About Depressive Disorders

Real Life Stories

Alex, l0-years-old, lives with his mother and grandmother. His parents separated when he was six. Alex's teacher reports that he is in danger of failing, that he becomes preoccupied, often staring out the window, and seldom finishes his work. Alex has stated that the other children in the class are much smarter than he is. He seldom attends Boy Scout meetings or plays baseball, which he used to enjoy. When he gets home each afternoon, he watches television and eats all the cookies he can find. He usually telephones his mother to make sure she's all right and then goes to bed until his mother comes home. "I don't have any reason to stay up; nothing good is going to happen," he said.

Cheryl usually went to school and to her part-time job, and then came home and played with her cats, rather than go out with her two best friends, as she used to. Looking back, her mother realized that Cheryl hadn't gone to the movies or shopping for the past month and seemed to have lost weight. Then her mother found a bottle of sleeping pills on Cheryl's dresser.

Both Alex and Cheryl have been diagnosed with depression.

What are the symptoms?

All children feel sad sometimes. However, some children are sorrowful beyond the range of normal sadness. In general, for children to be diagnosed with Major Depressive Disorder, they will have experienced depressive symptoms constantly for at least two weeks to such a degree that it interferes with their lives. According to the Diagnostic and Statistical Manual - IV, children will also have had at least five of the following symptoms.

• depressed or irritable mood
• difficulty concentrating
• irritability and anger
• fatigue
• feelings of worthlessness
• sleep problems
• appetite problems
• social withdrawal
• restlessness or slowing down
• decreased interest or pleasure in activities
• thoughts of death

There are two basic types of depression: major depression which lasts at least two weeks, and the milder but chronic dysthymic disorder, in which a long-standing depressed mood that lasts for a year or longer seems to characterize the child's temperament or personality.

Children who have major depression can actually be quite "up" at times, but when they are down, they're very "down." Depressed children can have trouble paying attention, feel tired, feel mad, cry, stay in their room, stop participating in favorite activities, think about death, or do risky things and not know why. Teens often exhibit symptoms of dramatic sadness more similar to those found in adults.

Some children don't realize that they are depressed. They may be under stress at school, be upset about something that happened with their friends, sleep or eat more than usual, or just want to be alone because they don't have fun when they are out. They are often bored by everything. Children who are depressed can't just "snap out of it" and are not being weak.

The children and teens most at risk are those who have difficulty seeing a solution to their problems. Sometimes they feel killing themselves is the only way to stop their pain. Children and teens who talk about suicide or death should be taken seriously; they are not necessarily just looking for attention. When a child talks about suicide, a professional should be consulted. As with most problems, parents and professionals are concerned with duration, frequency and intensity.

Who is likely to have it?

Anyone at any age can be depressed. Even 2 and 3-year-olds can be depressed. One to 2% of children aged 5 to 11 are diagnosed with depression and that number jumps to 8% for 12 to 18-year-olds. Although equal numbers of school-age boys and girls are affected, by adolescence females are more likely to suffer from depression. Depression can coexist with a variety of other disorders; for example, over 50% of children diagnosed with a major depressive disorder will also have an anxiety disorder.

Why does it happen?

No one knows for sure why some children get depressed while others just get a little sad and move on. Although external events can affect a child's mood, a preexisting physiological vulnerability probably existed, causing the depressed reaction. Most likely the depressed reaction is the result of a chemical imbalance in the brain which is probably inherited. The chemicals involved in depression are neurotransmitters that regulate mood and endorphins that are responsible for producing positive moods. Research has consistently shown that depression runs in families; children whose parents have depression have a greater than fifty percent chance of being depressed themselves. But however it originates, different life stresses can bring on depression or make it harder to manage.

How is it treated?

Getting help is vitally important. Keeping strong feelings of sadness, helplessness, loneliness, and pain inside can make things worse. Problems fester, making treatment more difficult. Depression is treated in a number of ways, and, in fact, it is one of the most easily and successfully treated mental illnesses.

