Children are not immune to depressiondepression. Just like for adults, treatment can be critical. Finding help for a depressed child may forestall years of anguish, and may even save that child's life. Yet ongoing controversy over the safety of antidepressant drugs has left many wondering what really helps or harms.
Few, least of all parents, think childhood is a state of constant bliss. Children's moods are like tropical seas: Tranquil waters can suddenly whip into a howling storm, returning just as quickly to sunshine and fair breezes. Depression, however, should not be confused with normal moodiness. It's as real and serious for children -- even very young children -- as it is for adults.
"It's relatively recent that we are recognizing depression in children," says David Fassler, MD, a child and adolescent psychiatrist at the University of Vermont College of Medicine. "When I went to medical school some 20-odd years ago, we were taught that kids didn't get depressed."
But kids do get depressed. According to the American Academy of Child and Adolescent Psychiatry, an estimated 2% of young children, and 4% to 8% of adolescents, suffer from depression.
While depression definitely exists in some younger kids, it's much more common in teenagers. Researchers predict that about one in 10 kids will develop a depressive disorder by age 16. That's based on a study in which 1,420 kids were evaluated for mental disorders every three months until their 16th birthday.
Depression in Children Has Lifelong Repercussions
Depression can have harsh and lasting consequences for children. It can lead to setbacks in a child's social life, emotional growth, and performance in school, as well as substance abuse.
"Without treatment, an average episode of depression in kids will last about nine months, which is about the length of a school year," Fassler says. "It's very difficult to catch back up."
Making matters worse, people who struggle with depression as kids may feel the impact in adulthood. A study published in The Journal of the American Medical Association found that adults diagnosed with depression as adolescents were at a disadvantage compared with those who never had depression. The findings showed:
- Their average income was lower.
- Fewer of them graduated from college.
- They were more likely to be unemployed.
- More reported having problems in their work and their social and family lives.
And those with a history of adolescent depression were twice as likely to have an episode of depression as an adult compared to a person who had no past or current history of a psychiatric condition.
The study's most disturbing finding was a high rate of suicide attempts and deaths. There were no suicide deaths among those who were not depressed in adolescence, while 7% of those who were depressed as kids killed themselves, and 34% attempted suicide.
This is not an isolated statistic. It's well known that depressed children are at high risk for suicide. Suicide is the third leading cause of death for 10- to 24-year-olds in the U. S.
Depression is dangerous territory. Having entered it, kids need every bit of help they can get to survive and find their way out.
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.
Other recent studies have shown that only about 2% of children and teens who killed themselves were taking an antidepressant at the time.
Prince says he thinks some good could also come from antidepressants carrying suicide warnings. "It's really a mixed bag," he says.
He shares concerns that the black-box label may scare people away from the medications, but it has raised awareness about the danger of suicide in depressed children and teens.
"It's also probably a good thing, although uncomfortable, that we actually have to talk about it with families," he says.