Depression in children and adolescents is a major health problem in the United States. Unfortunately, it is often ignored or misdiagnosed. It is not uncommon for parents to attribute moodiness to hormones or other factors that are a normal part of growing up. However, major depressive disorders occur in approximately 2 to 4 percent of children, and increase two- to threefold during adolescence. Depression is particularly common among children who are hospitalized for medical reasons—approximately 30 to 40 percent of hospitalized children can be diagnosed with major depression.
The following factors may be associated with childhood depression:
- family history of depression or bipolar illness (particularly parental)
- history of abuse
- divorce of parents
- death of a close relative (or pet)
- losing a friend
- separation anxiety
- attention-deficit/hyperactivity disorder (ADHD)
- perfectionist tendencies/high sensitivity to rejection
- chronic illness
- substance abuse
- mental retardation
Signs and symptoms of depression
- persistent sadness and increased crying
- loss of interest in favorite activities
- frequent physical complaints
- anxiety (separation anxiety or excessive anxiety about school performance)
- poor school performance and/or frequent absences
- boredom, unable to concentrate, or sluggish
- change in eating or sleeping patterns
- poor peer relationships
- alcohol and drug use
- thoughts of suicide
Treating depression in children and adolescents
The first step to helping your child is listening to him with support and impartiality. If your child says things like “Everyone hates me,” find out why he feels that way. Help him understand that what he is feeling is probably temporary and mostly from the interaction with only one or two people. Help your child focus on what is going well with those around him and ways he can make those relationships better.
Children with more severe forms of depression—shown by school failure, loss of weight, appetite changes and engagement in harmful behaviors—should seek the help of a professional who has experience working with children and adolescents. Treatment may involve psychotherapy, medications or both.
Psychotherapy can help children and adolescents recover from depressive episodes. Psychotherapy can also help children and adolescents develop coping skills to prevent future episodes.
If symptoms are extremely severe, or if counseling is not progressing, the use of medications may be appropriate. The newer antidepressants, especially SRIs (serotonin reuptake inhibitors) are showing promise in drug trials for the treatment of depression and anxiety disorders in children and adolescents. Examples of these medications include Prozac®, Luvox®, Zoloft®, and Paxil®.
A unique antidepressant, Wellbutrin®, may work for depression as well as ADHD. It may be a good alternative for children with both conditions.
Research studies have shown little benefit with older antidepressants, especially TCAs (tricyclic antidepressants), in the treatment of depression in children and adolescents.