Childhood Depression

Are you worried that your child may be depressed? Most kids have days when they feel sad, lonely, or depressed. But, if your child seems persistently sad or hopeless and it is affecting relationships, they may suffer from childhood depression, a serious mental health condition that needs medical assessment and treatment.

At any given time, one out of every five young people is dealing with mental health problems. The good news is that health care professionals can accurately diagnose, treat, and manage mental health problems -- including childhood depression -- with psychotherapy and medication.

How Is Childhood Depression Different From the Blues?

Childhood depression is different from the everyday "blues" that most kids get as they develop. The fact that a child feels sad, lonely, or irritable does not mean they have childhood depression.

Childhood depression is persistent sadness. When it occurs, the child feels alone, hopeless, helpless, and worthless. When this type of sadness is unending, it disrupts every part of the child's life. It interferes with the child's daily activities, schoolwork, and peer relationships. It can also affect the life of each family member.

Childhood depression can be assessed, diagnosed, and effectively treated with medications and/or psychotherapy. Left untreated, childhood depression is a serious depressive disorder that can lead to suicide.

What Causes Childhood Depression?

The causes of childhood depression are unknown. It could be caused by any combination of factors that relate to physical health, life events, family history, environment, genetic vulnerability, and biochemical disturbance.

What Are the Signs and Symptoms of Childhood Depression?

The symptoms of childhood depression may vary. It depends on the child and their particular mood disorder. Many times, childhood depression goes undiagnosed and untreated. That's because it's passed off as normal emotional and psychological change that occurs during growth.

The signs and symptoms of childhood depression include:

• Changes in appetite -- either increased appetite or decreased
• Changes in sleep -- sleeplessness or excessive sleep
• Continuous feelings of sadness or hopelessness
• Difficulty concentrating
• Fatigue and low energy
• Feelings of worthlessness or guilt
• Impaired thinking or concentration
• Increased sensitivity to rejection
• Irritability or anger
• Loss of interest in hobbies and other interests
• Physical complaints (such as stomachaches or headaches) that do not respond to treatment
• Reduced ability to function during events and activities at home or with friends, in school or during extracurricular activities, or when involved with hobbies or other interests
• Social withdrawal
• Thoughts of death or suicide
• Vocal outbursts or crying

Are These Symptoms Present In All Kids With Childhood Depression?

No. Not all children have all of the symptoms of childhood depression. In fact, kids have different symptoms of childhood depression at different times and in different settings.

Some children may continue to function reasonably well in structured environments. But most kids with childhood depression will suffer a very noticeable change in social activities, a loss of interest in school, poor academic performance, or a change in appearance. Children may also begin using drugs or alcohol. Or they may start smoking cigarettes, especially if they are over age 12.

Although it's uncommon in children under age 12, some young children do attempt suicide -- and may do so impulsively when they are upset or angry. Studies show that girls are more likely to attempt suicide. But boys are more likely to actually kill themselves when they make an attempt.

Children with a family history of violence, alcohol abuse, or physical or sexual abuse are at greater risk for suicide. So are those with symptoms of childhood depression.

What Increases the Likelihood of Childhood Depression?

About one out of every 40 children in the United States suffers from childhood depression. Under the age of 10, childhood depression is significantly more common in boys. By age 16, girls have a greater incidence of depression.

Studies show that, at any point in time, 10% to 15% of children and adolescents have some symptoms of depression. A child has an increased chance of childhood depression if they have a family history of depression, particularly a parent who had depression at an early age. Once a child experiences major depression, they are at risk of developing another depression within the next five years.

Bipolar disorder includes symptoms of depression. Bipolar disorder is more common in adolescents than in younger children. Many experts question whether younger children can develop true bipolar disorder. Bipolar disorder may also occur with attention deficit hyperactivity disorder (ADHD or ADD), obsessive- compulsive disorder (OCD), or conduct disorder (CD).

Can Childhood Depression Be Prevented?

Children with a family history of depression are at greater risk of experiencing childhood depression themselves. Children who have parents that suffer from depression tend to develop their first episode of depression earlier than children whose parents do not have depression. Children from chaotic or conflicted families are also at greater risk of childhood depression. So are kids who abuse alcohol and drugs.

How Do Doctors Diagnose Childhood Depression?

If your child has symptoms of depression that have lasted for at least two weeks, you should schedule a visit with their health care provider. You will want to make sure that there are no physical reasons for the symptoms. You'll also want to make sure that your child receives proper treatment.

A consultation with a mental health professional that specializes in treating kids with childhood depression is also recommended.

A mental health evaluation for childhood depression should include interviews with you and your child. In addition, psychological testing may be helpful for clarifying the diagnosis and making treatment recommendations. Information from teachers, friends, and classmates can be useful for showing that the symptoms of childhood depression are present during your child's various activities and are a marked change from previous behavior.

There are no specific tests -- medical or psychological -- that can clearly show childhood depression. But tools such as questionnaires (for both the child and parents) and interviews by a mental health professional that include taking a careful history can help to make an accurate diagnosis.

How Is Childhood Depression Treated?

Treatment options for kids with childhood depression are similar to those for adults. They include psychotherapy (counseling) and medication. Your child's doctor may suggest psychotherapy first and consider antidepressant medicine as an additional option if symptoms are severe or if there is no significant improvement with psychotherapy alone.

The best studies to date indicate that a combination of psychotherapy and medication is the most effective method to successfully treat childhood depression.

The FDA warns that antidepressant medications may increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider.

Does Medicine Work for Childhood Depression?

Yes. A large number of research trials have shown the effectiveness of depression medications in relieving the symptoms of childhood depression. One study, funded by the National Institute of Mental Health, reviewed different approaches to treating adolescents with moderate to severe depression and found that 71% of the adolescents who received combination treatment with the antidepressant medication Prozac and psychotherapy had fewer symptoms. In addition, more than 60% of the kids who took Prozac alone improved.

How Is Bipolar Disorder Treated In Children?

Children with severe bipolar disorder-like symptoms are often treated with psychotherapy and a combination of medicines. The medications usually include a mood stabilizing medicine (such as lamotrigine or lithium) sometimes in combination with an antidepressant.

Antidepressants need to be used with caution in children with suspected bipolar disorder because they have a small but significant risk for triggering mania (elation or hyperactive behavior).

What's the Long-Term Outlook for Childhood Depression?

Studies have found that first-time episodes of childhood depression occur at younger ages than previously thought. And, as in adults, depression may reoccur later in life.

Depression often occurs at the same time as other physical illnesses. Because studies have shown that depression may precede more serious mental illness later in life, diagnosis, early treatment, and close monitoring are crucial.

Childhood Depression: Warning Signs of Suicide?

Parents should be particularly vigilant for signs that may indicate that a child with depression is at risk for suicide. Warning signs of suicidal behavior in children include:

• A focus on morbid and negative themes
• Frequent accidents
• Giving away possessions
• Increased acting-out behaviors
• Increased crying or reduced emotional expression
• Increased risk-taking behaviors
• Many depressive symptoms (changes in eating, sleeping, or activities)
• Social isolation
• Substance abuse
• Talking about death and dying
• Talking about suicide or feeling hopeless or helpless

Can Childhood Depression Go Away Without Treatment?

Childhood depression tends to come and go in episodes. There can be spontaneous recovery from childhood depression. However, once a child has one bout of childhood depression, they are more likely to get depressed again. Without treatment for childhood depression, the consequences of depression can be extremely serious, even deadly.

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