Childhood Depression
What is it?
Depression is a strong feeling of sadness. Many times children feel sad for a short time, in response to a loss or sad event. However, sometimes the feelings of sadness are out of proportion to the event that triggered them, or they last for anywhere from months to
years.
Who gets it?
It is important to remember that children can become depressed just like adults, regardless of race, sex, or socioeconomic background. However, depression is more common in children who have other family members who have experienced
depression.
What causes it?
Factors that are known to contribute to depression are heredity, a chemical imbalance in the brain, and high levels of stress. Depression is frequently a response to a sad or traumatic event, such as the death of a loved one or pet. It may also be triggered by difficulties with friends or school, moving, divorce, childhood abuse and neglect, and drug or alcohol abuse. Heredity refers to the fact that children who have family members with any type of depressive disorder are more likely to also experience depression. Studies of brain functioning have revealed a complex system of neurotransmitters that produce chemicals that transfer signals from nerve cell to nerve cell. Some of these neurotransmitters, such as serotonin, are responsible for feelings of well-being. Drugs that correct neurotransmitter imbalances are very effective in treating depression, which supports the theory that there is some type of chemical imbalance that triggers depression. In some cases, the cause of childhood depression is not
known.
What are the symptoms?
While everyone experiences sadness at one time or another, these feelings are generally temporary. Children who are depressed feel down for more than just a few days. They may suddenly withdraw from friends or activities that they used to enjoy, may have problems sleeping, or want to sleep all the time. Other symptoms include changes in eating habits that cause weight loss or gain, feelings of worthlessness, a persistent sad expression, sudden decline in school performance, irritability or crying, and frequent complaints of vague physical problems such as stomach pain and headache. Usually two or more of these symptoms exist at the same time. A child who is depressed may act angry and aggressive in response to his or her sadness. Some children are also very good at hiding their depression from others by putting on a
"happy" face in public, but their sadness is evident at home. When symptoms of depression exist for one or more years, it is called chronic depression. In some children, periods of depression may alternate with periods of extreme happiness, or euphoria. This is called bipolar, or manic-depressive, disorder. Severe depression, which includes thoughts of suicide, is more common in adolescent children. Adolescents who are severely depressed have no interest in anything, including eating and basic personal hygiene. Many instances of teenage depression do lead to suicide
attempts.
How is it diagnosed?
Diagnosing depression at an early age is extremely important in preventing severe mental health problems later in life. Many times, children who are depressed withdraw from those around them, so it is difficult for loved ones to break through the barrier they put up and try to help. This is especially true with adolescents. If your child shows any of the listed symptoms of depression, talk to your doctor. He or she will examine your child to determine if there is a physical cause of the symptoms. He or she may refer you to a psychiatrist or psychologist, who specializes in mental health. This doctor will ask you and your child questions about the child's physical health, home and school environments, and any experiences that would affect how the child feels about him or herself and others. The doctor might use a special questionnaire, such as the Child Depression Inventory (CDI), that helps diagnose depression. The doctor will also ask about any possibility of drug, alcohol, or physical abuse that could cause
depression.
What is the treatment?
Childhood depression is commonly treated with a combination of drug and psychotherapy. Drugs are used to treat the symptoms of sadness and to correct any chemical imbalances in the brain that contribute to depression. Therapy helps the child to deal with any stresses that are contributing to the depression. The group of antidepressants most commonly used with children is called selective serotonin reuptake inhibitors (SSRIs).
Drugs classified as SSRIs include fluoxetine and sertraline. These drugs are very effective in treating depression because they increase serotonin levels, which contributes to a feeling of well-being. Any side effects, such as headache, anxiety, diarrhea, sweating, difficulty concentrating, nausea, and difficulty sleeping, are generally milder than with other types of antidepressants.
Other types of antidepressants that might be used depend upon the age of the child and the severity of the depression. These include tricyclic antidepressants (TCAs), such as amitriptyline, imipramine, and nortriptyline, and monoamine oxidase inhibitors (MAOIs), which include anylcypromine and phenelzine. MAOIs are so named because they block, or inhibit, the action of the enzyme monoamine oxidase in the central nervous system. However, they can cause severe and life-threatening side effects if combined with certain other drugs or foods. These include foods that are high in tyramine (such as soy sauce, beer on tap, red wines, and aged cheeses and meats), some over-the-counter cough and cold medicines, and both trycyclic and SSRI antidepressants. The combination of an MAOI and any of these causes a sudden and severe rise in blood pressure. Anyone taking MAOIs must be aware of any food or drug interactions. One final category of antidepressant is the heterocyclics. These include bupropion and trazodone. However, bupropion is not given to patients with a seizure disorder. Tazodone can cause sedation, so it is often effective in treating older adolescents with insomnia.
You and your doctor can decide which medication is best for your child by reviewing the child's medical history and evaluating the risks of negative side effects. It may take anywhere from two to six weeks for your child to feel the effects of an antidepressant. Antidepressants are not addictive. And, unless your child is severely depressed and at risk for suicide, hospitalization is generally not needed during treatment.
Just like there are different types of antidepressants, there are also different types of psychotherapy. Your doctor will help decide which is best for your child, but all types focus on figuring out what has caused the depression and developing special skills to cope with any problems. Your child may benefit from a combination of individual, group, and family therapy. Without family support, your child will not be able to recover completely. It is extremely important to make sure your child's school and teachers are aware of your child's special needs at this time. Remember that you are your child's best advocate. Don't be afraid to ask questions and discuss your child's treatment with your doctor so you know as much as
possible.
Self-care tips
If you suspect your child is depressed, it is important to get treatment as soon as possible. If your doctor recommends an antidepressant for your child, make sure he or she takes the recommended dose at around the same time each day. Even if your child is feeling great, do not stop the medication or skip a dose without your doctor's permission. Antidepressants need to be reduced gradually to prevent side effects. It is also important to work with a therapist or support group to get help with any problems that are contributing to your child's depression. They can help your child develop a positive attitude and a new way of looking at life and its challenges. And, never forget that good nutrition, plenty of rest, and regular exercise go a long way in helping a child to feel good again. If your child expresses thoughts of suicide, call your doctor or therapist immediately. Also call your doctor if your child is having any negative side effects from an antidepressant.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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