All kids have periods of sadness, says Ron Steingard, M.D., associate medical director of the Child Mind Institute in New York City. But depression is something else entirely. "It's not just that they're sad," he says. "It's that they're in a very low energy state and that it persists over a long period of time."
It's estimated that 2 percent of children (and between 4 and 8 percent of adolescents) suffer from depression. It's most often diagnosed in adolescents but can affect children in elementary school. At younger ages, the illness affects boys and girls equally, but in adolescence the illness begins to affect more girls than boys. This continues into adulthood, with depression affecting 12 percent of women and nearly 7 percent of men.
SIGNS & SYMPTOMS
Depression isn't a temporary mood swing, says Dr. Steingard. "The symptoms are there most of the day on most days, not a single day here or there." And the illness affects more than just mood. It also affects three other crucial areas: cognition, behavior, and physiology (causing fatigue or insomnia and aches and pains, among other symptoms). Warning signs include:
- feelings of sadness or irritability, or crying spells for no apparent reason
- loss of interest or pleasure in normal activities
- change in activity level
- agitation or restlessness
- change in appetite and weight
- problems with concentration, decision making, task completion, and school performance
- sleep problems
- negative thinking
- feelings of worthlessness
- talk of (or efforts to) run away from home
When a child has major depression, at least five symptoms are present for a period of at least two weeks. In a related condition called "dysthymia," fewer symptoms are present but they persist over a longer period of time -- at least a year. In both cases, a child's everyday life is disrupted.
Many factors contribute to depression in children. There is a genetic component, with 20 to 50 percent of kids having a family history of the illness, according to Dr. Steingard. Children with behavior problems and anxiety are also at higher risk, according to the American Academy of Adolescent & Child Psychiatry (AACAP). In addition, medical illness, the loss of a loved one, or stress can lead to depression in children, says the AACAP, but in many cases there doesn't seem to be a specific trigger.
Children with depression are typically treated with therapy, medication, or both.
Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have both been used successfully. "During CBT, kids learn how their thoughts are influencing the way they feel, and they're taught to reframe their thoughts to be more positive," says Dr. Steingard. During IPT, the therapist focuses on kids' relationships with family members and friends and encourages kids to seek out activities they once enjoyed.
When medication is prescribed, it's often a selective serotonin reuptake inhibitor (SSRI), such as Zoloft or Prozac. Many parents have concerns about the safety of these drugs -- in particular that they increase a child's risk of suicide -- and indeed, the FDA includes a warning about suicidal thinking and behavior with every antidepressant prescription. According to the Child Mind Institute, "The phenomenon is rare and has been tied only to suicidal ideation, not actual suicide attempts. Experts believe that the benefits of these medications for depression patients far outweigh the risks."
Dr. Steingard and other experts emphasize that depression is a treatable disorder. With strong family support, medication and therapy together often provides the best outcome, he says. "The goal is to impart a skill set and give children the tools they need to avoid a recurrence down the road."
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