Childhood depression is likely to persist because
Childhood Depression | Anxiety and Depression
Rates of childhood depression have been rising in the last several years. Yet, information and awareness about childhood depression has not caught on at the same rate. Millions of people across the world wonder and doubt if children can get depressed. Many well-intentioned adults still believe that children ‘can’t get depressed. They are so young- what do they have to be depressed about? When we were that age, we were just happy’. Alongside misunderstanding is stigma and the idea that mental illness is a taboo subject.
What we now know:
- Childhood depression is a real, distinct clinical entity.
- It is a serious health condition, which if left untreated, increases risk of future, prolonged and more severe depressive episodes. Untreated depression in childhood and adolescence can pose risk of suicide.
- Depression often has biological, psychological and social underpinnings. An individualized treatment plan that explores and addresses each of these aspects, works best.
- Effective treatment options for childhood and teen depression have been widely tested, proven and established, through several scientific studies over the years.
- Childhood depression can be hidden and therefore, easily missed. Timely recognition and treatment can be life-changing and life-saving.
- The barriers surrounding mental health stigma are beginning to give way due to powerful social movements and discussions that address realities of mental health.
Who is Affected by Depression in Childhood or Teenage?
Depression can affect anyone. However, children or teens who have immediate family members with a history of depression or other mood disorders (such as bipolar disorder) are more likely to suffer from depression, often due to a genetic predisposition. Predisposition implies greater likelihood; it does not mean that the child or teen will necessarily experience depression.
Children with chronic or severe medical conditions are at a greater risk of suffering from depression.
Common Signs of Depression in Childhood or Adolescence
Depression in childhood/adolescence can manifest somewhat differently than it does in adults. Irritability and/or anger are more common signs of depression in children and teens.
When depressed, younger children are more likely to have physical or bodily symptoms, such as aches or pains, restlessness, distress during separation from parents, as they may not have the emotional attunement and/or expressive abilities to talk about their emotions.
Other signs of depression in children and teens, can be:
- Loss of interest in usual fun activities
- Withdrawal from social or usual pleasurable activities
- Difficulties with concentration
- Running away from home or talking about running away from home
- Talking about death or dying, giving away (or talking about giving away) favorite possessions, writing goodbye letters
- Sleep increase (or decrease)
- Appetite/weight changes (more likely an increase, in depressed teens)
- Occasionally, new or recent onset agitation or aggression
- Comments indicating hopelessness or low self-worth
Not all of the above-mentioned symptoms have to be present for a diagnosis of depression.
Symptoms usually occur on most days, for at least 2 weeks, in order to meet criteria for depression. When seeing a professional to explore a diagnosis, you can utilize online health resources to prepare meaningful questions to ask a doctor in order to facilitate productive conversation for treatment.
Ruling Out Medical Conditions First
Psychiatric disorders are diagnosis of exclusion, which means that only if the symptoms are unexplained by medical conditions, or effect of substances or other non-psychiatric causes, would the cause of symptoms be deemed to be due to a primary psychiatric disorder.
Before arriving to the diagnosis of depression, a child or teen who is suspected to be depressed, must undergo a comprehensive medical evaluation to rule out any underlying medical condition which could be manifesting as or resulting in depression. For example, hypothyroidism (depressive symptoms, weight gain, low energy, cognitive difficulties, constipation).
Even conditions such as undiagnosed anemia can mimic depression, due to accompanying fatigue/low energy. Vitamin D deficiency, common in cold climates, increases risk of depressive symptoms and fatigue. The good news is that these conditions have effective treatments, and treatment of the underlying medical condition in a timely manner should resolve depressive symptoms.
Ruling Out Other Psychiatric Conditions
Rule out undiagnosed/untreated ADHD (attention Deficit Hyperactivity Disorder), anxiety disorders or other psychiatric conditions, which when left untreated, can result in depressive symptoms due to the impairment in functioning from ADHD or anxiety disorder itself.
Treatment
Why Treat?
Depression is associated with visible brain changes seen on functional brain MRI studies of depressed individuals. Treatment, for example, psychotherapy has been shown to confer long term benefit and neural changes in the brain.
