism/signs-and-symptoms/suicide-and-autism
Suicide risk in people with autism (2019, Jan 23) retrieved from: https://www.sciencedaily.com/releases/2019/01/190123082225.htm
Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study retrieved from: https://bmjopen.bmj.com/content/5/12/e008341
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