David Baxter PhD
Late Founder
Blues Clues: Childhood Depression
12/15/2005
by Mo Ibrahim
Your kid feels like an outsider? She often has headaches? He's acting a bit moody? Not to worry, right? Sounds like every kid. These are not uncommon descriptions of elementary, middle school and high school students. But parents, be wary: These symptoms could very well be warnings of serious childhood or adolescent depression.
According to the "Report of the Surgeon General on Mental Health," 10 to 15 percent of American children and adolescents have at least a few symptoms of depression. That's about 7 to 10 million children.
In 2000, according to the National Institute of Mental Health, suicide was the third leading cause of death among 15- to 24-year-olds, as well as the third leading cause of death among 10- to 14-year-olds. Although an equal amount of prepubescent boys and girls suffer from depression, twice as many girls have depression after puberty. While depression in children and adolescents is not prevalent, it is something to look for. Treating your child now can help prevent full-blown adult depression later and, more important, save your child's life.
It's also important to note that depression is not about "feeling low." It goes much deeper than that.
Most, but not all, mental health professionals agree that people diagnosed with depression tend to have a chemical imbalance in the brain. These chemicals, called neurotransmitters, aid communication between brain cells. Serotonin and norepinephrine are the two neurotransmitters that are most commonly imbalanced. Serotonin imbalance may lead to irritability, anxiety and sleepiness, whereas an imbalance of norepinephrine can cause fatigue and a depressed mood. Whether this imbalance causes depression or whether depression causes the imbalance is unknown.
Lucy, now 22, of Port Washington, suffered from depression throughout her youth in Northern Nevada. She was officially diagnosed at age 14 and hospitalized at 15, and it wasn't until last year that she finally weaned herself off Zoloft, an antidepressant she partially credits for her recovery.
"I initially felt sadness. I didn't feel like I fit in at school or with other kids at my school," Lucy recalls. "Headaches and sleeping disorders didn't come until later during my adolescence.
"Obviously, I knew I was different than my friends and family," she continues. "I was aware that I was somewhat of a hermit, an outcast, but my expression and my behavior was what got my parents to try to take action with therapy."
Most people who suffer from depression are so stuck in the mire of hopelessness and bleak, utter dispair, it's difficult for them to get out. As with Lucy, family is often the key.
Childhood Depression
But family can also be the cause.
Why would a child suffer from depression? David Fassler, M.D., director of the American Academy of Child and Adolescent Psychiatry (AACAP) in Washington, D.C., implicates both nature and nurture.
"Some people are genetically more vulnerable," he says. According to Fassler, a child with one parent who has depression has a 25 percent chance of having childhood depression. The child has a 75 percent chance if both parents are depressed.
Even if your child isn't exhibiting signs of depression, if one or both parents, or any close relative for that matter, suffers from the disorder, the child's mental health must be followed carefully.
Dr. David Shaffer, director of the Division of Child and Adolescent Psychiatry at Columbia University in New York City, notes that the biggest environmental causes for childhood depression is "repeated [marital] separations of parents," instability of child care or physical/sexual abuse. He also says that a recent move can be a trigger for suicide, if the child's anxiety is rigid.
"If there is a change, you must get professional support," Shaffer cautions.
Childhood depression is rare, according to Shaffer, who says that psychiatrists often over-diagnose prepubertal depression, when it's instead "probably a form of anxiety disorder." Rare, though, does not mean negligible. Shaffer notes that anorexia nervosa is also not that common, but both childhood depression and anorexia require immediate attention.
Dr. Fassler contends that childhood depression is difficult to diagnose as well.
"When we peel away the layers of the onion, we find depression," says Fassler. One reason mental health professionals need to look deep beneath the surface for childhood depression is that it's usually a secondary depression, meaning that it's often diagnosed with another disorder, such as attention deficit disorder or substance abuse.
So how can parents recognize childhood depression? Dr. Keith Harris, a psychiatrist in Huntington, has seen depression "in kids as young as 8 or 9." "There's usually a change in appetite and sleep patterns," says Harris.
