By Rachele Kanigel
Can children suffer from depression?
Decades ago when baby boomers were still children, parents might have dismissed very real signs of depression as sulkiness or chronic moodiness. Today, doctors know that depression can affect even young children, and sometimes it can follow them throughout their lives.
Roughly 7 percent of all children are depressed, studies show, including 2 to 3 percent of children and 6 to 8 percent of adolescents, according to the Anxiety and Depression Association of America. Adolescent girls are twice as likely to suffer from depression as boys their age. By recognizing the signs, you can help your child through a dark time, even if you don't know what's causing it.
My child seems sad. Is he suffering from depression?
Not necessarily: Normal sadness or grieving is not depression. Don't worry if your child occasionally feels blue or down in the dumps. Life has its ups and downs, and it's normal for children to grieve over a loss or feel sad for a few hours or days at a time. But if his melancholy lasts for more than a couple of weeks or seems to interfere with his regular activities and relationships, he may be clinically depressed.
Depression is far more than a temporary change in mood; it's marked by a prolonged sense of hopelessness and a lack of energy and enthusiasm that can last for weeks, months, or (in rare cases) even years at a time.
What are the symptoms?
It might seem logical that the most obvious symptom of depression would be sadness, but many depressed children say they don't feel sad or gloomy. Interestingly, one of the key signs of depression in children is chronic irritability. Children may be depressed if they have trouble getting along with other kids and family members or have dramatic swings in mood. Other signs of depression include apathy, lack of energy, inability to concentrate, difficulty sleeping, frequent bouts of crying, poor performance in school, a sense of hopelessness and helplessness, and frequent complaints about boredom and physical ailments like headaches or stomach aches.
Depression often goes hand in hand with other physical and mental health problems. Some children may be depressed because of a chronic illness, such as diabetes. A youngster who has an eating disorder or a substance abuse problem, as well as kids who are constantly defiant, disagreeable, and getting into trouble with authorities, may also suffer from depression.
What causes depression?
Psychiatrists still don't completely understand depression, but most believe it's caused by a combination of biological and environmental factors. Many people who are depressed have a family history of depression or other mental illness. A child who has one depressed parent, for example, has a 25 percent to 50 percent chance of suffering depression himself. If both parents have had problems with the disease, his chance goes up to 75 percent.
But depression is based on more than just genes. Traumatic life events -- abandonment; violence in the family; chronic problems in school; a difficult move; or physical, sexual, or emotional abuse or neglect at home, school, or by other trusted caregivers -- often trigger depression. Sometimes a loss such as the death of beloved pet, a loved one, or parents' divorce, can result in depression as well as grieving.
They may not know the exact cause, but scientists do know that depression is related to changes in brain chemistry. The specific changes involve chemicals called neurotransmitters, which help relay messages from one nerve cell to another. When there is a drop in certain neurotransmitters, the brain doesn't function normally, leading to depression and other forms of mental illness.
How do I know if my child is depressed?
If your child exhibits any symptoms of depression, ask yourself three questions: Is this behavior new? Is it long-lasting (going on for several weeks or more)? Are the symptoms interfering with his ability to function at home, in school, or with his friends?
If you answer yes to any of those questions, you should probably have your child evaluated by a child or adolescent psychologist or other licensed mental health professional trained to work with children and adolescents.
How is depression treated?
Research has repeatedly demonstrated that psychotherapy, especially cognitive behavioral therapy, is an effective treatment for depression. In some cases, drug therapy may be needed as well.
Most therapists take a comprehensive approach that looks at your child, his family and social group, and the factors that may contribute to his depression. In addition to counseling your child, a therapist may also suggest family therapy or parent counseling and treatment for any related conditions your child has, such as substance abuse or an eating disorder.
>Antidepressant use is decided on a case-by-case basis by the therapist and parents, but parents should be aware of a recent study challenging the effectiveness and safety of these drugs in children and teens. Whether children and teens can benefit at all from drug therapy has been called into question by a 2016 study published in Lancet. In the study, the researchers found that all but one of the antidepressants regularly prescribed to children and teen were ineffective and potentially dangerous. The only antidepressants that showed some promise was Prozac, which researchers felt should be the drug of choice if an antidepressant was prescribed. Even then, the researchers were not convinced Prozac worked well, either.
The Boston Globe's Stat section, which reported the study, quoted a leading child psychiatrist: "No [child or teen] should be on any other antidepressant [than Prozac], and I think it's doubtful that people should be on Prozac, as well," said Dr. Jon Jureidini, a child psychiatrist at the Robinson Research Institute at the University of Adelaide in Australia, who wrote a commentary that ran with the study. "The case for Prozac is quite weak."
The FDA also strongly advises caution when giving antidepressants to children, teens and young adults due to reports of increased suicidal thoughts,suicidal attempts and suicide in some antidepressant patients in those age groups.
