Childhood depression: Recognizing and managing it

While many children "bounce back" from problems, some have more difficulty. Trouble at home, problems at school, breaking up with a girlfriend or boyfriend -- can all trigger depression.

Since it can be inherited, depression also strikes children who don't seem to be having any problems.

As many as one in eight teens and one in 33 children have a problem with depression. Failure to get treatment can lead to poor results in school, violent and aggressive behavior, drug or alcohol abuse -- even suicide. (More than 90 percent of children and adolescents who end their own lives have a form of depression.)

Know the warning signs

If your child shows any of these symptoms, talk with the school counselor or your child's doctor about having a mental health professional (for example, a psychiatrist of psychologist) evaluate your child:

constant sadness
loss of interest in favorite activities or people
changes in eating or sleeping (e.g. extreme weight gain or loss, difficulty falling or staying asleep, sleeping too much)
frequent complaints of headaches, stomachaches or other pains
play with consistently sad themes or that involves aggression or violence toward self or others
increased irritability or agitation, for example, crying more than usual
feelings of hopelessness, worthlessness or guilt
desire to spend more time than usual alone
talk of hurting or killing him- or herself
aggressive or violent behavior

Types of depression

Like adults, children often feel sad after a bad experience, like not being picked for a team or the death of a friend. These normal reactions can last as short as a few moments or as long as two weeks.

But these types of depression last awhile and need to be treated by a mental health professional like a psychiatrist or psychologist:

Major depression lasts for weeks, months or longer. Like adults, children with major depression may lose interest in what they used to enjoy, feel unloved and hopeless about the future, and lack motivation. But they experience fears of separation, reluctance to meet people and physical complaints (headaches, stomachaches, etc.) more often than adults do.
Dysthymia is less severe than major depression. This general sadness can last for years and affect a child's ability to adjust to change. Sometimes, the child is so used to feeling down that he or she won't complain about it.
Double depression is a combination of major depression and dysthymia. It can start as dysthymia and lead into major depression.
Bipolar disorder often begins during adolescence, but can start earlier. People with this condition go back and forth between low-energy depression and high-energy "mania." A manic adolescent feels full of energy and confidence. He or she might have trouble sleeping, but not feel tired. The youth may talk a lot and complain of too many thoughts racing through his or her mind. Fast driving and un-safe sex are some risks he or she might take.

Depressed children tend to use alcohol or other drugs to escape from their feelings. This is just another reason why proper diagnosis and treatment is important.

Diagnosis and treatment

If you think your child is suffering from depression, first seek the opinion of your child's doctor. He or she may recommend an evaluation with a mental health professional like a psychiatrist or psychologist.

If a diagnosis of depression is made, treatment may include therapy and medication.

Talk therapy can help children understand their feelings and how to handle difficulties.
Some medications have been effective for the treatment of childhood depression. For example, fluoxetine (Prozac®) has been labeled by the Food and Drug Administration for use in children with major depression.

Relating to your child

Comments like, "Oh, cheer up. Don't be sad. You're actually lucky. Things could be much worse," won't help a depressed child feel better. Instead, address your child's reality by...

acknowledging what's going on
taking action to treat it
doing your best to maintain a good relationship

These techniques will help you show support, respect and love as you relate to your child:

Listen carefully.
Maintain good eye contact.
Show respect for feelings -- no teasing or belittling.
Use "I" statements instead of "you" statements. For example, "I'd like to understand why that makes you angry," works better than, "You're not making sense. You have no reason to be angry."
Discuss important things when your child is not distracted, tired or rushing off to an activity.
Exemplify honesty and fairness.