It wasn't uncommon for 10-year-old Eric to have a bad day now and again--but lately, they seem to be occurring more frequently. "What's wrong honey?" his mother would ask. "Nothing" he'd reply -- "I'm just having a bad day." On these days Eric would either stay in his room, "veg –out" on video games or just sleep.
For a few months Eric's mother chalked these "bad days" up to the pressures of school. His teacher told her that many kids experience difficulty adjusting, and that being 10 is an awkward age. "Just give him time," she said. So she did--until one day when Eric came from school and began to sob uncontrollably. "What's wrong honey--did you have another bad day?" "Mom" he replied, "I think I'm having a bad life."
There is no easy way to tell the difference between a bad case of the blues and symptoms of depression. So when feelings of sadness, loneliness, confusion, and anger persist, it may not be "just a phase" they will simply grow out of--it may be due to an illness called depression.
Depression affects approximately 5% of children (age 12 and under). Despite its increasing incidence and devastating effects on children and their families, depression among children remains woefully under-diagnosed and under-treated. Consequently, many depressed children become seriously ill before a proper diagnosis is made. Because depression is linked to increased risk taking, substance abuse, promiscuity, pregnancy, delinquency and suicide, early detection is critical.
The good news is that depression is highly treatable. Learning the facts about childhood depression can lead to early detection and treatment, saving much pain, heartache, and lives.
Major Depression and Dysthymia are the most common types of depression observed in children. Profound sadness, hopelessness, mental confusion, social isolation and thoughts of suicide characterize major depression. The course a depressive episode can vary, however if untreated an episode of major depression generally lasts one year.
Dysthymia is a "low-grade" type of depression characterized by long-term feelings of sadness. Children with dysthymia tend to have low self-esteem, poor social skills, and be pessimistic. They may have difficulty in school and trouble in forming relationships. Dysthymia can follow or precede a major depressive episode or be entirely unrelated.
What Causes Depression in children?
There are no clear-cut reasons as to why some children become depressed while others endure overwhelming stress, pain and loss in their lives and come out seemingly unscathed. Recent studies have demonstrated that depression is rarely due to a single event or condition. Rather, it is the result of a complicated matrix of family, social, genetic and biochemical influences. As with many diseases, some people are more susceptible than others. However, depression, like many other illnesses, tends to run in families. Or putting it another way, the vulnerability for depression is one of many family traits passed on from one generation to the next. For example, a child who has one parent with depression has a 10-to-13% GREATER chance of developing depression in his or her own lifetime. Clearly, the vulnerability for depression can be transmitted genetically. But genetic vulnerability is just that--a vulnerability--not destiny.
Symptoms of Depression
The symptoms of depression in children vary from child to child. While some children look sad, others appear anxious and worried. In general depressed children experience changes in their thinking, feelings and behavior. Here are some characteristics of each.
- Their thinking is characterized by negative, self-defeating thoughts and problems with concentration and memory.
- They may characterize themselves as "bad" "dumb," or "ugly."
- Hopelessness, and irrational fears about the future increase as the disease progresses.
- They are likely to obsess over minor faults and failures and see themselves as worthless.
- They frequently take on responsibility for events beyond their control such as family problems or divorce.
- They may appear visibly sad, worried and irritable.
- They cry easily, and lose interest in activities that once brought them pleasure.
- They may complain of feeling "bored" and reject opportunities to participate in activities that they once enjoyed.
- The child may begin to show tremendous anxiety about attending school or other social functions.
- Depressed children are likely to withdraw and isolate themselves from others, spend hours alone in their rooms or obsess on video games or television.
- They may cling excessively to a parent, sibling or friend.
- They can become preoccupied with death and dying, and make suicidal gestures.
- They may show symptoms of irritability, restlessness, and hyperactivity, which frequently mislead professionals to erroneously diagnosis them with attention deficit with hyperactivity disorder (ADHD) or social anxiety disorder.
- May experience difficulty sleeping and wake frequently during the night.
- Younger children may wake from persistent nightmares.
If you suspect your child is depressed get help immediately. Your pediatrician or family doctor may be the best place to start.
Diagnosing depression in children requires a clinical interview by an experienced mental health professional as well as the use of a reliable assessment tool. The Children's Depression Inventory, Reynolds Child Depression Scale and the Beck Depression Inventory-II are excellent screening instruments for depression in children. If a diagnosis of depression is made, treatment by a child psychiatrist or psychologist with expertise in childhood depression will follow.
Treatment for depressed children involves some form of psychotherapy and family counseling. Cognitive behavioral, insight-oriented, and group therapies are the most common approaches used in the treatment for children. The purpose of therapy is to help the child understand and express their hurt, fears and anger in a safe and appropriate manner as well as help them, and their family, develop new ways of thinking about and reacting to stress and problems.
Seeing a physician about depression is a good starting pointThe use of antidepressant medications is becoming increasingly common as a treatment strategy. The number of children in the US prescribed medications to treat depression has tripled since 1986. Antidepressant medications are thought to work by increasing amount and availability of certain neurotransmitters (brain chemicals) in the brain, thus restoring chemical balance and appropriate mood.
The newer antidepressants, especially selective serotonin reuptake inhibitors (SSRI's) have proven to be safe and effective for the treatment of depression and anxiety disorders in children and adolescents. Examples of these medications include Prozac®, Luvox®, Zoloft®, and Paxil®. Most of these medicines take several weeks before symptoms improve. Another, somewhat unique antidepressant, Wellbutrin®, has a similar mechanism of action as the SSRI's but works on different neurotransmitters. It has been successful in the treatment of depression and ADHD in children and teens and works much faster than the SSRI's. It may be a good choice for children with attention problems and depression. The combination of medication and therapy has been shown to be a very effective modality for many depressed children.
Final thoughts. If you suspect that your child is depressed get help immediately. Your pediatrician or family physician may be the best place to start. Remember that depression is highly treatable illness and most children can and do recover. Recent research shows that over 60 percent recover or partially recover after one year. Lastly, it is common for parents to second guess and blame themselves when a child is depressed. Keep in mind that depression is caused by numerous and largely unknown factors. Fretting about the cause will not change a thing--and may even make matters worse. The best way to help your child is to stay in the present, listen for their feelings, emphasize their worth and tell them how much you love them. Then let tomorrow take care of itself.
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