But, the condition can be recognized as early as infancy, according to John Ochoa, a psychologist at Henry L. Stimson Middle School in Huntington Station. Though crying is common among infants, depressed infants tend to "smile less and cry more," Ochoa says. A baby who rarely smiles may be evincing early symptoms of depression. Symptoms for older children typically include school avoidance, bed-wetting and temper tantrums. (See sidebar, "What To Look For," on page 11 for a more detailed list of symptoms.)
The most obvious symptom is threatening or attempting suicide. Childhood suicide is even more rare than childhood depression. One reason is that children often do not fully understand mortality. Shaffer notes that children usually confuse acts that their parents scold them for with acts that are lethal. Children may act out suicide threats by swallowing analgesics.
"Some think a few Tylenol pills will kill them," says Columbia University's Shaffer, hastening to add that the urgency of the situation can't be judged by the method a child uses to attempt suicide. All threats and attempts warrant immediate attention. As Dr. Harris says, "If someone is making a gesture but the intention is to kill themselves, that's a high risk." Fassler finds that suicidal children do not know that they will never come back. Some might play video games, for example, and think that they have three lives left. Others who attempt suicide might not even be depressed, but delusional. A young girl might jump out the window because she believes she can fly.
And parents should not wait for suicide threats, experts warn. At the first signs of overwhelming sadness, withdrawal, serious personality changes, loss of appetite or the desire to sleep the day away, parents should take heed.
Adolescent Depression
One assumption that needs to be tackled is the age at which adolescence begins. Shaffer has observed children who are 10 years old who have the height of 12-year-olds. Thus, having reached puberty at an early age, they often have adolescent depression.
"Younger adolescents are somewhat more likely to present with physical complaints and/or signs of irritability in conjunction with depression," says Fassler. "They are also more likely to act impulsively when depressed."
Fassler also notes that depressed adolescents tend to have a change in sleeping patterns, a drop in grades, or morbid or suicidal thoughts.
Sometimes, they act out the morbid thoughts.
"I would cut myself on my arm with a scissor," Lucy recalls, "and that would take my mind off of the persistent mental anguish and send a soothing drug-like adrenaline through me and give me something else to focus on, giving me a sense of relief."
Although this is an obvious symptom, sometimes the signs are more subtle. Middle-school psychologist Ochoa suggests that parents look for "changes in friends or isolation from friends." Though hanging with the wrong crowd might not necessarily be a sign of depression, growing apart from positive friends who do well in school or involve themselves in healthy extracurricular activities can be a red flag. Shaffer tells parents to notice when their kids "compare themselves negatively to other kids." Even the classic high-school crush can be a trigger for serious depression. If the adolescent still thinks, after two weeks, that they will never love somebody other than the person they had a crush on who did not reciprocate the attraction, and the lovesick individual has other symptoms (failure in school, substance abuse), this can be a sign of depression. Do not underestimate the impact of a teenager's broken heart.
The Light At The End Of The Tunnel
Professional help from a school psychologist or a private professional is important at every stage. First of all, it's necessary for diagnosis. Personality tests used for diagnosis include the Beck Depression Inventory, Behavior Assessment System for Children II (BASC-II) and Personal Problems Checklist for Adolescents.
After diagnosis, Ochoa recommends a "good clinical interview with the child [and] family members." Fassler recommends a range of therapies depending on the individual case, such as individual, family or cognitive behavioral therapy.
Two types of antidepressants are used to correct the chemical brain imbalance. Selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, are used to correct imbalances in serotonin, whereas monoamine oxidase inhibitors (MAOIs) interact with norepinephrine as well as serotonin. MAOIs, which include Nardil, Parnate and Marplan, carry more side effects.
Though antidepressant medication can certainly be helpful, the FDA issued a "black box" warning label to health professionals in 2004 describing the increased risk of suicidal thoughts and behavior in children and adolescents being treated with such medications. The warning emphasized that psychiatrists and parents should closely watch children and teenagers who take Prozac, for instance, in case symptoms get worse.
Surprisingly, some doctors—Fassler, for one—do not scoff at alternative medicine.
Lucy, for example, has tried network chiropractic, a noninvasive form of chiropractic that is closer to Reiki than traditional bone cracking.
"I still see a therapist, but he's a chiropractor who performs semi-hypnotic touch therapy," she explains. "I believe it rearranges energy, poisons and patterns that have been instilled in me for so long."
