Depression is the most common mental health problem in the United States. Each year it affects 17 million people of all age groups, races, and economic backgrounds.
As many as 1 in every 33 children may have depression; in teens, that number may be as high as 1 in 8.
So it’s wise for parents and caregivers to learn about depression and how to help if your child, or a child you know, seems depressed.
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.
What is childhood depression?
Clinically significant depression can be broadly understood as depression that is severe enough that it interferes with the person’s ability to function in some way.
It is quite common in every age group, affecting more than 16% of the populations in the United States at some point in their lifetime. Other statistics about depression include that it tends to occur at a rate of about 2% during childhood prior to the teenage years.
This illness is a leading cause of health impairment (morbidity) and death (mortality). About 3,000 youths die by suicide each year in the United States, making it the third leading cause of death in the 10-24 year age group.
What are the types of depression in children?
Children may suffer from the episodes of moderate to severe depression of major depressive disorder, or more chronic, mild to moderate depression of dysthymia.
Depression may also be part of other mood problems like bipolar disorder, as a consequence of psychosis, as part of a medical condition like hypothyroidism, or the result of exposure to certain medications such as cold medications or drug abuse, like cocaine withdrawal.
What are causes and risk factors for depression in children?
Depression in children does not have one single definitive cause. Rather, people with this illness tend to have a number of biological, psychological, and environmental risk factors that contribute to its development.
Biologically, depression is associated with a reduced level of the neurotransmitter serotonin in the brain, a decrease in the size of some areas of the brain, as well as increased activity in other areas of the brain.
Girls are more likely to be given the diagnosis of depression than boys, but that is thought to be the result of, among other things, a combination of biological differences based on gender, as well as the differences in how girls are encouraged to interpret their environment and respond to it compared to boys.
There is thought to be at least a partially genetic contribution to the fact that children and adolescents with a depressed parent are up to four times more likely to develop the illness themselves.
Children who develop depression are also more prone to having other biological challenges, such as low birth weight, trouble sleeping, and having a mother younger than 18 years old at the time of their birth.
Psychological risk factors for depression include low self-esteem, poor body image, a tendency to be highly self-critical, and feeling helpless when dealing with negative events.
Children who suffer from conduct disorder, attention deficit hyperactivity disorder (ADHD), clinical anxiety, or who have cognitive or learning problems, as well as trouble relating to others also are at higher risk of developing depression.
Depression may be a reaction to environmental stresses, including trauma like verbal, physical, or sexual abuse, the death of a loved one, school problems, being the victim of bullying, or peer pressure.
Research differs as to whether children that are obese are at higher risk of developing depression.
The aforementioned environmental risk factors tend to specifically predispose children to depression. Other risk factors tend to predispose people to depression as well as putting them at risk for other problems.
Such risk factors to depression include poverty, exposure to violence, being socially isolated, parental conflict, divorce, and other reasons for family dissolution.
Children who have low physical activity, poor academic performance, or lose a relationship are at higher risk for depression as well.
What are the symptoms and warning signs of depression in children?
Clinical depression, also called major depression, is more than sadness that lasts for a day or two before feeling better. In true depressive illnesses, the symptoms last weeks, months, or sometimes years if no treatment is received.
Depression often results in the sufferer being unable to perform daily activities, such as getting out of bed or getting dressed, performing well at school, or playing with peers.
General symptoms of major depression, regardless of age, include having a depressed or irritable mood for at least two weeks and have at least five of the following clinical signs and symptoms:
- Feeling sad or blue and/or irritable
- Loss of interest or pleasure in usual activities
- Significant increase or decrease in appetite, with or without significant weight loss, failing to gain weight appropriately or gaining excessive weight
- Change in sleep pattern: inability to sleep or excessive sleeping
- Physical agitation or retardation (i.e., restlessness or feeling slowed down)
- Fatigue or loss of energy
- Trouble concentrating
- Feelings of worthlessness or excessive guilt
- Thoughts of death or suicide
Children with depression may also experience the classic symptoms but may exhibit other symptoms as well, including
- poor school performance,
- persistent boredom,
- quickness to anger,
- frequent complaints of physical symptoms, such as headaches and stomachaches,
- more risk-taking behaviors and/or showing less concern for their own safety.
If You Suspect a Problem
The good news is that professionals can help. Depression can be successfully treated in more than 80% of the people who become depressed. But if it goes untreated, it can be deadly — it is a major risk factor for suicidal behavior.
Depression can be treated with psychotherapy, medicine, or a combination of therapy and medicine.
A psychiatrist can prescribe medicine, and although it may take a few tries to find the right drug, most people who follow their prescribed regimen eventually begin to feel better.
Psychotherapy focuses on the causes of the depression and works to help change negative thoughts and find ways to allow someone to feel better.
Cognitive behavioral therapy has been shown to be very effective in treating depression, as well as anxious feelings that may come with it.
Depression can be caused by and maintained with negative thinking, and this type of therapy, when given by a trained professional, can be extremely effective in helping fight it.
How is depression in children diagnosed?
Many providers of health care can help make the diagnosis of clinical depression in children, including licensed mental-health therapists, pediatricians, other primary-care providers, specialists seen for a medical condition, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers.
These professionals will likely conduct or refer for an extensive medical interview and physical examination as part of establishing the diagnosis.
Depression is also associated with a number of other mental-health problems, like attention deficit hyperactivity disorder (ADHD), Asperger’s syndrome and other autism-spectrum disorders, bipolar disorder, posttraumatic stress disorder (PTSD), and other anxiety disorders, so the evaluator will likely screen for signs of manic depression, a history of trauma, and other mental-health symptoms.
Childhood depression also may be the result of a number of medical conditions, or it can be a side effect of various medications, or exposure to drugs of abuse.
For this reason, routine laboratory tests are often performed during the initial evaluation to rule out other causes of symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed.
As part of this examination, the sufferer may be asked a series of questions from a standardized questionnaire or self-test to help assess the risk of depression and suicide.
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.