For Families and Carers : Depression

It is now recognised that depression is a relatively common condition in the general population.  According to the NHS Choices website, depression affects about one in ten adults at some time in their lives. Studies have shown that about 4% of children in the UK (aged five to sixteen) suffer from anxiety and/or are depressed.

Is depression common in people with Down’s syndrome?


Depression is at least as common in children and adults with Down’s syndrome as it is in the general population and affects them in the same way.   Depression is not part of the condition or inevitable, but it is one of the most frequently diagnosed mental health issues for those with Down’s syndrome.

What does depression look like in a person with Down’s syndrome?


It is much more than just feeling sad or low for a while. There are a wide range of symptoms, some more common than others, which persist for at least two weeks and often considerably longer. You will find a list of common symptoms in DSA’s booklet about depression.  Dr Kerim Munir (Boston Children’s Hospital) has written that children and adults with Down’s syndrome and symptoms of depression often lose the ability to enjoy many activities they used to love, they lose skills and they become very withdrawn. Depression may have appeared relatively quickly or may have developed gradually over many months.

What causes depression?


In people with Down’s syndrome, as with the general population, there are a number of factors that can lead to the development of depression:

  • Illness – the health problems that are more likely to contribute to depression in a person with Down’s syndrome may include hypothyroidism, sleep apnoea, coeliac disease, Vitamin B12 deficiency and vision or hearing impairment.
  • Biochemical or structural differences in the brain
  • Stress

There is a list of possible causes, with particular emphasis on how certain issues may unduly and negatively affect people with Down’s syndrome, in DSA’s booklet about depression. We know, for example, people with Down’s syndrome are very sensitive to changes in their environment and routine. Sometimes, what seems to us like an everyday life event, such as a sibling leaving home, is viewed by a child or adult with Down’s syndrome as a major unexpected upheaval and frightening change which leads to a disproportionate effect on their mental health.

Symptoms of depression in people with Down’s syndrome may not always occur at around the time of the event or events that have actually triggered the depression.   For example, some young people and adults with have a delayed response to grief. It may be many months after the event that the person seems to grieve. This may be because some people take longer to really understand the magnitude or permanence of their loss.

It is important to note that sometimes there will be no apparent cause for a person’s depression and nothing you could have done to prepare a person for life changes could have prevented them from becoming depressed.

How is depression diagnosed?


In people who do not have learning disabilities, depression is usually diagnosed through a face-to-face interview with a health professional. Laboratory tests and a physical exam may help the health professional make the diagnosis. It may be more difficult to diagnosis depression in people with Down’s syndrome, particularly if they are children because they cannot give a history of the changes they have experienced and/or describe how they feel.  Where this is the case, it is important that relatives, professionals in the person’s life and supporters are able provide evidence of any changes that they have noticed. Sometimes it can help if the person making the diagnosis observes the person going about their everyday life at home, school, college or work.

Who can help?


If you are worried about any changes you have noticed in a child, young person or adult, make an appointment with the GP. The GP may feel confident to make a diagnosis or they may make a referral, if the patient is a child, to the local Child & Adolescent Mental Health Service (CAMHS) or, if the patient is an adult, to a psychiatrist working for the local Community Learning Disability Team. You should expect to have your concerns taken seriously by health professionals. The changes you have noticed should not be attributed to the fact a person has Down’s syndrome. Appropriate investigation for underlying medical causes should be carried out in the same way as it would be for anyone in the general population.

How is depression treated in people with Down’s syndrome?


The range of treatment options should be the same as for anyone diagnosed with depression:

  • Counselling
  • Identifying and reducing stress
  • Medication
  • Treatment of any associated medical conditions
  • Encouraging exercise and getting involved in activities that help build self-esteem

Resources


Information for GPs about depression in adults (DSA)

Easy Read


Feeling Down – Looking After My Mental Health (Foundation for People with Learning Disabilities)

Ron’s Feeling Blue (Books Beyond Words) – Ron is depressed and has no interest in doing things. With the help of his GP and family he begins to feel better.

Sonia’s Feeling Sad (Books Beyond Words) – Sonia is feeling so sad that she shuts herself off from her family and friends. She agrees to see a counsellor and gradually begins to feel better.

Mental Health and Learning Disabilities – Depression (Royal College of Psychiatrists)