How Do I know My Child Needs Treatment?
In addition to an overall assessment, your child’s pediatrician may administer rating scales and other forms of assessment to determine the degree of depression and may refer you to a psychiatrist or a psychotherapist.
We know a child/teen needs treatment for depression when their school, social, and/or home functioning is significantly affected by depressive symptoms, on a frequent basis.
If your child/teen is feeling suicidal and/or having thoughts/urges to hurt themselves, call 911 or take your child/teen to the nearest ER.
What Kind of Treatment?
For mild to moderate depression, CBT (Cognitive Behavioral Therapy) is the typical first-line treatment of choice for children and teens. There can be exceptions to this, depending on the specific clinical condition, age and circumstance of the child. For children younger than 10, other modalities of psychotherapy such as play therapy, psychodynamic psychotherapy, and behavior therapy may be utilized.
For moderate to severe depression, evidence-based guidelines recommend a combination of CBT and antidepressant medications (typically SSRI medications, also known as Selective Serotonin Re-Uptake Inhibitors).
SSRI Use for Depression in Children
- SSRIs and other antidepressants have a black box warning from FDA about risk of increase in suicidal thoughts and behavior with use, particularly in the early phase of treatment. Studies did not show completed suicides.
- After this warning came out in 2004, antidepressant prescription rates dropped, and suicide rates climbed up.
- Close monitoring during dose initiation, titration and dose changes helps to reduce this risk
- Antidepressant medication use in children and adolescents is preceded by a weighing of benefits and risks of use versus risks of untreated depression.
- Fluoxetine and Escitalopram are FDA approved for treatment of depression in children and teens.
- Studies involving paroxetine (another SSRI) have shown a higher profile of side effects with its use in children, and therefore, may not be recommended for children and teens.
- Studies show a higher likelihood of an individual responding to an SSRI that an immediate family member benefitted from (however, this is a likelihood, not necessary that it will happen in each situation)
If depressive symptoms are secondary to other conditions, such as untreated ADHD or anxiety disorders, adequate treatment of those disorders is essential and will usually resolve the depressive symptoms. However, in certain situations, specific antidepressant medications and/or psychotherapy targeted towards depression may be needed in addition. One might note that if trials of two or more antidepressants are not effective, or if a child/teen is sensitive to medications in general, there are additional avenues that can be explored. One plausible route for consideration is genetic testing that combines personal genetic data with medication information to achieve the desired remedy.
Your child’s pediatrician/psychiatrist, therapist, together with you, may also explore for any bullying, trauma, and will try to understand your child/teen’s inner life and look further for any school, social, family or other stressors that may be contributing to, or exacerbating/perpetuating the depressive condition. If family stressors are significantly contributing to your child’s depression, your doctor may recommend family therapy in addition. With your permission, the doctor/therapist may coordinate with your child’s school to share recommendations to optimize your child’s school functioning and emotional well-being at school.
Overcoming Mental Health Stigma
In 1999 the United States Surgeon General labeled stigma as quite possibly the biggest barrier to mental health care. Stigma manifests as misguided stereotypes and negative attitudes or beliefs towards those with mental illness. Research shows that stigma and embarrassment were the top reasons why people with mental illness did not engage in medication adherence, such as self-care, therapy and medication compliance.
As of late, there has been an increase in available resources and tools to overcome stigma for children and teens, as well as their caregivers. Allies such as Bring Change to Mind, an organization focused on encouraging dialogue about mental health, as well as raising awareness through education, offers high-school and college programs that foster a culture of peer support within schools.
A Word About Substance Use and Depression
Sadly, substance use among teens is becoming rampant across the country, even in reputed school districts, and thus, needs to be addressed when exploring and treating depression.
Marijuana use is particularly common among teens. Marijuana is considered to be a ‘gateway drug’ and can lead to ‘amotivational syndrome’. This syndrome manifests as low motivation to do things, and in conjunction with marijuana related ‘munchies’ can mimic a primary depressive disorder. In many cases, a teen may be ‘self-medicating’ for untreated or undiagnosed depressive or anxiety symptoms through substance use.
