Childhood depression is different from the normal "blues" and everyday emotions that occur as a child develops. Just because a child seems depressed or sad does not necessarily mean they have depression. But if these symptoms become persistent, disruptive and interfere with social activities, interests, schoolwork and family life, it may indicate that they are suffering from the medical condition depression.
How Can I Tell if My Child Is Depressed?
The symptoms of depression in children vary. Early medical studies focused on "masked" depression, where a child's depressed mood was evidenced by acting out or angry behavior. While this does occur, particularly in younger children, many children display sadness or low mood similar to adults who are depressed. The primary symptoms of depression revolve around sadness, a feeling of hopelessness, and mood changes and may include:
- Irritability or anger
- Continuous feelings of sadness or 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
- Fatigue and low energy
- Physical complaints (such as stomachaches, headaches) that do not respond to treatment
- 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
- Impaired thinking or concentration
- Thoughts of death or suicide
Not all children have all of these symptoms. In fact, most will display different symptoms at different times and in different settings. Although some children may continue to function reasonably well, most kids with significant depression will suffer a noticeable change in social activities, loss of interest in school and poor academic performance, or a change in appearance. Children may also begin using drugs or alcohol, especially if they are over age 12.
Although relatively rare in youths under age 12, young children do attempt suicide -- and may do so impulsively when they are upset or angry.
Suicide is a serious problem within the teenage population. Adolescent suicide is a leading cause of death among youth and young adults in the U.S. It is estimated that 500,000 teens attempt suicide every year with 5,000 completing the act. These are epidemic proportions.
Children with a family history of violence, alcohol abuse, or physical or sexual abuse are at greater risk for suicide, as are those with depressive symptoms.
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 their 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, they 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.
What Is the Long-Term Outlook?
Studies have found that first-time depression in children is occurring at younger ages than previously. As in adults, it may occur again later in life. Depression often occurs at the same time as other physical illnesses. And because studies have shown that depression may precede more serious mental illness later in life, diagnosis, early treatment and close monitoring are crucial.
As a parent, it is sometimes easier to deny that your child has depression. You may put off seeking the help of a mental health care professional because of the social stigmas associated with mental illness. It is very important for you -- as the parent -- to understand depression and realize the importance of treatment so that your child may continue to grow physically and emotionally in a healthy way. It is also important to seek education about the future effects depression may have on your child throughout adolescence and adulthood.
Communicating With Your Teen
If you are a parent of a teenager, you are aware of the challenges involved, especially when it comes to communicating. Here are some tips to make communicating with your teenager easier:
- When disciplining your child, replace shame and punishment with positive reinforcement for good behavior. Shame and punishment can make an adolescent feel worthless and inadequate.
- Allow your teenager to make mistakes. Overprotection or making decisions for teens can be perceived as a lack of faith in their abilities. This can make them feel less confident.
- Give your teen breathing room. Don't expect them to do exactly as you say all of the time.
- Do not force your child down a path you wanted to follow. Avoid trying to relive your youth through your child's activities and experiences.
If you suspect that your child or teenager is depressed, take the time to listen to their concerns. Even if you don't think the problem is of real concern, remember that it may feel very real to them. It is important to keep the lines of communication open, even if your child seems to want to withdraw. Try to avoid telling your child what to do. Instead, listen closely and you may discover more about the issues causing the problems.
If you feel overwhelmed or unable to reach your child, or if you continue to be concerned, seek help from a qualified health care professional.