Depression in children

Can children really have depression?

Yes. Childhood depression is different from the usual blues and everyday emotions that arise as a child develops. The fact that a child appears sad does not necessarily mean that he is suffering from major depression. If the sadness becomes persistent or interferes with his usual social activities, interests, studies, or family life, this may indicate that he is suffering from a depressive illness. Keep in mind that although depression is a serious condition, it can also be treated.

How do I know if my child has depression?

The symptoms of depression in children are varied. This often goes undiagnosed and untreated as they present as normal emotional and psychological changes. Early medical research focused on "disguised" depression, where acting out or angry behavior indicated a child's depressive mood. Although it happens, especially in young children, many children experience sadness or depressed mood, similar to depressed adults. The main symptoms of depression revolve around sadness, feelings of hopelessness, and mood swings.

Signs and symptoms of depression in children include:

Irritability or anger
Continuous feelings of sadness and hopelessness
Social withdrawal
Increased sensitivity to rejection
Changes in appetite -- either increased or decreased
Changes in sleep -- sleeplessness or excessive sleep
Vocal outbursts or crying
Difficulty concentrating
Fatigue and low energy
Physical complaints (such as stomachaches, headaches) that don't respond to treatment
Reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in 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 of them will experience different symptoms at different times and under different conditions. Although some children may continue to function reasonably well in a structured environment, most children with severe depression experience marked changes in their social activities, loss of interest in school, and poor academic performance or changes in appearance. Children may also start using drugs or alcohol, especially if they are over 12 years old.

Although young children are relatively uncommon among young adults under the age of 12, they do attempt suicide—and may do so impulsively when upset or angry. Girls are more likely to attempt suicide, but boys are more likely to commit suicide while trying. Children with a family history of violence, alcohol abuse, physical or sexual abuse are at higher risk of suicide, as are children with depressive symptoms.

Which children are depressed?

Depression is significantly more common in boys under 10 years of age. But at 16, girls have a higher incidence of depression.

Bipolar disorder is more common in teenagers than in young children. However, bipolar disorder in children can be more severe than in adolescents. It can also occur with or be masked by attention deficit hyperactivity disorder, obsessive-compulsive disorder or conduct disorder.

What causes depression in children?

As in adults, depression in children can be caused by any combination of factors related to physical health, life events, family history, environment, genetic vulnerability, and biochemical abnormalities. Depression is not a transient mood or a condition that will go away without proper treatment.

Can depression in children be prevented?

Children with a family history of depression are more at risk of suffering from depression themselves. Children whose parents are depressed usually develop their first episode of depression earlier than children whose parents do not. Children from dysfunctional or conflict families, or children and adolescents who abuse substances such as alcohol and drugs, are also at higher risk of depression. How is depression diagnosed in children?

How Is depression diagnosed in children?

If your child's symptoms of depression continue for at least two weeks, you should make an appointment with a doctor to make sure there are no physical causes for the symptoms and to make sure your child is receiving appropriate treatment. Consultation with a mental health professional specializing in children is also recommended. Be aware that the pediatrician may ask you to speak to your child in private.

The mental health assessment should include an interview with you (the parent or primary caregiver) and your child, and any additional psychological testing required. Information from teachers, friends, and classmates can be helpful in demonstrating that these symptoms show up in all your child's activities and are a marked change from previous behavior.

There are no specific tests—medical or psychological—that can clearly identify depression, but tools such as questionnaires (for the child and parents) combined with personal information can be very helpful in diagnosing depression in children. Sometimes these therapy sessions and questionnaires can reveal other problems that contribute to depression, such as attention deficit hyperactivity disorder, obsessive-compulsive disorder, or conduct disorder.

Some pediatricians start using mental health screening tests when an 11-year-old has a good attendance and then every year thereafter.

What are the treatment options?

Treatment options for children with depression are the same as for adults, including psychotherapy (counseling) and medication. Your child's doctor may suggest psychotherapy first and consider antidepressants as an additional option if there is no significant improvement. The best research to date shows that a combination of psychotherapy and medication is most effective in treating depression.

Treatment of children with bipolar disorder

Children with bipolar disorder are usually treated with psychotherapy and a combination of medications, usually antidepressants and mood stabilizers.

Antidepressants should be used with caution as they may provoke episodes of manic or hyperactive behavior in children with bipolar disorder. Managing a child's medications should be part of an overall care plan that includes therapy and routine visits to the doctor.

Antidepressants may increase the risk of suicidal thoughts and behavior in children and adolescents with depression and other psychiatric disorders. If you have any questions or concerns, please discuss them with your healthcare provider. In addition, if your child is taking these medications, it is very important to continue to closely monitor the doctor and therapist.

Long term outlook

Studies have shown that the first depression in children occurs at a younger age than before. As with adults, depression can return later in life. Depression often occurs at the same time as other physical illnesses. And because research has shown that depression can precede more serious mental illness later in life, early diagnosis, treatment, and close monitoring are essential.

It is sometimes easier for a parent to deny that your child has depression. You may be putting off seeking help from a mental health professional because of the social stigma associated with mental illness. It is very important for you as a parent to understand depression and understand the importance of treatment so that your child can continue to grow in a physically and emotionally healthy way. It is also important to learn about the future effects that depression may have on your child in adolescence and adulthood.