Depression in Children and Adolescents

Introduction (Brief Summary)

Childhood depression is different from the normal “blues” and everyday emotions that occur as a child develops. Just because a child seems sad, this does not necessarily mean he or she has significant depression. If the sadness becomes persistent, or if disruptive behavior that interferes with normal social activities, interests, schoolwork, or family life develops, it may indicate that he or she has a depressive illness. Keep in mind that while depression is a serious illness, it is also a treatable one.

Overview and Facts

About 2.5% of children in the U.S. suffer from depression. Before puberty, depression is significantly more common in boys than girls. But by age 16 years, girls have a greater incidence of de¬pression.

Symptoms

The symptoms of depression in children vary. It is often undiagnosed and untreated be¬cause 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 similar to 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, 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 do not respond to treatment.
Reduced ability to function during events and activities at home or with friends, in school, extra curricular activities, and in other hobbies or interests.
Feelings of worthlessness or guilt.
Impaired thinking or concentration.
Thoughts of death or suicide

Not all children with depression have all of these symptoms. In fact, most will display dif¬ferent 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 the age of 12.

Causes and Risk Factors

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 bio¬chemical disturbance. Depression is not a passing mood, nor is it a condition that will go away without proper treatment.
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 cha¬otic or conflicted families, or children and teens who abuse substances like alcohol and drugs, are also at greater risk of depression.

Tests and Diagnosis

Your doctor or another health professional will evaluate and diagnose depression in your child by asking questions about your child's medical history and conducting tests to find out if symptoms are caused by something other than depression. Your child may be given a physical exam or blood tests to rule out conditions such as hypothyroidism and anemia. Your child may be asked to complete a mental health assessment, which tests his or her ability to think, reason, and remember.

You may be asked to help complete a pediatric symptom checklist, a brief screening questionnaire (like Children Depression Inventory) that helps to diagnose depression or other psychological problems in children. Also, your child may be asked to take a short written or verbal test for depression.

Sometimes a more thorough evaluation may be needed to fully assess your child's depression. Interviews may be conducted with the parents or with other people who know the young person well. Specific information may be obtained from the child's teachers or from social service workers.

Treatment

Treatment options for children with depression are similar to those for adults, including psychotherapy and medication. The role that family and the child’s environ¬ment 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.