OCD and severe depression in 12 year old - advice needed

[Victoria]

My 12 year old daughter was diagnosed with depression and severe OCD around 18 months ago, following the death of her father in September 2014.  She had quite a bit of CBT and has been on Sertraline (100mg)  both of which helped dramatically with the OCD, however her depression seems to be getting worse and worse.  Over the last 6 months she has been self harming badly (enough to have to go to hospital) and is often feeling suicidal.  She does have some good days (when she is almost a bit hyper) but is mostly very low and not managing school or to do very much.  She is also receiving Psycotherapy to help her deal with depression and the loss of her father but it does not really seem to be helping.  She is getting so fed up as she feels she is just getting worse and worse and her psychiatrist at Camhs is reluctant to change her medication for now....and just keeps saying that she will get better with time.....but this has been going on for months now and she is missing an awful lot of school and losing touch with friends etc.  It is kind of taking over everything since as a single parent since my husband died, it is hard to work and also hard to be able to keep her safe at all times since whenever i think she is a little better it will turn out that she has found scissors or something else sharp (I have hidden everything I can think of away) and will be trying to hurt herself.

It seems that now the OCD is kind of under control, that the depression has just totally taken over....I just wondered if this is a common pattern in OCD and if anyone else has experience of it with a child of this age and if so, what treatment did they get.

Any advice much appreciated....

[snowbear]

Welcome to the forum, Victoria.

I'm sorry to hear of your loss and how this has affected your daughter. You say her OCD is under control (or at least not the most pressing problem) and that her depression has worsened. My first thought is to wonder why a combination of medication and talking therapy isn't helping her?

There could be many reasons for this, but the first question to ask is what kind of psychotherapy she's receiving and whether this is based in (or includes) Cognitive Behavioural Therapy (CBT.) Because of her bereavement I suspect it may be Interpersonal Therapy (IPT) she's receiving and while this would help her cope with her emotions (and maybe a bit with the depression) it won't address the OCD directly. 

I also wonder whether her OCD is as under control as it perhaps appears from the outside. She's at the age where children develop the ability to think in abstract terms and seek deeper meaning in their thoughts and feelings. So she may have acquired greater ability to control and suppress visible (physical) rituals, but simultaneously start experiencing an increase in invisible (mental) rituals. If she's having difficulty making sense of it all and either feels unable to talk about it or isn't being asked about it, the sense of isolation that results could possibly lie behind the self-harm and suicidal feelings.  

Paradoxically, it's also not uncommon for depression to worsen as OCD improves. An over-simplistic way of thinking about it is the upset feelings have to be expressed one way or another and as one outlet for self-expression is closed another opens up. 

My suggestion would be to speak to her therapist about the kind of therapy your daughter is receiving, whether it has addressed her OCD or just the bereavement/depression, whether the therapist believes there may be more covert OCD continuing which needs further CBT, and whether the therapist is happy with the results achieved so far. (If not, what's her plan?)

I'm sure you regularly talk to your daughter too, so perhaps aim to have a conversation about whether she has troubling thoughts she tries to push away or deal with inside her head. You might also want to discuss the self-harm behaviour at a calm moment when things are good (rather than in response to an attempt to harm or when emotions are high.) A good approach is to ask what kind of feelings make her hurt herself (rather than asking why she does it) and then exploring together what situations make those feelings arise, what makes them seem overwhelming, and what alternative ways she could use to cope. 

I hope that gives you some ideas for where to start. Let us know how you're both getting on.