At first, Andrea Carpenter* blamed preadolescent hormones for her 10-year-old daughter's moodiness. "Allie was extremely irritable at home, and she'd get snippy with her dad and me for no apparent reason," says the Marietta, GA, mom. Life at the Carpenters' home grew so tense that the family started seeing a counselor who, after a few sessions, recommended that Allie visit a psychiatrist. "He mentioned depression, but I thought it was just puberty," Andrea says. Her thinking quickly changed after Allie said she wished she was never alive and talked about cutting her throat. "I was devastated — I knew she wasn't a happy-go-lucky kid, but I never thought a 10-year-old could be suicidal."
In fact, depression is the second most common childhood mental health problem. (Attention deficit/hyperactivity disorder is number one.) An estimated one in 33 children and one in eight teens are depressed, and the World Health Organization predicts that the number of kids — and adults — diagnosed with the disorder could double by the year 2020. Fewer than a fourth of the estimated 12 million kids in the United States who suffer from psychiatric disorders receive treatment, however, which places them at high risk for failing school, abusing drugs and alcohol, and committing crimes. Kids with untreated depression also are 12 times more likely to commit suicide. The nation's suicide rate for children jumped nearly 10 percent from 2003 to 2004, the largest increase in 14 years.
Even though up to 80 percent of depressed kids improve with treatment, many parents delay seeking help because of the stigma of mental illness. "I wish I would have reacted quicker, but it's a hard thing to admit your 7-year-old child is mentally ill," says Carmen Vandyne, a Columbus, OH, mom whose 11-year-old daughter, Addison, was diagnosed with depression at age 7. Other parents hope their child will just get over it on their own. But "depressed kids aren't just going through phases that they'll outgrow — they find it difficult to manage their emotions without professional help," says child psychiatrist Harold Koplewicz, M.D., founder of the New York University Child Study Center.
Figuring out the difference between true depression and temporary moodiness is crucial. Here's how to tell if your child has a problem — and what you can do to help.
*Names have been changed.
What are the warning signs?
While all children feel sad from time to time or have the occasional bad day, a child with depression remains in a funk for weeks or months. During this time, she's likely to struggle at school, isolate herself from friends, cause problems at home, and act like Allie Carpenter did — angry, moody, and irritable. Depressed kids are also as confused by their emotions as their parents are; they can't describe how they're feeling. Instead, they might complain about stomachaches, develop exaggerated fears, grumble about being bored, lack energy, or talk about death.
Three years ago, Boston resident Robyn Hanley assumed her then 16-year-old son, Matthew, was going through typical teenage angst when his grades slipped and he started missing school because his stomach hurt. "I wasn't really worried until he stopped hanging out with his friends and participating in activities that he loved so much," she says. Matthew's guidance counselor noticed the changes in him and suggested that the family talk to their doctor. After Matthew was referred to a psychiatrist and diagnosed with depression, Robyn learned that withdrawing from pleasurable activities and family and friends is a key sign that a child is depressed. "It's frustrating, because you just want your child to lighten up and enjoy life," she says, "but I've learned that a depressed kid can't control how his illness makes him feel."
Why do some kids suffer?
Though experts still aren't sure why certain children are more likely to become depressed, the following factors may play a role:
They're born with a "blue gene." There's a 25 percent chance a child will struggle with depression if one parent has it; that risk jumps to 50 percent or more if both parents are affected.
They have a chemical imbalance. Chemicals in the brain called neurotransmitters — namely serotonin, norepinephrine, and dopamine — play a vital role in regulating emotions. Experts think that depressed kids may not produce enough of these chemicals.
They're dealing with trauma. Up to half of all depressive episodes (among kidsand adults) are preceded by life-altering events. Losing a loved one, dealing with a parental divorce, moving to a new home, or being the victim of abuse can be particularly traumatic to kids who haven't yet developed coping skills. Addison Vandyne's first major bout with depression happened when she was 7, after her mom was injured in an accident. "Addison shut down emotionally, but we thought she'd snap out of it," says Carmen. Instead, Addison bullied kids, drew frightening pictures of people getting injured or killed, and clawed at her face when she was upset.
Their hormones are in flux. Kids as young as preschool age can have depression, but the disorder is most likely to be diagnosed around puberty, when hormones kick in. Boys and girls are equally at risk for depression until puberty; during the teen years and throughout adulthood, females are up to two times as likely to be depressed. Fluctuating hormones, as well as differences in societal expectations, likely account for this gender bias. "Girls are encouraged to express their emotions, while boys learn to bottle them up," says Koplewicz. As a result, depression in girls may often be easier to recognize.
How can you get help?
Even if a child's dark cloud lifts, research shows there's a 60 percent chance she'll be depressed again unless she gets treatment, and her lifetime risk for depression goes up with each untreated episode. First, talk to your child's pediatrician; if she suspects a problem, she'll likely refer you to a mental health specialist, such as a child psychiatrist. If depression is diagnosed, the following treatments can help:
Psychotherapy. Kids with mild depression often respond well to talking about their problems with a mental health professional, who helps them identify and change negative patterns of thinking. Addison Vandyne's mood has improved dramatically since she's been in therapy, says mom Carmen.
Medications. Antidepressants, namely selective serotonin reuptake inhibitors (SSRIs) such as Prozac (the only medication FDA-approved to treat depression in kids), can greatly alleviate symptoms in children by elevating brain chemicals. Despite this, pediatric prescriptions for SSRIs have declined nearly 25 percent since 2004, when the FDA issued a warning that their use may induce suicidal thoughts in youths. "Overall, depressed kids see significant improvements with SSRIs. But because every child responds differently, kids starting these medications should be closely monitored," says David Fassler, M.D., author of Help Me, I'm Sad: Recognizing, Treating, and Preventing Childhood Depression. A large study found that the benefits of giving antidepressants to kids outweigh the risks.
How can you get help? continued...
Combined treatment. Depressed kids improve the most when they take medications and participate in psychotherapy. Nearly three out of four children on combined treatment reported that their depression lifted, while 61 percent improved with medication alone and about a third got better with only psychotherapy. Allie Carpenter and Matthew Hanley, both now 19, are enjoying happier lives thanks to a combination of drugs and therapy. "Allie's a completely different kid," says Andrea. "She enjoys herself. She sings. She's easier to be around. It's wonderful to see her so happy."
To learn more about childhood depression and to find a mental health professional in your area, visit Families for Depression Awareness at familyaware.org.
Signs your child is depressed
Is your child:
- irritable, angry, or cranky for no good reason?
- uninterested in spending time with friends or participating in fun activities?
- experiencing frequent stomach or head pains?
- losing weight?
- sleeping more than usual?
- doing poorly in school?
- talking about running away from home?
- lacking energy or complaining a lot about being bored or tired?
- suffering from low self-esteem?
- talking about hurting or killing herself?
- giving away favorite belongings?
If you answered yes to five or more of these questions and your child has displayed these behaviors for at least two consecutive weeks, she may be clinically depressed.
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