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    Mental Health: Depression in Children

    Suicide Warning Signs

    Parents should be particularly vigilant for signs that may indicate that their child is at risk for suicide. Warning signs of suicidal behavior in children include:

    • Many depressive symptoms (changes in eating, sleeping, activities, or restlessness/agitation)
    • Social isolation
    • Talk of suicide, hopelessness, or helplessness
    • Increased acting-out of undesirable behaviors (sexual/behavioral)
    • Increased risk-taking behaviors
    • Frequent accidents
    • Substance abuse
    • Focus on morbid and negative themes
    • Talk about death and dying
    • Increased crying or reduced emotional expression
    • Giving away possessions

    What Causes Depression in Children?

    As in adults, depression in children can be caused by any combination of factors that relate to physical health, life events, family history, environment, genetic vulnerability, and biochemical disturbance.

    Depression in Children: Who's At Risk?

    Children with a family history of depression are at greater risk of experiencing depression themselves. Children who have parents that suffer from depression tend to develop their first episode of depression earlier than children whose parents do not. Children from chaotic or conflicted families, or children and teens who abuse substances like alcohol and drugs, are also at greater risk of depression.

    How Is Depression Diagnosed?

    If symptoms of depression in your child have lasted for at least two weeks, you should schedule a visit with his or her health care provider to make sure there are no physical reasons for the symptoms and to ensure that your child receives proper treatment. If your child's health care provider suspects depression, he or she will recommend you take your child to see a mental health care professional, typically either a psychiatrist or a psychologist.

    There are no specific tests -- medical or psychological -- that can clearly show depression, but clinical interviews conducted by trained and experienced mental health professionals along with tools such as questionnaires (for both the child and parents) combined with personal information can be very useful. Information from teachers, friends and classmates can be useful for showing that these symptoms are consistent during your child's various activities and are a marked change from previous behavior.

    What Are the Treatment Options?

    Treatment options for children with depression are similar to those for adults, including psychotherapy (counseling) and medicine. The role that family and the child's environment play in the treatment process is different from that of adults. Your child's health care provider may suggest psychotherapy first, and consider antidepressant medicine as an additional option if symptoms are especially severe or if there is not significant improvement from psychotherapy alone. Currently, there are no good studies documenting the effectiveness of medicine over psychotherapy in children.

    However, studies do show that the antidepressant Fluoxetine (Prozac) is effective in treating depression in children and teens. The drug is officially recognized by the FDA for treatment of children ages 8 to18 with depression.  Other selective serotonin reuptake inhibitors (SSRIs) are used, as well.  Most medications used to treat depression in children have a black box warning about increasing suicidal thoughts.  It is important to start and monitor these medications under the care of a trained professional.

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