Depression: A-to-Z Guide from Diagnosis to Treatment to Prevention

Introduction to depression:

Mental illness severe enough to hinder kids from learning or developing appropriately is quite common — but fewer than one in five affected children get the help they need to deal with depression. Mental disorders are a major untreated problem in children. Recognizing and treating conditions such as depression can be a powerful contribution to children’s lives. Some children’s depression is missed because they appear to have ADHD.

What is it?

Major depression is a mood disorder that affects sleep, eating, growth, mood, and interest level. Dysthymic disorder is a milder (but often longer lasting) variant, where the child has a depressed mood for at least a year.

Not long ago, people used to think that young children did not suffer from depression. Now we know that depression in children is both real and common – although the symptoms are often different from those seen in adults.

Depression of Infancy and Early Childhood is defined as a pattern of depressed or irritable mood with diminished interest or pleasure in developmentally appropriate activities, diminished capacity to protest, excessive whining, and diminished social interactions and initiative. This is accompanied by disturbances in sleep or eating and lasts for at least 2 weeks.

Who gets depressed?

Depression affects up to one in 40 children. It involves the interplay of a genetic predisposition to depression, an imbalance of brain chemicals, and events in the child’s life.

There is a strong link between mental disorders in parents and their children. When parents have major depression, their children are at increased risk for emotional and behavioral problems of their own.

Depression in parents is associated with depression, social phobia, disruptive behavior disorder, separation anxiety disorder, multiple anxiety disorder, and/or poorer social functioning in children.

Yet when parents are diagnosed, the children are often not even considered. I hope that this will prompt caregivers to notice whether the children are in any distress and to provide support for them, even at a very young age. And of course, I hope that parents will get the treatment and support that they themselves deserve, both for their own sake and for their children.

What are the symptoms?

Children may have many of the same symptoms as adults. In general, though, children may be less likely to report sadness or depressed mood, and more likely to develop phobias, anxieties, physical complaints, behavior problems and hallucinations. In addition, the pattern of symptoms in children can vary by age.

• Infants and toddlers – developmental regression, increased crying, increased clinginess, increased anxiety, irritability, head banging, increased sleep issues, increased feeding problems, falling off growth curves, developmental delay, limited speech, limited social interaction
• Preschoolers – uncontrollable behavior, hyperactivity, tantrums, breath-holding, biting, kicking, scratching, nightmares, toileting problems (refusal, withholding, smearing, bedwetting, increased “accidents”)
• School-age children – worsening school performance, worsening homework performance, increasing school and homework resistance, headaches, tummy aches, fatigue, lack of motivation, anxiety, increased lying, stealing, masturbation
• Teens – school failure, promiscuity, delinquent behavior, increased aches and pains, suicidal thoughts or attempts, may look more like adult depression

Sometimes ADHD and depression are confused with each other. Many children have both.

Is it contagious?

Depression in parents and caregivers can worsen depression in children, and vice versa.

How long does it last?

The symptoms of depression usually develop over several days or weeks. Without treatment, the depression usually lasts between six months and a year. About 90% of cases will resolve – some without treatment. However, about 40 to 80% of these children will often become depressed more than once.

How is it diagnosed?

Whenever there is concern that a child might be depressed, an evaluation is important. This might include rating scales or structured interviews. Sometimes blood tests or EEGs are used to support the diagnosis.

How is it treated?

Depression in children may be treated with antidepressant medication and/or therapy, such as cognitive behavioral therapy. The response to treatment in children can be quite good.

How can it be prevented?

Parents taking care of their own needs can help prevent depression in their children. In addition, nurturing attention, exploration and activity, good sleep, and good nutrition can be helpful. Some kids will become depressed, though, even in an ideal situation.

Related concepts:

Major Depression, Mood Disorders, Dysthymic Disorder, Childhood Depression, Infant Depression.