Depression in Children

Can Children Really Have Depression?

Yes. Childhood depression is different from the normal "blues" and everyday emotions that children go through as they develop. Just because a child seems sad doesn't necessarily mean they have significant depression. But if the sadness becomes persistent or interferes with normal social activities, interests, schoolwork, or family life, it may mean they have a depressive illness. Keep in mind that while depression is a serious illness, it’s also a treatable one.

How Can I Tell if My Child Is Depressed?

The symptoms of depression in children vary. The condition is often undiagnosed and untreated because symptoms are passed off as normal emotional and psychological changes. Early medical studies focused on "masked" depression, where a child's depressed mood was evidenced by acting out or angry behavior. While this does happen, particularly in younger children, many children display sadness or low mood similar to adults who are depressed. The primary symptoms of depression revolve around sadness, a feeling of hopelessness, and mood changes.

Signs and symptoms of depression in children include:

• Crankiness or anger
• Continuous feelings of sadness and hopelessness
• Social withdrawal
• Being more sensitive to rejection
• Changes in appetite, either increased or decreased
• Changes in sleep (sleeplessness or excessive sleep)
• Vocal outbursts or crying
• Trouble concentrating
• Fatigue and low energy
• Physical complaints (such as stomachaches and headaches) that don't respond to treatment
• Trouble during events and activities at home or with friends, in school, during extracurricular activities, and with other hobbies or interests
• Feelings of worthlessness or guilt
• Impaired thinking or concentration
• Thoughts of death or suicide

Not all children have all of these symptoms. In fact, most will show different symptoms at different times and in different settings. Although some children may continue to do reasonably well in structured environments, most kids with significant depression will have a noticeable change in social activities, loss of interest in school, poor academic performance, or a change in appearance. Children may also begin using drugs or alcohol, especially if they are over age 12.

Although relatively rare in youths under 12, young children do attempt suicide -- and may do so impulsively when they are upset or angry. 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, as are those with depressive symptoms.

Which Children Get Depressed?

Up to 3% of children and 8% of adolescents in the U.S. have depression. The condition is significantly more common in boys under age 10. But by age 16, girls have a greater incidence of depression.

Bipolar disorder is more common in adolescents than in younger children. But bipolar disorder in children can be more severe than in adolescents. It may also happen with, or be hidden by, attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), or conduct disorder (CD).

What Causes Depression in Children?

As in adults, depression in children can be caused by any combination of things that relate to physical health, life events, family history, environment, genetic vulnerability, and biochemical disturbance. Depression is not a passing mood, nor is it a condition that will go away without proper treatment.

Can Depression in Children Be Prevented?

Children with a family history of depression are also at higher risk of depression. Children who have parents with depression tend to have their first episode of depression earlier than children whose parents don’t have the condition. Children from chaotic or conflicted families, or children and teens who abuse substances like alcohol and drugs, are also at greater risk of depression.

How Is Depression Diagnosed in Children?

If the symptoms of depression in your child have lasted for at least 2 weeks, schedule a visit with their doctor to make sure there are no physical reasons for the symptoms and to make sure that your child gets proper treatment. A consultation with a mental health care professional who specializes in children is also recommended. Keep in mind that the pediatrician may ask to speak with your child alone.

A mental health evaluation should include interviews with you (the parent or primary caregiver) and your child, and any other psychological testing that is needed. Information from teachers, friends, and classmates can be useful for showing that these symptoms are consistent during your child's various activities and are a marked change from previous behavior.

There are no specific medical or psychological tests that can clearly show depression, but tools such as questionnaires (for both the child and parents), combined with personal information, can be very useful in helping diagnose depression in children. Sometimes those therapy sessions and questionnaires can uncover other concerns that contribute to depression such as ADHD, conduct disorder, and OCD.

Some pediatricians start using mental health screens at a child's 11th-year well visit and each year after.

What Are the Treatment Options?

Treatment options for children with depression are similar to those for adults, including psychotherapy (counseling) and medication. Your child's doctor may suggest psychotherapy first and consider antidepressant medicine as an option if there is no significant improvement. The best studies to date show that a combination of psychotherapy and medication is most effective at treating depression.

But studies do show that the antidepressant fluoxetine (Prozac) is effective in treating depression in children and teens. The drug is officially recognized by the FDA for treatment of children ages 8 to 18 with depression.

Most medications used to treat depression in children have a black box warning about the possibility of increasing suicidal thoughts. It is important to start and monitor these medications under the care of a trained professional and talk with them about the potential risks and benefits for your child.

Treating children who have bipolar disorder

Children with bipolar disorder are usually treated with psychotherapy and a combination of medicines, usually an antidepressant and a mood stabilizer.

Antidepressants need to be used with caution, as they can trigger bouts of manic or hyperactive behavior in children with bipolar disorder. Managing a child's medication must be part of an overall care plan that includes therapy and routine primary care appointments.

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 doctor. Also, if your child is placed on these medications, it is still very important to continue to follow closely with the doctor and therapist.

Long-Term Outlook

Studies have found that first-time depression in children is happening at younger ages than previously. As in adults, depression may come back later in life. Depression often appears at the same time as other physical illnesses. And because studies have shown that depression may precede more serious mental illness later in life, diagnosis, early treatment, and close monitoring are crucial.

As a parent, it is sometimes easier to deny that your child has depression. You may put off seeking help because of the social stigmas associated with mental illness. It is very important for you -- as the parent -- to understand depression and realize the importance of treatment so that your child may continue to grow physically and emotionally in a healthy way. It is also important to seek education about the future effects depression may have on your child throughout adolescence and adulthood.

Depression in Children: Warning Signs

Parents should be particularly vigilant for signs that may indicate that their child is at risk for suicide.

Warning signs of suicidal behavior in children include:

• Many depressive symptoms (changes in eating, sleeping, activities)
• Social isolation, including isolation from the family
• Talk of suicide, hopelessness, or helplessness
• Increased acting-out of undesirable behaviors (sexual or behavioral)
• Increased risk-taking behaviors
• Frequent accidents
• Substance abuse
• Focus on morbid and negative themes
• Talk about death and dying
• Increased crying or reduced emotional expression
• Giving away possessions

If you suspect that your child or teenager is depressed, take the time to listen to their concerns. Even if you don't think the problem is of real concern, remember that it may feel very real to them. It’s important to keep the lines of communication open, even if your child seems to want to withdraw. Try to avoid telling your child what to do. Instead, listen closely and you may discover more about the issues causing the problems.

If you feel overwhelmed or unable to reach your child, or if you continue to be concerned, seek professional help.

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