“It was not really alarming at first, since the change was subtle, but I did notice that my surroundings took on a different tone at certain times: the shadows of nightfall seemed more somber, my mornings were less buoyant, walks in the woods became less zestful, and there was a moment during my working hours in the late afternoon when a kind of panic and anxiety overtook me…” - William Styron, Darkness Visible
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 Depression in Children
- 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.
Related Disorders
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.
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 depression, 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.
Parents of a child with depression should start looking for a child psychiatrist by contacting the nearest university medical center, mental health clinic or organization.