Fassler sees benefits in these alternative treatments.
"Some forms of alternative medicine may be a useful component of treatment for depression in certain individuals," he says. "However, treatment is generally most effective when it's comprehensive and individualized to the needs of the specific person."
Though it might be difficult for families with depressed children, giving up should be the last thing on anybody's mind. Lucy now copes with her illness.
"It's a powerful force, but I think real personal truth is already programmed into all of us," she explains. "And that helps us realize right from wrong and, as a result, happy from sad."
She adds that she felt better sharing her story—proof that it's never too late.
"I still feel feelings of depression and anger," Lucy says. "I think the trick in battling this illness is truly knowing yourself, recognizing when it's building, and be active in combating it."
Depressed Kids: What To Look For
Depression can manifest itself in many different ways. Here's a list of symptoms that children and adolescents might have that could be signs of depression. The information was provided by Dr. David Fassler, director of the American Academy of Child and Adolescent Psychiatry, and Dr. John Ochoa, psychologist at Henry L. Stimson Middle School in Huntington Station.
Ages 3-6
Ages 6-12
Ages 12-17
How To Help
12/15/2005
by Mo Ibrahim
Your kid feels like an outsider? She often has headaches? He's acting a bit moody? Not to worry, right? Sounds like every kid. These are not uncommon descriptions of elementary, middle school and high school students. But parents, be wary: These symptoms could very well be warnings of serious childhood or adolescent depression.
According to the "Report of the Surgeon General on Mental Health," 10 to 15 percent of American children and adolescents have at least a few symptoms of depression. That's about 7 to 10 million children.
In 2000, according to the National Institute of Mental Health, suicide was the third leading cause of death among 15- to 24-year-olds, as well as the third leading cause of death among 10- to 14-year-olds. Although an equal amount of prepubescent boys and girls suffer from depression, twice as many girls have depression after puberty. While depression in children and adolescents is not prevalent, it is something to look for. Treating your child now can help prevent full-blown adult depression later and, more important, save your child's life.
It's also important to note that depression is not about "feeling low." It goes much deeper than that.
Most, but not all, mental health professionals agree that people diagnosed with depression tend to have a chemical imbalance in the brain. These chemicals, called neurotransmitters, aid communication between brain cells. Serotonin and norepinephrine are the two neurotransmitters that are most commonly imbalanced. Serotonin imbalance may lead to irritability, anxiety and sleepiness, whereas an imbalance of norepinephrine can cause fatigue and a depressed mood. Whether this imbalance causes depression or whether depression causes the imbalance is unknown.
Lucy, now 22, of Port Washington, suffered from depression throughout her youth in Northern Nevada. She was officially diagnosed at age 14 and hospitalized at 15, and it wasn't until last year that she finally weaned herself off Zoloft, an antidepressant she partially credits for her recovery.
"I initially felt sadness. I didn't feel like I fit in at school or with other kids at my school," Lucy recalls. "Headaches and sleeping disorders didn't come until later during my adolescence.
"Obviously, I knew I was different than my friends and family," she continues. "I was aware that I was somewhat of a hermit, an outcast, but my expression and my behavior was what got my parents to try to take action with therapy."
Most people who suffer from depression are so stuck in the mire of hopelessness and bleak, utter dispair, it's difficult for them to get out. As with Lucy, family is often the key.
Childhood Depression
But family can also be the cause.
Why would a child suffer from depression? David Fassler, M.D., director of the American Academy of Child and Adolescent Psychiatry (AACAP) in Washington, D.C., implicates both nature and nurture.
"Some people are genetically more vulnerable," he says. According to Fassler, a child with one parent who has depression has a 25 percent chance of having childhood depression. The child has a 75 percent chance if both parents are depressed.
Even if your child isn't exhibiting signs of depression, if one or both parents, or any close relative for that matter, suffers from the disorder, the child's mental health must be followed carefully.
Dr. David Shaffer, director of the Division of Child and Adolescent Psychiatry at Columbia University in New York City, notes that the biggest environmental causes for childhood depression is "repeated [marital] separations of parents," instability of child care or physical/sexual abuse. He also says that a recent move can be a trigger for suicide, if the child's anxiety is rigid.
