Childhood Depression

Depression isn’t just bad moods and occasional melancholy. It’s not just feeling down or sad, either. These feelings are normal in kids, especially during the teen years. Even when major disappointments and setbacks make people feel sad and angry, the negative feelings usually lessen with time.

But when a depressive state, or mood, lingers for a long time — weeks, months, or even longer — and limits a person’s ability to function normally, it can be diagnosed as depression.

Types of depression include: major depression, dysthymia, adjustment disorder with depressed mood, seasonal affective disorder, and bipolar disorder or manic depression. All of these can affect kids and teenagers.

Major depression is a serious condition characterized by a persistent sad mood, feelings of worthlessness or guilt, and the inability to feel pleasure or happiness. Major depression typically interferes with day-to-day functioning like eating and sleeping. A child with major depression feels depressed almost every day. In kids, depression can appear as “bad moods” or irritability that persists for a long time, even if a child doesn’t acknowledge being sad.

Dysthymia may be diagnosed if sadness or irritability is not as severe but continues for a year or longer. Kids with dysthymia often feel “down in the dumps.” They can have low self-esteem, feel hopeless, and even have problems sleeping and eating. Unlike major depression, dysthymia does not severely interfere with day-to-day functioning but the “down mood” is a pervasive part of the child’s world. However, at least 10% of those with dysthymic disorder go on to develop major depression.

Bipolar disorder, another type of mood disturbance, is characterized by episodes of low-energy depression (sadness and hopelessness) and high-energy mania (irritability and explosive temper). Bipolar disorder may affect as many as 1% to 2% of kids. More than 2 million adults have bipolar disorder, which often develops in the late teen years and early adulthood.

Research in kids is not comprehensive, but experts believe that kids and teens with bipolar disorder can experience a number of problems, including attention deficit disorders, oppositional behavior disorders, anxiety, and irritability in addition to changes in mood from depression to mania.

Depression usually isn’t caused by one event or reason, but is usually the result of several factors. Causes vary from person to person.

Depression can be caused by lowered levels of neurotransmitters (chemicals that carry signals through the nervous system) in the brain, which limits a person’s ability to feel good. Genetics are likely involved as depression can run in families, so someone with a close relative who has depression may be more likely to experience it.

Significant life events such as the death of a loved one, a divorce, a move to a new area, and even a breakup with a girlfriend or boyfriend can bring on symptoms of depression. Stress also can be a factor, and because the teen years can be a time of emotional and social turmoil, things that are difficult for anyone to handle can be devastating to a teen.

Also, chronic illness can contribute to depression, as can the side effects of certain medicines or infections.

First, we should know that childhood depression may not take the form of “clinical” or adult depression in which the person becomes lethargic, unmotivated, and “down” or “blue” (although this form is often present in children, and becomes more common as youngsters enter adolescence). In identifying depression in children, it is important to avoid making the mistake of looking only for symptoms that characterize adult depression such as fatigue, suicidal fantasies, low self esteem, and social withdrawal. Depression in children is often “disguised” by “active” behavior such as irritability, temper tantrums, violence, risky actions, and/ or refusal to go to school. It is also important to note that sometimes something as simple as sleep deprivation due to staying up too late can mimic depression. If a better night time schedule and a nap or two usually clear things up, it wasn’t true depression.
Signs and symptoms can vary depending on the age, personality, and home situation of the youth. Again, symptoms may vary from mild to profound. Typically, the indicators listed below are first thought by parents to be reflective of a physical condition or illness. They then visit the pediatrician who (hopefully) detects the condition (although many pediatricians are not knowledgeable in this area). To assist in identification, it is important that professionals working with children be alert for the following signs, often seemingly contradictory:

*Feelings (as identified by verbalizations)
*Feeling sad (cries, pouts, looks sad or troubled)
*Feeling hopeless about the future (says that nothing s/he does will make a difference, not caring about outcomes)
*Feeling poorly about oneself and one’s abilities (makes negative remarks about self, evaluates oneself poorly in contrast with others)
*Feeling responsible (blames self for past events and negative outcomes in the present)
*Feeling alone (expresses that no one likes him or her, says that no one understands)

Your first consultation should be with your child’s pediatrician, who probably will perform a complete examination to rule out physical illness.

If depression is suspected, the doctor may refer you to a:
psychiatrist: a medical doctor who can make a diagnosis, offer treatment, and prescribe medicine
psychologist: a health professional who can diagnose and treat depression but is unable to write prescriptions
licensed clinical social worker: a person who has a degree in social work and is qualified to treat childhood depression

When it comes to managing your child’s depression, all of these health professionals can help. The important thing is that your child feels comfortable with the person. If it’s not a good fit, find another.

Your child’s teacher, guidance counselor, or school psychologist also might be able to help. These professionals have your child’s welfare at heart and all information shared with them during therapy is kept confidential.

When it comes to treatment, earlier is better. If depression goes untreated, an individuals may start to feel so hopeless that they become suicidal. Some common treatments for depression include:

Medication – Anti-depressant medications are designed to correct certain chemical imbalances in the brain. This class of medicines improves the metabolism of neurotransmitter chemicals, normalizing moods that interfere with children’s ability to learn and develop socially. Anti-depressant medication has been found effective in about 80% of adults. Researchers believe that these medications greatly help a large number of children as well.

Don’t put off your child’s treatment. Early detection and diagnosis are key in treating kids with depression.

A child or adolescent psychiatrist or psychologist can perform a complete evaluation and start a treatment plan that may include counseling, medicine, or both. The counselor might prescribe some sort of group counseling where the family works with the child in therapy sessions.

Depending on your child’s age and maturity, it may be beneficial for him or her to participate in treatment decisions.