A mood disturbance, depression is characterized by feelings of sadness, worthlessness, loss, hopelessness and a withdrawal from life and activity. Psychiatrists use the term major depressive disorder to distinguish serious depression from temporary and realistic feelings of sadness. Previously it was thought that clinical depression did not exist among young children, whose emotions are still forming—and who lack the vocabualary to describe the complex feelings they are experiencing. Currently, it is accepted that mood disorders such as depression do affect children, even very young ones. However, the condition occurs very rarely.
WHEN SHOULD I SUSPECT DEPRESSION?
According to the diagnostic system of the American Psychiatric Association, [Diagnostic and Statistical Manual of Mental Disorders] (third edition, revised), if your child exhibits five or more of the following symptoms, she may be suffering from major depressive disorder. They symptoms should be present concurrently for at least two weeks, except for items 3 and 9, which might not be apparent on a regular basis.
1. Sad or irritable mood
2. Diminished interest or pleasure in activities
3. Failure to make expected childhood weight gains
4. Too little sleep or too much sleep
5. Agitated physical movements
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Lack of concentration
9. Thoughts of death or suicide
A troubled home environment can cause a parent to overlook signs of depression in a child. Sometimes a teacher, relative or other care provider may alert a parent to certain behaviors in a child, such as "acting out" or learning problems, that are actually indications of depression.
School performance may suffer in a depressed child; in fact, depression is sometimes misdiagnosed as a learning disability. These learning problems usually correct themselves after the depression has been successfully treated.
If a child has recently experienced a serious trauma such as an illness or loss of a parent, depressive symptoms may be part of the normal recovery process. In such a case, the symptoms are temporary, lasting up to six months, and a diagnosis of major depressive disorder is not applied.
WHAT CAUSES DEPRESSION?
Numerous causes may underlie a child's severe depressive symptoms. Family dynamics can be a primary cause. For example, in a family where the father is too detached and removed from the child and the mother is overprotective to the point of stifling, the child could become depressed. A child who thinks of her parents as always being distant, angry and critical, might also suffer from depression. So might a child whose sense of self becomes threatened due to intense pressure to conform to her parents' expectations.
Some studies suggest that a tendency to be depressed can, in fact, be inherited, but there is no conclusive evidence to support this. However, a severely depressed parent, unable to perform normal parenting tasks, such as listening, stimulation, encouragement or even preparing regular meals, can pass depression down to the child as surely as if the condition had been inherited.
IS MEDICAL ATTENTION NECESSARY?
Yes. Depression is serious. If left untreated it can lead to future problems, such as low self-esteem, inability to form relationships and, later in life, dependence on drugs and alcohol.
WHAT TREATMENTS ARE AVAILABLE?
If a diagnosis of depressive disorder is confirmed, a mental health professional will develop a treatment plan. Professionals may differ dramatically in the treatments they prescribe. Some may advise a course of antidepressant medication, which seems to alleviate symptoms in children and can be stopped after the condition is stabilized. However, antidepressants have possible side effects, and some professionals oppose prescribing them for children.
Some professionals recommend psychotherapy, alone or in conjunction with drugs. The goals of therapy are to help the child confront anger that may underlie the depressive feelings, to build a stronger sense of self-worth and to draw upon reserves of inner strength to combat depression now and in the future.
COPING WITH DEPRESSION IN A CHILD
• If your child's verbal skills are strong enough, try to discuss what he or she is feeling. Ask about feeling sad, feeling empty, wanting to cry or having bad feelings that won't go away. Give plenty of time for answers, and don't pressure the child to respond. Pick a time when you both are relaxed and enjoying each other's company.
• When a preschooler or younger child has difficulty expressing feelings, try to get a sense of what's wrong by observing facial expressions, body posture, tone of voice and level of activity. Offer support, affection and time together to help alleviate the sad feelings.
