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they are withdrawn, sad, tearful, and have trouble sleeping.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
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.