Depression in Children - A Parent's Life - Harvard Commentaries

"Childhood" and "depression." The words don't seem as if they should be in the same sentence. People think of childhood as a carefree, happy time. Sure, kids get sad sometimes — but not depressed, right?

Actually, children do get depressed. Exact numbers are hard to come by, but about 5% of children and teens suffer from serious depression. If you include those with milder symptoms, that number rises as high as 15%.

Children who have a family history of depression or are going through a stressful event such as a divorce or move, are at higher risk for depression. Attention, learning, or conduct disorders also increase a child's risk for depression.

But depression can develop even when there are no clear risk factors. Sometimes a child who seems angry, cranky, or sick may actually be depressed. That's why it's very important that parents, teachers, and caretakers recognize the signs of childhood depression and take action. Mental Health America, an organization dedicated to helping Americans protect and improve their mental health, lists the following signs on their website :

Feelings: Sadness, emptiness, hopelessness, guilt, worthlessness
Thoughts: Difficulty concentrating, making decisions, completing school work, maintaining grades; lack of motivation
Health: Headaches, stomachaches, joint or backaches, lack of energy, insomnia or excessive sleeping, weight gain or loss
Behavior: Restlessness, irritability, loss of interest in everyday pleasures, not wanting to go to school, wanting to be alone, trouble getting along with others, skipping classes or school, dropping out of sports or activities, drinking or using drugs, excessive crying
Suicide: Talking or thinking about death or suicide

If you see several of these signs in a child, they may be suffering from depression and need help. The first place the child should go is to the doctor for a thorough checkup to rule out any physical reasons for the symptoms. (If the doctor can't see them right away, go to the emergency room.) If a child is talking about suicide (even just once) they need help immediately.

Fortunately, depression is a treatable illness. Meeting with a psychologist or other mental health professional to talk about what is going on is the first line of treatment. It can help the child cope and think differently. Family therapy can be crucial to help everyone understand and be supportive. Sometimes medications are prescribed for depression, which can make a big difference for some children.

Nobody recognizes the child's depression, family members think the child is just going through a temporary phase or they ignore the symptoms, hoping they will go away. So the child is never diagnosed.

Some families worry that their child will be "labeled" or made fun of if anyone finds out they are seeing a therapist. A recent study showed that Americans think that children with mental health problems are more likely to be violent and be rejected at school. While mental health problems can indeed cause violence or school problems, treatment is the very best way to prevent both!

Some families are concerned that medications for mental health problems are overused in children and can make them act like "zombies."

Depression medication is generally not overused in children. Careful dosing and monitoring can prevent zombie-like side effects. There are, however, legitimate reasons to be concerned about medications called selective serotonin reuptake inhibitors (SSRIs). SSRIs are the most commonly used medications to treat depression. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox). In 2004, the U. S. Food and Drug Adminstration (FDA) issued a "black box" warning — their most serious kind of warning — saying that these medications) may increase suicidal thinking in some children and adolescents with depression.

In a review published in the April 2007 issue of the Journal of the American Medical Association, experts carefully evaluated the results of all the studies on this subject and found that the benefits of SSRIs outweigh the risks, as long as a child is closely monitored by a doctor. The study concluded that depressed children treated with both therapy and medication are more likely to get better than children treated with either one alone.

It's really important that parents understand depression and realize the importance of treatment to assure that a child has every opportunity to grow in a healthy way. Depression in childhood can lead to a higher risk of mental health problems, substance abuse, and suicide in adolescence and adulthood.

If you know a child who is showing signs of possible depression, get them help. Even if you're not sure it's depression, don't wait. Waiting just delays getting help. Call your doctor. He or she can refer you to a mental health professional in your area. You can also use the U.S. Department of Health and Human Services' Mental Health Services Locator to find mental health services anywhere in the United States. With treatment and support, any child suffering from depression can have the carefree, happy childhood that he or she deserves.

Claire McCarthy, M.D. is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.