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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.

Good Medicines With Careful Monitoring continued...

Michael Faenza, president and CEO of the Alexandria, Va.-based National Mental Health Association, tells WebMD that his group estimates that "one in eight adolescents is affected by depression. Think about it, that's kids in every classroom."

He agrees that antidepressants do appear to work in most children, although he notes that it is still unclear if the drugs are associated with an increased risk of suicide. "We have had a tripling of the suicide rate in young people since 1960," he says. "Much of that increase occurred in the absence of antidepressant treatment."

Faenza says his group is worried that recent headlines about suicide and antidepressants will keep parents from seeking treatment for their children, which could have disastrous effects since "only about one in three children who need mental health care are currently receiving it."

What is urgently needed, says Faenza, is more research into the effect of antidepressants and other treatments, such as talk therapies. And that research is needed now, he says.

One doctor who agrees with the urgency is Harvard-trained pediatrician Neal Bahr, MD, who is now executive producer of the television program Law and Order: SVU. Bahr tells WebMD that he decided to dramatize the problem of depressed kids in a show broadcast last year. In that show, a 14-year-old has a "manic reaction" to antidepressants.

While antidepressants are very appropriate when properly used, Bahr says he wanted to illustrate the potential dangers when the drugs are not used properly and the patient is not closely supervised. "I think we need more research into the ways in which these drugs affect developing brains, and until we have that research, we need to be cautious," he says.

What About Talk Therapy?

Part of that caution means age appropriate treatment, says Luby. She notes that there are no studies that demonstrate the efficacy of talk therapies in very young children, but says that it is very possible that the youngest children may be especially receptive to therapy because their brains are still developing and changing.

In the youngest children, play therapies are usually the first treatment option. Play therapy uses dolls and toys as well as drawings to help children open up. Usually several sessions are needed and parents should realize that the number of sessions is likely to relate to the extent of the depression. It is not uncommon for children to have weekly sessions for three to six months.

Older children may benefit from more traditional talk therapies, such as cognitive behavioral therapy, which is also known as CBT. This approach combines "thinking" therapy with behavior therapy. The goal is to modify mood by changing thinking.

One approach is called Child and Family Focused Cognitive Behavioral Therapy, which is structured for 12 sessions with the child, siblings, and parents. This approach is specifically designed for use with children who have been diagnosed with bipolar disorder -- which involves episodes of both depression and mania. Mania symptoms include inflated self-esteem, decreased need for sleep, and excessive talking. Mani N. Pavuluri, MD, from the University of Illinois at Chicago developed the therapy and he says it can be used with both young children and teens. Moreover, sessions can be planned on a weekly basis or can be spaced at intervals of two to four weeks.

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