Use or withdrawal from other substances can cause depressive, mood symptoms as well.
Proper and timely treatment can be very effective in resolving depressive symptoms and in reducing risk of relapse. Please consult your child’s pediatrician or health care provider if you suspect your child/teen may be suffering from a medical or a psychiatric condition.
Note: This article is for informational purposes only and is not intended to provide medical or psychiatric advice or recommendations, or diagnostic or treatment opinion. This is not a complete review or description of this subject. If you suspect a medical or psychiatric condition, please consult a health care provider. All decisions regarding an individual’s care must be made in consultation with your healthcare provider, considering the individuals’ unique condition. If you or someone you know is struggling, please contact the 24x7, confidential National Hotline at 1-800-273-8255 or use the crisis text line by texting HOME to 741741 in the US, or go to http://www.
suicide.org/international-suicide-hotlines.html for the suicide hotline number for your country.
Behavioural and emotional disorders in childhood: A brief overview for paediatricians
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What is childhood depression?
Childhood depression is an emotional disorder accompanied by behavioral disturbances and mood swings.
Symptoms and risk factors for depression differ between children and adults. There is an assumption that from a genetic point of view, these are two different diseases. However, the treatment of childhood depression in terms of its content and methods is close to the treatment of this disorder in adults. High-quality treatment from qualified specialists helps to get rid of childhood depression in just a few months. nine0003
Symptoms of childhood depression
In children, depression can begin to develop from 3-4 months - this is the so-called infantile depression. This type of depression, in contrast to childhood, is more similar in symptoms to an adult. An infant suffering from this disorder loses all interest in life and experiences constant apathy. Childhood depression may begin to manifest itself at the age of 3-4 years, but usually develops during the early school years. nine0003
In children, as a rule, depression manifests itself in the form of problematic, deviant behavior.
Any depression in the first place is always associated with a decrease in mood. Treatment for depression in adults usually focuses on dealing with negative emotions. However, in children, this disorder does not present with the symptoms that are characteristic of adolescents or adults with depression. Children usually do not want to sleep much or not get out of bed at all. They have a normal appetite and no suicidal thoughts. In children, as a rule, depression manifests itself in the form of problematic, deviant behavior. Very often, parents, teachers and even professionals confuse such symptoms with behavioral problems. Adults see a child as a bully or a bad student, and do not even realize that this is a form of childhood depression. The child begins to rebel against the school, the rules and the system. For children, unlike adolescence, this behavior is not normal, unless the child is exposed to serious negative factors, such as physical abuse. nine0003
See also
What is depression?
It is extremely important for a child to be involved in society and thus develop basic cognitive and social functions.
When this involvement is disturbed, the child stops going to school, to circles and is not interested in anything, and his normal development is also disturbed. Unfortunately, without the help of a psychiatrist and psychotherapist, the development of a depressed child cannot be restored. At the first manifestations of deviant behavior, parents should seek help from a specialist. nine0003
Causes of childhood depression and risk factors
The most likely cause of childhood depression is a genetic predisposition to the disease. However, in order for a genetic disorder to manifest itself, the child must be under the influence of certain risk factors. As a rule, in childhood, such factors are related to what happens in the family. A risk factor that provokes the development of the disease can be a divorce of the parents or a tense relationship between them. nine0003
To reduce the risk factors for depression in a child, parents should maintain a healthy family environment.
Another serious risk factor is bullying. If a child has a predisposition to depression, bullying by peers can trigger the mechanisms for the development of the disease. The child will begin to skip school and run away from interaction with the educational system in every possible way. Such children often run away from home so that they are not forced to go to school, to clubs and go out into the yard. Sometimes, however, school can be a place where a child feels safe and secure, running away from home problems. To reduce the risk factors for depression in a child, parents should maintain a healthy family environment. nine0003
Treatment of childhood depression
Childhood depression is diagnosed through a clinical interview with a psychiatrist or psychotherapist who specializes in child development. A psychiatrist may prescribe medication to help ease some of the symptoms and improve the child's mood. The psychotherapist will work with the patient himself and his parents using cognitive-behavioral or dynamic psychotherapy techniques.
