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Recognizing Childhood Depression and Anxiety

Parents often mistake depression in children for moodiness.
(continued)

Treating Childhood Depression

What happens when a child is treated for depression?

 

"What a parent should expect is a discussion about the depression, a discussion about the various intervention methods one would consider from the least to the most aggressive, and a discussion about suicide or self-harm and what parents should be alert to," Benoit says.

 

Treatment requires the involvement of the parents.

 

"Parent must be given a lot of information about what the options are, and a sense that it is they, the parents, who choose how they would like treatment to start," Benoit says. "I tell people about medication, I talk about providing psychotherapeutic support, and what I might want to do first. I never do anything at that first session, unless the child is suicidal. I say, "I want you to think about it, then come back. As long as a child is not suicidal, we have some time to think and talk to the pediatrician."

 

But Dolgan stresses the importance of treating the symptoms of depression before tackling any long-term issues.

 

"The comprehensive treatment is individual and family work. Parents are in the mainstream of the treatment," he says. "The short-term goal ought to be symptom reduction. You have to work on symptoms. And if some situation is prompting or triggering the depression, you know that from meeting the parents."

 

Antidepressant medication can be an important part of treatment. But it can't be the only treatment.

 

"Watch out for providers who promise magic in a bottle," Dolgan says. "Maybe you don't have to invest in a full course of psychotherapy. But with little ones, there is nothing like it. They have to learn how to manage the illness, what to do, how to know if they are relapsing into a severe depression, and what are some coping and compensatory skills. There is a lot you can teach kids of what to do when getting depressed."

 

But when properly prescribed, antidepressant medication can be very helpful.

 

"People worried about the side effects of psychiatric medications should know that there is a side effect to not taking medications, too -- kids remain sick," Koplewicz says. "Medications for these disorders shouldn't be controversial -- if a teen or child or adult has been properly diagnosed with this disorder. Then it is effective and remarkably safe if properly monitored. But first, you have to have the disorder. You need someone to really clarify and say this is not a response to a bad life situation, this is acute clinical depression."

Child Demoralization

Unfortunately, many children have very good reasons to be sad and to feel depressed. Such children, Koplewicz stresses, do not have depressive disorders. They are demoralized.

 

"A lot of kids' life experiences are very depressing. They live in poverty. Their parents are abusive or neglectful or just divorced and still fighting. They are in inadequate educational systems. All those are depressing situations," Koplewicz says. "These situations don't necessarily create depression, but they may create behavioral symptoms. These kids may become rambunctious, unhappy, tearful. But we are not talking about the same thing as adult depression. You should feel badly when life is crummy."

 

And it's not only underprivileged kids whose lives can make them act depressed, says Alvin Rosenfeld, MD, a child and adolescent psychiatrist in private practice in Connecticut and New York.

 

"Much that looks like depression is the product of over-pressured, overscheduled youth and families," Rosenfeld tells WebMD. "When you cut back, the symptoms diminish."

 

Originally published April 14, 2004.

Medically updated July 2006.

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Reviewed on July 31, 2006
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