Getting the right diagnosis - The diagnosis is a clinical diagnosis based on information provided by parents and others who know the child well, as well as information obtained directly from the child about his or her thoughts and feelings and physical observations of the child.

Psychopharmacology - Studies show that medications are helpful for children and teenagers with depression.

Cognitive therapy - Therapy with the individual child or the whole family can also be effective, alone or in combinations with medication. In cognitive behavior therapy children learn that everyone can feel unhappy, how to monitor potentially troubling situations and feelings, how to counteract negative thinking, and new ways to handle being sad.

Questions & answers

How can my child be depressed if he runs around and looks like he's having a good time?

Depression in children looks different than it does in adults. It is rare for young children to look down or sad for long periods of time. The depressed child is more likely to be irritable, complain of being bored, and difficult to please.

My child says "I want to die." Is this normal?

There is reason to be concerned if your child makes this type of statement. Parents should take it seriously and a professional evaluation may be warranted. This does not necessarily mean that the child is suicidal. However, if he or she is seriously depressed there are ways medication and/or other forms of treatment will be helpful. Parents should also be aware that not all suicidal children express their thoughts verbally. Withdrawal, isolation, moodiness, or upset over certain events can also be a red flag.

Where does my child's depression come from? No one in my family is depressed.

We do not know of one single reason why some children get depressed. For some children, depression seems to be a biological response that is not under their control. We do know that depression does not stem from children being spoiled or indulged.

Will the medication make children "high" or change their personality?

No. Taking medication for depression can be compared to taking medicine for a horrible headache. A headache can make you irritable, distracted, and unable to enjoy or focus on activities. A headache makes it difficult to get through the day. Medication doesn't change who you are, but it takes away the headache so you can act like yourself again . Similarly, the medication for depression lets the child be him or herself and pursue and enjoy activities.

How long does a child have to take medication?

Once an appropriate medication and dose is determined and a child is doing well, it is usually advisable to continue at that level for a year. At that time it may be worthwhile to start a program of tapering and withdrawing medication. Sometimes if the depression is episodic, all that is needed is a short course of medication to help a child get over a bout of depression.

Isn't there anything else to help depression besides medication?

So far there is no clear evidence as to whether medication or behavioral treatment is more effective in treating children with depression. They can be equally effective, and a parent, child, and professional may choose one or both. However, if a child is suicidal or has difficulty with basic everyday functions, medication should be considered. For most kids, most of the time, medication alone is not enough. A supportive, understanding, caring environment is also necessary medicine.

About the Author

Robin F. Goodman, Ph.D., is a clinical psychologist specializing in bereavement issues.

References and Related Books

For Adults:

Darkness Visible: A Memoir of Madness
W. Styron
Vintage Books 1992

Help Me, I'm Sad
D. Fassler and L. Dumas
Penguin USA 1998

For Children:

Depression is the Pits, But I'm Better: A Guide for Adolescents
E.J. Garland
Magination Press 1997

Double-dip Feelings: Stories to Help Children Understand Emotions
B.S. Cain
Magination Press 1990

Ignatius Finds Help: A Story About Psychotherapy for Children
E. J. Garland
Magination Press 1991

Proud of our Feelings
L. Leghorn
Magination Press 1995

 

About the NYU Child Study Center

The New York University Child Study Center is dedicated to increasing the awareness of child and adolescent psychiatric disorders and improving the research necessary to advance the prevention, identification, and treatment of these disorders on a national scale. The Center offers expert psychiatric services for children, adolescents, young adults, and families with emphasis on early diagnosis and intervention. The Center's mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training utilizing the resources of the New York University School of Medicine. The Child Study Center was founded in 1997 and established as the Department of Child and Adolescent Psychiatry within the NYU School of Medicine in 2006. For more information, please call us at (212) 263-6622 or visit us at http://www.aboutourkids.org/.