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Depression Health Center

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Childhood Depression: Matter of Life or Death

Because some depressed children appear happy, depression in children can be difficult to diagnose. But many depressed children become suicidal, making diagnosis crucial.

Childhood Depression: How Do You Know? continued...

The problem, however, is that while clinically depressed adults rarely appear happy, depressed children often appear happy, says child psychiatrist David Fassler, MD. He tells WebMD, "Children present in a lot of different ways. Sometimes kids are just like classically depressed adults -- they are withdrawn, sad, tearful, and have trouble sleeping. Other times they are irritable, can't sit still, and have trouble concentrating. And sometimes they 'look' happy." Fassler is a spokesman for the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.

Luby agrees and notes that children are "inherently joyful and often don't appear obviously sad." Also, their sadness is not constant, she adds. Sadness is often interrupted by normal mood periods, so it can be missed. Thus, rather than attempting to measure sadness, she measures the lack of pleasure by having parents interact in games and scenarios that "are specifically designed to elicit joy." Luby says, too, that the most reliable gauge of childhood depression is "parent reports."

Michael Naylor, MD, director of the division of child and adolescent psychiatry at the University of Illinois at Chicago, says, too, that depressed children are less likely to lose their appetites and sleep disturbances are more likely to have difficulty falling asleep, rather than waking in the middle of the night.

No Magic Pills

As difficult as it is to diagnose depression, treatment can be even more challenging, says Naylor.

He tells WebMD that most psychiatrists follow the "Texas Children's Medication Algorithm," which outlines a step-by-step approach to treatment. He says the plan recommends Prozac as the first-line drug treatment, because there is so little research into the efficacy and safety of antidepressant drugs in children that "the research is really only unequivocal in one drug, and that drug is Prozac, which has demonstrated that it is more effective than placebo."

He says another study suggested that Zoloft is also more effective than placebo, but the difference was not as great as in the Prozac studies.

But recently, antidepressants have been in the news because of concerns that they may be linked to increased suicidal thoughts or actual suicide in children and teens. The concerns prompted the FDA to require makers of 10 antidepressants to include warning labels on their products. The new labels, which will appear on Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro, Wellbutrin, Effexor, Serzone, and Remeron, warn of possible suicide, worsening depression, anxiety, and panic attacks in adults and children. The FDA said in a news release that it was not yet clear whether antidepressants contribute to the emergence of suicidal thinking and behavior, but they recommended close monitoring of all patients taking antidepressants.

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