What is depression?
Childhood depression is a serious mood disorder. Depression
is more than just feeling down or sad. Even when major
disappointments and setbacks make people feel sad and angry,
the negative feelings usually lessen with time. But when
depression lasts for weeks or months and limits a child's
ability to function normally, it is considered major
depression.
How does it occur?
The exact causes of depression in children and young teens
are unclear. It may be triggered by stressful events like
problems at school, troubles with other children, parents'
divorce, or the death of a pet or family member. Children
with severe learning disabilities, physical handicaps, or
medical problems often develop depression. However,
depression often begins with no specific event.
In childhood, both boys and girls are equally at risk.
Depression is more serious when it begins before the age of
10 or 11 and is not the result of a specific event. During
the teen years, girls are twice as likely as boys to develop
depression.
Depression runs in families. If you, or others in your
family, have had depression or bipolar disorder then your
child is more likely to develop depression.
Some research suggests that depression may be caused by a
chemical imbalance in the brain.
What are the symptoms?
Depression is somewhat different in children and teens than
in adults. Adults usually describe feelings of sadness and
hopelessness along with fatigue. Depressed children are
usually more irritable and moody. They may be defiant.
They may shift from sadness or irritability to sudden anger.
Teenagers have to deal with puberty, peers, and developing a
sense of self. In all the confusion, it's easy to miss the
signs of teenage depression. Some children and teens don't
realize that they are depressed. Instead of communicating
how bad they feel, they may act out. You may interpret this
as misbehavior or disobedience.
Here are common symptoms of depression you might see with
your child:
Your child gets irritated often. Little things make him
or her lose his or her temper or become tense. Your child
may have frequent outbursts of shouting or complaining, or
act reckless.
Your child starts destroying things such as household
items or the child's own toys.
Your child has low self-esteem, saying things like, "I
hate myself" or "I'm stupid."
Your child feels restless, bored, or tired most of the
time.
Your child loses interest in a lot of the things he or
she used to like, such as music, sports, or being with
friends, and wants to be left alone most of the time.
Your child forgets lots of things, and has trouble
concentrating. Unlike a child with attention
deficit/hyperactive disorder (ADHD), the depressed child is
not distracted by noises or events, but rather by thoughts
or daydreams. Staying on task with homework can be a major
problem.
Your child's sleep pattern changes. Your child may be
sleeping a lot more or having trouble falling asleep at
night. Many depressed children and teens wake up in the
middle of the night and can't get back to sleep.
Your child's eating pattern changes, losing his or her
appetite, becoming a picky eater, or eating a lot more.
Your child becomes extremely sensitive to rejection or
failure. Or your child rejects others, such as by refusing
affection from parents or pushing friends away.
Your child talks about death and suicide, such as saying,
"I wish I were dead."
Your child feels guilty for no reason or believes that he
or she is just no good. Your child may self-injure, for
example by biting, hitting, or cutting him- or herself.
Your child doesn't care about rewards or consequences of
doing or not doing chores or homework.
How is it diagnosed?
Sometimes it is difficult to tell depression from other
problems such as bipolar disorder, anxiety, and
post-traumatic stress disorder. Many symptoms of depression are
also symptoms of other disorders. A mental health therapist
who specializes in working with children and teens is best
qualified to diagnose depression. Along with depression
children and teens may have other disorders as well, such
as:
anxiety disorders
attention deficit/hyperactive disorder (ADHD)
conduct disorder (delinquent behavior such as stealing
and criminal acts)
oppositional defiant disorder (ODD).
The mental health professional will ask about your child's
behavior and symptoms, medical and family history, and any
medicines your child takes. Sometimes your child may need
lab tests to rule out medical problems such as thyroid
disorders.
Diagnosing depression in children is difficult and often
requires seeing your child over weeks or months.
How is it treated?
Both medicines and therapy are useful to treat depression in
children and adolescents.
Cognitive behavior therapy (CBT) helps children learn about
depression, along with teaching specific skills for managing
their physical symptoms, negative thoughts, and problem
behaviors.
Family therapy is often very helpful. Family therapy treats
the family as a whole rather than focusing on just the
child. Children often feel very supported when parents and
siblings attend therapy with them and work as a group.
Antidepressant medicines are often needed. Some of the
medicines used for children and teens include fluoxetine
(Prozac), paroxetine (Paxil), citalopram (Celexa),
sertraline (Zoloft), and bupropion (Wellbutrin). These may
help reduce symptoms including irritability and symptoms of
anxiety. If anxiety symptoms continue, then medicines just
for anxiety may be added. If your child also has ADHD,
medicines for ADHD may be prescribed.
It is important to have an experienced professional working
with you and your child. Symptoms of depression may return.
The mental health professional treating your child may
recommend continuing with therapy or medicines even after
your child begins to feel better.
How long will the effects last?
Depression in children may be a one-time problem or may
continue. Many children have trouble for weeks or months.
Without treatment, depression may come back and get worse.
With proper medicine and regular therapy, however, the
disease is often well controlled. Many children function
very normally once a good treatment program is in place.
Children who have had depression are at greater risk for
depression in their late teens and adult years.
What can I do to help my child?
If your child or teen is suicidal, get professional help
immediately.
Don't dismiss your concerns if the symptoms have lasted
more than 6 weeks. The symptoms may not go away, and may
get worse, without professional help.
Learn all you can. Read, join support groups, and
network with others who are dealing with depression.
Understand that you are not responsible for your child's
depression, even if something such as a divorce may have
triggered it.
If your child shuts you out, don't walk away. Let
children know that you are there for them whenever they
need you. Remind children of this over and over again.
They may need to hear it a lot because they feel
unworthy of love and attention.
Encourage children to talk about whatever they want to
talk about. Be a good listener. This helps children
begin to realize that their feelings and thoughts really
do matter, that you truly care about them, and that you
never stopped caring even when they became depressed.
Make sure your child takes his or her medicines every
day, even if feeling well. Stopping medicines when he or
she feels well may start the problems again.
Stick to daily routines like regular bed and meal
times. Keep activities very structured and predictable for
your child.
Be firm and consistent with rules and consequences.
Staying calm and in control while you enforce rules and
consequences is important with depressed children.
Watch your child for the beginning signs of depression.
Ask others, such as school counselors or teachers, to
also watch closely.
Tell all health care providers who treat your child
about all medicines the child takes to make sure there is
no conflict with antidepressant medicines.
When should I seek help?
If your child or teenager often has the symptoms of
depression listed above, seek professional help. Do not try
to treat these symptoms by yourself. Professional treatment
is necessary. Get emergency care if your child or teenager
has ideas of suicide or harming others or harming him- or
herself.
You can get more information from organizations such as:
Depression and Bipolar Support Alliance
Telephone: 800-826-3632
Web site: http://www.dbsalliance.org
National Alliance for the Mentally Ill
Telephone: 800-950-NAMI (6264)
Web site: http://www.nami.org
National Institute of Mental Health
Telephone: 866-615-NIMH (6464)
Web site: http://www.nimh.nih.gov/
National Mental Health Alliance
Telephone: 800-969-NMHA (6642)
Web site: http://www.nmha.org
