Childhood Depression

by William R. Beardslee, MD, Children's Hospital Boston

Depression in children has dramatically increased in recent years with approximately 3 to 5 percent of preteens and up to 15 percent of teenagers suffering from depression. The good news is that awareness and intervention from parents or other adults can help children with depression live normal, happy, functioning lives.

What is childhood depression?
Depression is a medical condition that can affect brain chemistry. It is important to understand that your child, or anyone with depression, cannot just "snap out of it" or will himself to feel better. A child with depression typically feels a constant sense of discouragement, a loss of self-worth and loss of interest in activities they used to enjoy.

Without treatment, symptoms can last for months or even years. Depression is typically marked by a long-term change in mood, personality or behavior, says William R. Beardslee, M.D., Psychiatrist-in-Chief at Children's Hospital Boston.

Why children become depressed?
While no single theory completely explains the increase of depression in children, Dr. Beardslee believes it is due to the way our society has changed. "We are a highly mobile, less family-oriented society today," he says. For both children and adults, the weakening of family bonds can contribute to depression. Even more than adults, children are affected by events such as the death of a loved-one, break-up of a relationship, or a parent's divorce. Another contributor to depression for children can be a child's failure to accomplish tasks, such as learning to read, or keep up with peers in other activities. The stresses of today's world can push kids beyond unhappiness, to a point where life becomes overwhelming and hopeless. But despite the underlying cause, your child can be helped.

Ratios of Depression in Children
Preschoolers: Depression is rare
Elementary school age: Boys are three times more likely to be depressed than girls
Age 14 and up: Girls are twice as likely to suffer from depression as boys (similar to the rate of depression in adults)

Diagnosing depression in your child As a parent, you shouldn't have to try to be a doctor and diagnose your child. But you can be aware of changes you see in your child's behavior, mood and level of interest in their usual activities. When diagnosing depression, doctors look for a set of symptoms that occur together. Parents should use this same criteria because being aware of these symptoms can help your family know if your child is having a normal reaction to a difficult situation or if he is experiencing clinical depression.

Symptoms of depression

Core Symptoms:
A persistent sadness
A persistent lost of almost all activities

Associated symptoms:
Loss of energy
Loss of appetite (or increase)
Changes in sleeping patterns
Agitation or irritability
Feelings or worthlessness or excessive guilt
Wanting to die

One or both of the core symptoms must persist for at least two weeks to constitute a formal diagnosis of depression. Major depression is when one or both of the core symptoms persist for at least two weeks along with five of the associated symptoms. If the symptoms are due to substance abuse, a medical illness, or grief over a recent loss, they usually are not a sign of depression.

Diagnosing Depression
Depression:One or both of the core symptoms must persist for at least two weeks
Major Depression:One or both of the core symptoms must persist for at least two weeks along with five of the associated symptoms

How to help your child
A diagnosis of depression can be helpful because it allows a child to get the treatment he needs, and assures him that he is not totally unique or alone in how he is feeling. If you suspect your child is depressed, there are two things you can do:

Also, look at what has been happening in his life, particularly loses, setbacks, and how he perceives himself.

Schedule an evaluation with a professional, either your pediatrician or a psychologist. Important: If a child ever talks about or shows signs of hurting him or her self, get professional help immediately.

Cognitive or "talking" therapy with a counselor or psychologist should always be part of treatment for depression. Often this is all that is needed. Therapy focuses on identifying and working through difficult relationships and situations, improving a child's view of herself and her environment, and teaching ways to cope.

Sometimes antidepressant medications are necessary if a child's depression does not improve with therapy. Extensive studies have been done regarding the safety and effectiveness of antidepressant medications in children. Prozac and other medications known as selective serotonin reuptake inhibitors (SSRIs) have been shown to be safe in most studies and can be effective for teenagers, but should be carefully monitored by the prescribing physician. Prozac is the only SSRI currently approved by the FDA for pre-teens.

Research on antidepressant medications for children is on going. More studies are needed to fully answer which medications are safe and effective for which types of depression in children.

If a child's depression is particularly severe, debilitating or self-endangering, hospitalization may be required.

Source: Dr. William R. Beardslee is the Academic Chair of the Department of Psychiatry at Children's Hospital Boston and the Gardner/Monks Professor of Child Psychiatry at Harvard Medical School. He is the author of "When a Parent Is Depressed: How to Protect Your Children from the Effects of Depression in the Family." (Originally titled Out of the Darkened Room: When a Parent Is Depressed: Protecting the Children and Strengthening the Family) (Little, Brown and Company, June 2002. First paperback edition, December 2003.) For more information about Children's Hospital Boston, please visit our website at:


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