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Anxiety and depression in boys: what to do before getting to psychiatric treatment

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Acting with a range of interventions ranging from the recovery of sleep rhythms to the development of the imagination up to real psychiatric treatments when necessary: ā€‹ā€‹this is the strategy proposed by English psychologist Miranda Wolpert, teacher of Evidence-Based Practice at University College London, to help young people suffering from anxiety and depression.

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The alteration of sleep rhythms is common in anxiety and especially in depression, of which it can represent an early manifestation and also a trigger factor: in fact, an irregular night’s rest is associated with symptoms such as unstable mood, tiredness, reduced activity, changes in the appetite and body weight and various physical ailments. Many physiological, psychological and behavioral variables are influenced by the so-called ritmi circadiani: periodic oscillations of about 24 hours regulated by some brain centers (such as the suprachiasmatic nucleus of the hypothalamus), which adapt our mood and our energy level to periodic changes in the external environment, first of all the alternation between light and dark. The alteration of these rhythms (circadian dysrhythmia) is the basis of many forms of depression. In young people, for example, a phase delay in the sleep-wake cycle is very common, which leads to falling asleep and waking up several hours after conventional hours; this leads to a decrease in the intake of sunlight during the day and an increase in exposure to artificial light at night, with consequent suppression of melatonin production by the pineal gland and further difficulties in falling asleep.

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Appetite and social behavior are also affected, and the development of depressive symptoms is very common. Individual interventions, such as education for a correct sleep rhythm or morning exposure to light to improve mood (phototherapy), but also collective interventions, such as postponing the opening of schools by half an hour to improve the quality of sleep of children and adolescents can play a preventive role in the development of depression in this age group.

Even the psychotherapeutic techniques based on imagination they can play a vital role in the treatment of anxiety and depression in boys. Through active imagination, the emotional states at the origin of these disorders can be recognized and processed and a transformative and reparative process capable of generating positive emotions can be triggered. There psychologist Victoria Pile, of the Institute of Psychiatry at King’s College London, examined the mechanisms by which the main therapeutic techniques based on active imagination act: some help the patient to “rewrite” traumatic memories, others stimulate positive imagination and still others support and enhance traditional psychotherapy.

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Adolescence is an age of profound transformations on the level of the development of the nervous system, of the way of seeing the world, of personal identity and social relationships. For these reasons, the use of antidepressant drugs should be limited in children to the most severe cases that do not respond to other strategies, even if their effectiveness in severe forms of depression can be decisive. These drugs work by enhancing the effect of serotonin, a fundamental neurotransmitter in the regulation of mood and affective states, have a beneficial action on nerve cells and help modulate the emotional response to the environment. An increase in anxiety can be observed in the first days of treatment, but this can be effectively managed by intervening on the dosage or temporarily resorting to anxiolytic drugs, while for the most common side effects such as weight gain or sexual difficulties it is necessary to choose the most suitable drug to the individual profile of every single person: in fact, everyone reacts in his own way, especially in such a delicate age, and an open and integrated approach is needed that takes into account all the variables involved.

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Francesco Cro is a psychiatrist at the Department of Mental Health, Viterbo

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