Unlike adults, it is quite difficult for a child of primary school and preschool age to explain that his condition is a disease that requires certain actions and treatment. Treatment for childhood depression is usually through music, art, games, and sports. By participating in games, the child can express himself, and through art, he can perceive the psychotherapeutic work of a specialist. nine0003
Parents are often unable to help their child cope with depression because they themselves are the cause of his condition. The psychotherapist works with parents and provides them with the tools to properly interact with the child. During the sessions, they learn about the methods of psychological support in such situations, and learn how to apply them in practice. If parents meet halfway, cooperate with a psychotherapist and follow all the recommendations, most symptoms of childhood depression can be removed within a month. The younger the child, the faster the healing process. nine0003
- Depression
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Childhood depression - Neurocenter
It seems that depression is not a child's diagnosis at all.
Does depression happen in children? Alas, but this one is.
The most susceptible to this psycho-emotional disorder are teenagers, however, this disease can manifest itself much earlier, for example, at the age of 3-4 years. The course of childhood depression, of course, differs from that of adults. The biggest difficulty is that it is quite difficult for children to explain what is happening to them. Children cannot, like adults, consciously talk about their feelings and emotions. Even distinguishing feelings within themselves can be problematic for children. More often, a child's internal discomfort manifests itself in altered behavior, which only sensitive parents can notice. In young children, somatic symptoms become manifestations of depression: malaise, frequent morbidity, weakened immunity. Therefore, in order to understand the condition of the child, parents need to pay attention, and not write off his behavior as whims and bad character. nine0003
The symptoms of depression in children are different from the symptoms of depression in adults.
primary symptoms of depression in children include: irrational fears, sadness, feelings of helplessness, mood swings. Sleep disturbances (insomnia, drowsiness, nightmares), appetite disturbances, decreased social activity, a feeling of constant fatigue, a desire for self-isolation, low self-esteem, problems with memory and concentration, thoughts of death, suicide may also appear. Elements 9 appear frequently0017 non-standard behavior - a sharp unreasonable unwillingness to play your favorite games or unreasonably aggressive reactions, children become rebellious and irritable, they "do not like everything." Anxiety in depressed children is most pronounced in the evening and at night.
Probably the most striking manifestation of childhood depression is the so-called "hospitalism" syndrome that occurs in children with prolonged separation from their parents. Variants of a difficult experience of breaking the emotional connection with the mother can be the hospitalization of the mother or child due to illness, business trips of the parents.
nine0003
Childhood depression can be caused by a difficult family situation: alcoholic parents, mentally ill relatives, grief over the loss of another family member, changes in family composition, physical or psychological abuse in the home.
Often, depression in school-age children is manifested as a result of such a phenomenon as “mobbing” or “bullying” by peers or teachers themselves. Many children, out of fear, may not even tell their parents about such facts. nine0003
In some children with sensitive unstable nervous system, depressive episodes may occur even without any abrupt and traumatic events: parents are too busy with their own affairs or work, they began to pay less attention to the child; classmates did not take the game; the teacher did not give an opportunity to answer or did not praise...
However, not everything is explained only by psychogenic factors. The causes of childhood depression can also be:
- Pathology of the nervous system: the absence of a revitalization complex in a child aged 1 month may be a manifestation of the so-called cerebral depression, which is characteristic of premature babies or children who have undergone oxygen starvation during childbirth or intracranial birth trauma; nine0042
- Endogenous causes caused by the genetic predisposition of the child.
Manifestations of endogenous depression are usually protracted (chronic): children are lethargic, with reduced activity, there are signs of motor and mental retardation, it is difficult for such children to get out of bed in the morning; - Severe somatic illnesses, injuries or operations suffered by children.
Before diagnosing " depression " it is necessary to carefully observe the mental and physical state of the child. Only a stable long-term combination of depressive symptoms allows you to accurately determine the type of disorder and also select the necessary treatment. nine0003
What should you do if you suspect depression in your child's behavior?
Creative activities have a positive effect on the state of the child: drawing, music, dancing. nine0042 
