Children And Teenagers - Depression Sex And Age: Depression

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Children and teenagers

While some people idealize childhood, in reality, children may feel shaken by developmental changes and events over which they have little or no control. Studies show that 2 out of every 100 children and 8 in 100 adolescents have major depression.

While a full-blown depression most often starts in adulthood, low-grade depression, or dysthymia, may begin during childhood or the teenage years. Although an adult has to have depressive symptoms for at least two years before he or she is diagnosed with dysthymia, in children and teens a diagnosis is made after one year. When dysthymia appears before age 21, major depressive episodes are more likely to emerge later in life.

In teens, as in adults, bipolar disorder and depression are clearly connected. As many as 30% of teenagers who experience an episode of major depression develop bipolar disorder in their late teens or early 20s. While rare in early childhood, this disorder occasionally appears in adolescence, especially in cases where a family history of depression exists. Bipolar disorder that emerges during puberty often displays a mixture of high and low symptoms or rapid cycles of highs and lows.

Red flags for teenage depression and mania

If you are a parent of a teenager, a list of depressive symptoms may make the hairs on the back of your neck rise. Storminess, apparent exhaustion, apathy, irritability, and rapid-fire changes in every realm, including appetite and sleep habits, are common in adolescents. You might find yourself wondering whether a sudden loss of interest in the clarinet signals depression or merely that your teen now thinks that playing in the school band is uncool. Staying up late and sleeping until noon or throwing over one interest in favor of others probably doesn't signal depression. But constant exhaustion and an unexplained withdrawal from friends and activities a child once enjoyed are reason for concern.

Because depression in children and teens often coexists with behavioral problems, anxiety, or substance abuse, experts consider a wide range of potential indicators, such as these:

• poor performance in school or frequent absences

• efforts or threats to run away from home

• bursts of unexplained irritability, shouting, or crying

• markedly increasing hostility or anger

• abuse of alcohol, drugs, or other dangerous substances

• social isolation or loss of interest in friends

• hypersensitivity to rejection or failure

• reckless behavior.

Young children may express feelings of depression as vague physical ailments, such as persistent stomachaches, headaches, and tiredness. Although they may truly be sad, depressed children and teens are more likely to appear irritable. Depressed children don't oversleep or act sluggish as often as depressed adults do, but otherwise, the symptoms of depressive disorders in children, teenagers, and adults are generally similar (see "What is depression?"). Discuss any of the red flags listed above with your child. If you're still concerned, speaking with your child's pediatrician or guidance counselor may help.

A sudden withdrawal from friends and activities that were once enjoyed can be a sign that your teen is depressed.

If a family history of bipolar disorder exists, be especially vigilant about watching for manic symptoms. The signs of manic behavior are similar in adults and children (see "What is bipolar disorder?"). However, teens who are in a manic episode may also:

• talk very fast

• be very easily distracted

• get much less sleep than usual, but seem to have the same amount of energy or even more

• have extreme mood changes, for example, shifting between irritability, anger, extreme silliness, or high spirits

• indulge in, think about, or describe hypersexual behavior.

If you notice these symptoms, your child's pediatrician can help you decide whether to seek professional help.

Treating depression in teens and children

Just like depressed adults, depressed children and teens need to get help, and the two main methods of treatment are psychotherapy and medication. But there are distinct differences between treating adults and children in most medical fields, and psychiatry is no exception.

Although many studies have shown antidepressant medications to be effective in teens and children, these drugs can also have some dangerous, unintended side effects in a small number of teens. A review by the FDA found that the average risk of suicidal thoughts in depressed teens and children who are taking an antidepressant was 4%, twice the placebo risk of 2%. As discussed in the section "Can antidepressants trigger suicide?", the FDA responded to these concerns in 2004 by requiring that drug manufacturers place a "black box" warning about these risks on the package inserts that come with antidepressants.

What does this mean for your depressed child or teen? Of course, treatment decisions should be made (with your input) by a qualified psychiatrist, preferably one who is trained to care for children. Many experts believe that antidepressants play an important role in treating depression in children and teens — but they must be used with caution. They shouldn't be viewed as harmless pills to be prescribed flippantly; nor should they be deemed a dangerous therapy that should be reserved as a last resort. If your child needs an antidepressant, the best way to prevent a dangerous outcome is to pay close attention to how he or she is thinking and feeling. Monitor him or her for suicidal thoughts or tendencies, especially in the first few months of treatment, when the risk is thought to be the greatest.

Dealing with suicidal remarks

Children and teenagers are by nature more impulsive than adults, their emotions less tempered by experience. Research suggests that regions of the brain that govern judgment do not develop completely until later in life. All too often in this age group, suicidal thoughts translate into action. Never ignore or brush off comments about suicide or even such sweeping, dramatic statements as "I wish I was dead" or "I wish I'd never been born." Instead, follow through by talking to your child about them.

Perhaps these sentiments reflect nothing more than an isolated, angry outburst or hyperbole in the middle of an argument. But you can say, "Tell me what you've been thinking" or "Are you telling me about your frustration, or do you really feel like ending your life?" If the answers raise any concerns, if your child always refuses to engage in the conversation, or if he or she seems to exhibit signs of depression or mania, call his or her pediatrician for advice.

Last updated:	January 23, 2007