"If there is a change, you must get professional support," Shaffer cautions.
Childhood depression is rare, according to Shaffer, who says that psychiatrists often over-diagnose prepubertal depression, when it's instead "probably a form of anxiety disorder." Rare, though, does not mean negligible. Shaffer notes that anorexia nervosa is also not that common, but both childhood depression and anorexia require immediate attention.
Dr. Fassler contends that childhood depression is difficult to diagnose as well.
"When we peel away the layers of the onion, we find depression," says Fassler. One reason mental health professionals need to look deep beneath the surface for childhood depression is that it's usually a secondary depression, meaning that it's often diagnosed with another disorder, such as attention deficit disorder or substance abuse.
So how can parents recognize childhood depression? Dr. Keith Harris, a psychiatrist in Huntington, has seen depression "in kids as young as 8 or 9." "There's usually a change in appetite and sleep patterns," says Harris.
But, the condition can be recognized as early as infancy, according to John Ochoa, a psychologist at Henry L. Stimson Middle School in Huntington Station. Though crying is common among infants, depressed infants tend to "smile less and cry more," Ochoa says. A baby who rarely smiles may be evincing early symptoms of depression. Symptoms for older children typically include school avoidance, bed-wetting and temper tantrums. (See sidebar, "What To Look For," on page 11 for a more detailed list of symptoms.)
The most obvious symptom is threatening or attempting suicide. Childhood suicide is even more rare than childhood depression. One reason is that children often do not fully understand mortality. Shaffer notes that children usually confuse acts that their parents scold them for with acts that are lethal. Children may act out suicide threats by swallowing analgesics.
"Some think a few Tylenol pills will kill them," says Columbia University's Shaffer, hastening to add that the urgency of the situation can't be judged by the method a child uses to attempt suicide. All threats and attempts warrant immediate attention. As Dr. Harris says, "If someone is making a gesture but the intention is to kill themselves, that's a high risk." Fassler finds that suicidal children do not know that they will never come back. Some might play video games, for example, and think that they have three lives left. Others who attempt suicide might not even be depressed, but delusional. A young girl might jump out the window because she believes she can fly.
And parents should not wait for suicide threats, experts warn. At the first signs of overwhelming sadness, withdrawal, serious personality changes, loss of appetite or the desire to sleep the day away, parents should take heed.
Adolescent Depression
One assumption that needs to be tackled is the age at which adolescence begins. Shaffer has observed children who are 10 years old who have the height of 12-year-olds. Thus, having reached puberty at an early age, they often have adolescent depression.
"Younger adolescents are somewhat more likely to present with physical complaints and/or signs of irritability in conjunction with depression," says Fassler. "They are also more likely to act impulsively when depressed."
Fassler also notes that depressed adolescents tend to have a change in sleeping patterns, a drop in grades, or morbid or suicidal thoughts.
Sometimes, they act out the morbid thoughts.
"I would cut myself on my arm with a scissor," Lucy recalls, "and that would take my mind off of the persistent mental anguish and send a soothing drug-like adrenaline through me and give me something else to focus on, giving me a sense of relief."
Although this is an obvious symptom, sometimes the signs are more subtle. Middle-school psychologist Ochoa suggests that parents look for "changes in friends or isolation from friends." Though hanging with the wrong crowd might not necessarily be a sign of depression, growing apart from positive friends who do well in school or involve themselves in healthy extracurricular activities can be a red flag. Shaffer tells parents to notice when their kids "compare themselves negatively to other kids." Even the classic high-school crush can be a trigger for serious depression. If the adolescent still thinks, after two weeks, that they will never love somebody other than the person they had a crush on who did not reciprocate the attraction, and the lovesick individual has other symptoms (failure in school, substance abuse), this can be a sign of depression. Do not underestimate the impact of a teenager's broken heart.
The Light At The End Of The Tunnel
Professional help from a school psychologist or a private professional is important at every stage. First of all, it's necessary for diagnosis. Personality tests used for diagnosis include the Beck Depression Inventory, Behavior Assessment System for Children II (BASC-II) and Personal Problems Checklist for Adolescents.
