By Dr. Amir Petrus Dawood
The symptoms of depression in children vary. It is often undiagnosed and untreated because they are passed off as normal emotional and psychological changes that occur during growth. 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 like adults who are depressed. The primary symptoms of depression revolve around sadness, a feeling of hopelessness, and mood changes.
Signs and symptoms of depression in children include:
• Irritability or anger
• Continuous feelings of sadness and 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 don’t 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 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 in structured environments, 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.
Which Children Get Depressed?
Up to 3% of children and 8% of adolescents in the U.S. suffer from depression. Depression is significantly more common in boys under age 10. But by age 16, girls have a greater incidence of depression. Bipolar disorder is more common in adolescents than in younger children. Bipolar disorder in children can, however, be more severe than in adolescents.
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 is not a passing mood, nor is it a condition that will go away without proper treatment.
Can Depression in Children Be Prevented?
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. If the symptoms of depression in your child have lasted for at least two weeks, you should schedule a visit with his or her doctor to make sure there are no physical reasons for the symptoms and to make sure that your child receives proper treatment. A consultation with a mental health care professional who specializes in children is also recommended. Keep in mind that the pediatrician may ask to speak with your child alone.
A mental health evaluation should include interviews with you (the parent or primary caregiver) and your child, and any additional psychological testing that is necessary. 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 medication. The role that family and the child’s environment play in the treatment process is different from that of adults. Your child’s doctor may suggest psychotherapy first, and consider antidepressant medicine as an additional option if there is no significant improvement. The best studies to date indicate that a combination of psychotherapy and medication is most effective at treating depression.
Treating Children With Bipolar Disorder
Children with bipolar disorder are usually treated with psychotherapy and a combination of medicines, usually an antidepressant and a mood stabilizer.
Antidepressants need to be used with caution, as they can trigger bouts of manic or hyperactive behavior in children with bipolar disorder. Managing a child’s medication must be part of an overall care plan that includes therapy and routine primary care appointments.
The FDA warns that antidepressant medications may increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider. Additionally, if your child is placed on these medications, it is still very important to continue to follow closely with the physician and therapist.
Warning signs of suicidal behavior in children include:
• Many depressive symptoms (changes in eating, sleeping, activities)
• Social isolation, including isolation from the family
• 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