Depression is one of the most prevalent mental health disorders in the country and it is on the rise as one of the most serious health concerns facing us. The irony is that it is also one of the most treatable disorders, through psychotherapy and/or medication. Yet barely a third of the people with depression seek help or are properly diagnosed.
It is estimated that about 10 to 15 percent of children and teens are depressed at any given time. Research indicates that one of every four adolescents will have an episode of major depression during high school with the average age of onset being 14 years!
These episodes typically last several months when untreated. While this indicates the main problem is likely to abate without treatment, these teens are at much higher risk for suicide which is a leading cause of death during adolescence. In addition, during an untreated episode of major depression, teens are more likely to get into serious substance abuse addictions or suffer significant rates of dropping out of their typical activities and social groups. Thus, even if the depressive episode wanes, significant problems may continue on.
The milder form of depression, called dysthymia, is more difficult to diagnose, especially in elementary school children. Yet this form of depression actually lasts much longer. Typical episodes last seven years and often longer. Many depressed adults can trace their sad, discouraged, or self-dislike feelings back to childhood or adolescence.
With children, although typical adult features may be present, they are more likely to show symptoms of somatic complaints, withdrawal, antisocial behavior, clinging behaviors, nightmares, and boredom. Yes, many of these are common for non-depressed children. But usually they are transient, lasting about four to six weeks. You should become concerned when the symptoms last for at least two months, don’t respond to reasonable parental interventions, and seem to pervade the child’s life rather than be confined to just one aspect.
I have referred to major depression and dysthymia as two primary forms of depression. Very briefly, there are a number of symptoms common to both but with a greater severity in the former. In adults, depressed mood, loss of interest or pleasure in activities, loss of appetite or overeating, sleeping a lot or not being able to sleep, loss of energy, loss of self-esteem, indecisiveness, hopelessness, problems with concentration, and suicidal thoughts or attempts are the signs of depression. People rarely have all of them.
We usually look for at least four or more and, again, severity and longevity are important determinants when making a diagnosis. Teens will exhibit more adult-like symptoms but severe withdrawal is especially significant.
In childhood, boys actually may have a higher rate of depression than girls but it is often missed because many of the depressed boys act out and the underlying depression is missed. In adolescence, girls begin the same predominance as women, about two to three times the rate of males. Contrary to popular belief, research rejects the notion that it is related to hormonal changes associated with adolescence. Instead, just as with adult women, sexual harassment and experiences of discrimination appear to be more significant causes.
Primary causes of depression in children are parental conflict (with or without divorce), maternal depression (mothers interact much more with their children), poor social skills, and pessimistic attitudes. Divorced parents who are still fighting have the highest rate of depressed children (about 18 percent).
Regarding depression in mothers, it is the symptoms of irritability, criticism, and expressed pessimism that are especially significant. Also, the environmental factors contributing to the mother’s depression (marital or financial problems) also may impact directly on the children. Depressed children are more likely to have poor social skills, fewer friends, and give up easily (which also contributes to poor school performance and lack of success in activities). You must differentiate, however, from the shy, loner child who is actually content to spend more time alone.
What to do? When concerned, talk with teachers and pediatricians. (However, both of these front-line professional groups need more training in diagnosing depression.) If there seems to be a valid concern, then seek help from mental health professionals who specialize in working with children. (Parents: above all, follow your instincts because there is a tendency to underdiagnose problems in younger children.)
If marital conflict is present, then seek couples therapy (if divorced, seek help for cooperative parenting). If one or both parents are depressed, then individual therapy may be needed for each. Children’s therapy groups are particularly effective for those with social skills deficits. Family therapy is also very effective, particularly with older children or teens.
Depression does run in families and may have a biological basis. Antidepressants are especially important in these cases and may also be important even if the causes are primarily psychological because they help the child (or adult) attain the level of functioning needed to benefit from other interventions. Since children and teens are less certain to respond positively to medications for depression than adults, it is especially important to use child psychiatrists who specialize in psychopharmacology.