After diagnosis, Ochoa recommends a "good clinical interview with the child [and] family members." Fassler recommends a range of therapies depending on the individual case, such as individual, family or cognitive behavioral therapy.
Two types of antidepressants are used to correct the chemical brain imbalance. Selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, are used to correct imbalances in serotonin, whereas monoamine oxidase inhibitors (MAOIs) interact with norepinephrine as well as serotonin. MAOIs, which include Nardil, Parnate and Marplan, carry more side effects.
Though antidepressant medication can certainly be helpful, the FDA issued a "black box" warning label to health professionals in 2004 describing the increased risk of suicidal thoughts and behavior in children and adolescents being treated with such medications. The warning emphasized that psychiatrists and parents should closely watch children and teenagers who take Prozac, for instance, in case symptoms get worse.
Surprisingly, some doctors—Fassler, for one—do not scoff at alternative medicine.
Lucy, for example, has tried network chiropractic, a noninvasive form of chiropractic that is closer to Reiki than traditional bone cracking.
"I still see a therapist, but he's a chiropractor who performs semi-hypnotic touch therapy," she explains. "I believe it rearranges energy, poisons and patterns that have been instilled in me for so long."
Fassler sees benefits in these alternative treatments.
"Some forms of alternative medicine may be a useful component of treatment for depression in certain individuals," he says. "However, treatment is generally most effective when it's comprehensive and individualized to the needs of the specific person."
Though it might be difficult for families with depressed children, giving up should be the last thing on anybody's mind. Lucy now copes with her illness.
"It's a powerful force, but I think real personal truth is already programmed into all of us," she explains. "And that helps us realize right from wrong and, as a result, happy from sad."
She adds that she felt better sharing her story—proof that it's never too late.
"I still feel feelings of depression and anger," Lucy says. "I think the trick in battling this illness is truly knowing yourself, recognizing when it's building, and be active in combating it."
Depressed Kids: What To Look For
Depression can manifest itself in many different ways. Here's a list of symptoms that children and adolescents might have that could be signs of depression. The information was provided by Dr. David Fassler, director of the American Academy of Child and Adolescent Psychiatry, and Dr. John Ochoa, psychologist at Henry L. Stimson Middle School in Huntington Station.
Ages 3-6
- Anxiety (excessive clinging to parent)
- Avoiding school
- Regression
- Bed-wetting
Ages 6-12
- Oppositional behavior
- Temper tantrums
- Sensitivity
- Short temper
- Suicidal thoughts or attempts
Ages 12-17
- Behavioral problems in school
- Bad grades
- Sadness or despair
- Low self-esteem
- Fatigue
- Physical complaints with no obvious cause
- Change in sleep, energy or appetite
- Lack of enthusiasm for activities previously considered enjoyable
- Self-destructive behavior
- Difficulty with relationships
- Eating-related problems
- Isolation
- Unkempt appearance
- Extreme sensitivity to rejection or failure
- Physical slowness or agitation
- Irritability, fighting or trouble concentrating
- Morbid thoughts or actions
- Suicidal thoughts or actions
How To Help
- Look for danger signs.
- Talk with your child.
- Seek support from and share coping techniques with trusted family members, relatives, friends or parents of other children affected by depression.
- Encourage your child to become involved, if possible, in healthy outlets—things about which he or she is passionate (such as hobbies or sports).
- Have a meeting with your child and the school psychologist.
- Talk to your child's pediatrician about treatment either with antidepressants or alternative approaches (chiropractic or exercise, for instance).
- Take your child to a private psychiatrist, psychologist or qualified counselor.
- Consider counseling for yourself and other family members who are affected by the child's depression.
- Take all talks and attempts of suicide seriously, no matter how absurd the attempt might seem (swallowing a few aspirin).
- Try taking your child to a cognitive-behavioral therapist or to an interpersonal-theory therapist (deals with people's characteristic interaction patterns, as in dominance and friendliness).
- Talk to a psychiatrist about antidepressants.
- If the psychiatrist prescribes antidepressants, constantly monitor your child. Ask your child if she is still depressed. If she talks about suicide, immediately contact the psychiatrist.
- Always listen to your child.