The FDA requires warnings on all antidepressant packaging, directing manufacturers of all antidepressant drugs to add "black box" warnings that describe the increased risk of suicide and suicidal thoughts in children and teens who take the drugs. Several years later, the FDA extended the same warning to include young adults ages 18 to 24. Black box warnings are the most serious type of warning placed on prescription medications.
Patients on antidepressants should be monitored for a worsening of their depression or the development of suicidal tendencies. This monitoring is particularly important, when the patient first begins taking the drug. Parents who are concerned about the lack of safety data may prefer alternate treatments.
Experts also caution that doctors should prescribe antidepressants only in cases of persistent, severe depression, or when therapy is impossible or is not working. It should not be used to treat kids suffering from painful situations like the death of a friend or relative, family violence, conflicts at home or school, or the loss of an important relationship. In those cases, using drugs can actually mask the real cause of the depression and keep a child from getting effective treatment. If he's depressed because of family strife or an abusive teacher, for example, the depression may end if family conflicts are resolved or he's transferred to another teacher.
Although some experts believe drug treatment can be useful, they stress that it must be combined with therapy: Medication alone won't cure the problem. Depression can be a chronic disease that often recurs, and to successfully battle it, a child must develop new coping skills.
How do I find a good therapist?
Talk to your family doctor, your health providers, relatives, clergy, and friends; they may be able to refer you to someone they're familiar with and trust. The American Psychological Association, (800) 374-2721, can also connect you with the state or local referral agency in your area. If you belong to a health maintenance organization, you may not have these options. Instead, your plan will refer you to two or three providers, and that's where you'll start.
If your child has another mental health problem related to depression, such as substance abuse or an eating disorder, look for a professional with expertise in that area. It's important that you and your child have a good rapport with the therapist you choose. Find someone your child or teenager can talk with comfortably.
Once you have the names of several people, ask them some questions like these about their background: Are you a licensed psychologist/psychiatrist? What are your degrees? Are you board-certified? (If the therapist is a psychologist, ask if he or she is certified by the American Board of Professional Psychology; if he or she is a psychiatrist, ask about certification by the American Academy of Child and Adolescent Psychiatry.) How long have you been practicing? What's your specialty? What treatment do you usually use? How long does treatment usually take? What are your fees? Will you accept my insurance coverage? Do you have a sliding scale fee? Can you set up a payment plan?
When you meet with the therapist, he or she will probably begin by doing an interview, get a complete family history, and give your child a standardized test for depression such as the Beck inventory.
What should I do if my child talks about suicide?
Always take this threat seriously. Suicide is the third leading cause of death for teens aged 15 to 19. Get your child evaluated immediately by a licensed professional to see whether he should be hospitalized. Also, get professional advice on how to make your home safer for your teenager, which usually means moving razor blades, pills, and guns, if you have them, out of the house.
Studies indicate that about one in five teenagers seriously contemplate suicide, and one in 8 try to kill themselves. Girls are more likely to try suicide, but boys, who tend to choose more violent methods, are more likely to succeed.
Be especially concerned if your child begins giving away treasured possessions or stops talking about his future. If you suspect he may be considering suicide, get help immediately -- and again, make sure that he can't get hold of a firearm. Most communities have suicide prevention hotlines that can refer you to local resources.
Recognizing your child is depressed early on and seeking treatment can help him or her find the skills to get it under control. And if depression runs in the family, it can also help you and others get the same help.
National Institute of Child Health & Human Development
Weintraub, Karen. Most antidepressants don't work on kids and teens, study finds. Boston Globe STAT, June 8, 2016
Mental Health: A report of the surgeon general. Depression and Suicide in Children and Adolescents, http://www.surgeongeeneral.gov/library/mentalhealth/chapter3/sec5.html
American Family Physician. Depression in Children and Adolescents, Sung E. Son, M.D., Jeffrey T. Kirchner, D.O. http://www.aafp.org/afp/20001115/2297.html
FDA Statement Regarding the Anti-Depressant Paxil for Pediatric Population. June 19, 2003. FDA Talk Paper T03-43.
FDA Issues Public Health Advisory Entitled: Reports Of Suicidality in Pediatric Patients Being Treated with Antidepressant Medications for Major Depressive Disorder (MDD). October 27, 2003. FDA Talk Paper T03-70.
FDA MedWatch. Paxil (paroxetine hydrochloride) warnings added concerning emergence of suicideal ideation and behavior. June 22, 2004.
FDA MedWatch. Wellbutrin (bupropion hydrochloride) warnings added concerning emergence of suicidal ideation and behavior. June 22, 2004.
FDA Launches a Multi-Pronged Strategy to Strengthen Safeguards for Children Treated With Antidepressant Medications. October 15, 2004. P04-97.
The Lancet. Treatment of depression in children and adolescents. 366(9489):933-40. thelancet.com/journals/lancet/article/PIIS0140673605673217/abstract
National Youth Violence Prevention Resource Center. Teen Suicide. http://www.teendepression.org/related/teen-suicide-statistics/
National Conference of State Legislators. Teen Suicide Prevention. http://www.ncsl.org/default.aspx?tabid=14111