Childhood Depression
One of the most common responses to hearing that a child
has depression is, "But what does he/she have to be depressed
about?" This statement reveals two major misconceptions.
One is the lack of understanding about clinical depression.
It is not the same as the "blues" or "down"
moods that everyone has from time to time, which may actually
be caused by unhappiness with one's job, home life or other
factors. Clinical depression may resemble these emotional
dips, but it is much more pervasive, long-lasting, and life-threatening.
It is not necessarily caused by an event or state of affairs
in a child's life. The other misconception is that childhood
is a carefree, trouble-free period in our lives. How many
people can say that they didn't worry about peer acceptance,
grades, or parental expectations? Adults often forget that
children are powerless and have no control over their own
lives. This can be a frightening and frustrating state of
affairs to live through day after day.
Causes of Childhood Depression
As with adult depression, diagnosis of depression in children
is not as clear-cut as it is for other ailments. There is
no test that can be given which will positively say that an
individual has depression, much less pinpoint the cause(s).
The medical community still knows relatively little about
the brain, how it works, and what makes it malfunction. In
fact, anti-depressant properties of certain medications were
discovered by accident in the 1950s while seeking a cure for
tuberculosis.
We do know that certain children have risk factors in their
lives which could predispose them to depression or could "trigger"
depression. Among these are a family history of mental illness
or suicide, abuse (physical, emotional or sexual), chronic
illness and the loss of a parent at an early age to death,
divorce or abandonment. However, some infants exhibit depressive
symptoms at an early age before most of these factors come
into play, so there is an argument to be made for depression
being wholly chemical in some children. Each child's depression
is individual, and causes will be different for each one.
The depression could be wholly chemical, wholly due to psychological
factors, or a combination of the two. More important than
the cause is identifying the illness and treating it.
Symptoms of childhood depression
• Persistent sadness and/or irritability.
• Low self-esteem or feelings or worthlessness. A child
may make such statements as, "I'm bad. I'm stupid. No
one likes me."
• Loss of interest in previously enjoyed activities.
• Change in appetite (either increase or decrease).
• Change in sleep patterns (either increase or decrease).
• Difficulty concentrating.
• Anger and rage
• Headaches, stomachaches or other physical pains that
seem to have no cause.
• Changes in activity level. The child either becomes
more lethargic or more hyperactive.
• Recurring thoughts of death or suicide.
Any change in a child's behavior that seems to have no external
or physical cause should be looked at. A low mood which results
from a loss (death of a loved one, moving, changing schools)
which lasts more than a few weeks should be considered possible
depression and checked out.
If the child has bipolar disorder, also known as manic depression,
these symptoms could be present:
• abrupt, rapid mood swings
• periods of extreme hyperactivity
• prolonged, explosive temper tantrums or rages
• exaggerated ideas about self or abilities
Bipolar disorder is often mis-diagnosed as attention-deficit
disorder with hyperactivity (ADHD), obsessive-compulsive disorder
(OCD), oppositional defiant disorder or conduct disorder
Depression often goes hand-in-hand with other mental illnesses
or disorders such as Attention Deficit Disorder, and, especially
in teenage girls, eating disorders and self-injury. If any
of these conditions are present, they need to be treated along
with the depression for treatment to be effective.
Childhood Depression Treatment
The parents of any child who is in immediate danger of harming
himself or others should consider hospitalization. This is
a tough choice for parents to make, but it must be emphasized
that children do commit suicide.
Once a child has been diagnosed with either major depression
or dysthymia, both psychotherapy and medication could be options.
More and more, doctors are realizing that chemical imbalances
often account for mental illness, but at the same time, the
importance of psychotherapy cannot be discounted. If a child's
depression has been caused wholly or in part by psychological
factors, medication may relieve the depression, but the underlying
cause will not be "cured" by medication alone. Therapy
can help the child deal with his past in a healthy manner,
and also in learning ways to cope with the very difficult
process of growing up.
Antidepressant medication for children is a controversial
topic. There are no long-term studies that show what kind
of impact this medication will have on a child's development.
The maker of the antidepressant Effexor, in fact, has warned
against it being prescribed for children, and the U.S. Food
and Drug Administration has issued the same warning for Paxil.
There has also been some question as to whether the older
tricyclic antidepressants are effective with children. Most
professionals will recommend therapy as a first line of defense
for a child with depression, except in cases where the child
is severely depressed or suicidal.
But keep in mind that it is almost a certainty that depression
will have negative long-term effects on the child and his
family. From my own experience, I am positive that my growing
up with depression had negative effects on the development
of my personality. For instance, even with my successful treatment
with antidepressants, it's very hard for me to completely
shake the crippling shyness I grew up with. The decision of
whether to treat a child with medication is wholly individual,
depending on the severity of the child's depression and what
toll it will take on the child's life without successful treatment.
Parents should educate themselves as much as possible in order
to make an informed decision.
Note: Bipolar disorder must be ruled out before a child is
prescribed antidepressants for depression or stimulants, as
these can trigger mania.
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