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Depression: Is Your Child Depressed?

Depression in children can have dire lifelong consequences. Do you know the signs?

Depression in Children: Symptoms and Treatment

Parents can help children through the maze of depression by looking for and recognizing the symptoms of depression in kids. Symptoms include:

  • Irritability or anger
  • Continuous feelings of sadness, 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
  • FatigueFatigue and low energy
  • 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
  • Thoughts of death or suicide

The seriousness of these symptoms only underscores the importance of treatment such as antidepressant drugs, psychotherapy sessions, or both.

"In my experience, almost all kids with depression benefit from individual therapy," Fassler says. "By the time kids get help there are often secondary effects of the depression," such as a low self-esteem and bad relationships with family and peers. "Kids need help working those through. Medication doesn't fix those problems," Fassler says.

Antidepressants and the FDA's Black Box

There was always a quiet debate about the pros and cons of treating children with antidepressants, but in 2004 the FDA cranked up the volume when it put a strong warning on antidepressant drug labels. The "black box" warning says that antidepressants have been shown to increase suicidal thinking and behavior in children and adolescents, and should be used with caution.

The FDA meant to urge doctors to watch young patients carefully for suicidal tendencies during the first few months of treatment, but their warning seems to have done a lot more than that.

Before the FDA released its first advisory in March 2004, antidepressant use in children and teens had been rising steadily for years. By the end of June 2005 there was a 20% drop in antidepressant prescriptions for kids aged 18 and under.

Now some mental healthmental health professionals worry that the FDA's action could result in a terrible irony. Frightened parents and doctors might withhold needed medication from depressed youth, leading to an increase in suicide deaths.

"It's much more risky for someone not to be treated for depression than it is for them to take their antidepressant," Jefferson Prince, MD, a psychiatrist at Massachusetts General Hospital in Boston, tells WebMD.

Antidepressants: Research Behind the Black Box

The FDA's black-box warning is based on a review of 24 studies, which found that in the first four months of treatment, kids on antidepressants were twice as likely to think about suicide or have suicidal behavior compared with kids taking a placebo. There were no actual deaths by suicide in the studies, however.

The suicide death rate for kids aged 10-19 fell by about one-third from 1993-2003. Many things could explain the decrease, but evidence suggests the rise in antidepressant drug use may have been partly responsible. Researchers compared antidepressant prescriptions for this age group to suicides in hundreds of U.S. ZIP codes. The study, published in the Archives of General Psychiatry, shows that in places where more kids got antidepressants there were fewer suicides.

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