Depression in Children & Adolescents

Unfortunately, these disorders often go unrecognized by families and physicians alike. Signs of depressive disorders in young people often are viewed as normal mood swings typical of a particular developmental stage. In addition, health care professionals may be reluctant to prematurely "label" a young person with a mental illness diagnosis. Yet early diagnosis and treatment of depressive disorders are critical to healthy emotional, social, and behavioral development.

Although the scientific literature on treatment of children and adolescents with depression is far less extensive than that concerning adults, a number of studies, mostly conducted in the last four to five years, have confirmed the short-term efficacy and safety of treatments for depression in youth.

Given the challenging nature of the problem, it is usually advisable to involve a child psychiatrist or psychologist in the evaluation, diagnosis, and treatment of a child or adolescent in whom depression is suspected.

Symptoms

Symptoms of Major Depressive Disorder Common to Adults, Children, and Adolescents:

• Persistent sad or irritable mood
• Loss of interest in activities once enjoyed
• Significant change in appetite or body weight
• Difficulty sleeping or oversleeping
• Psychomotor agitation or retardation
• Loss of energy
• Feelings of worthlessness or inappropriate guilt
• Difficulty concentrating
• Recurrent thoughts of death or suicide

Signs That May Be Associated with Depression in Children and Adolescents:

• Frequent vague, non-specific physical complaints such as headaches, muscle aches, stomachaches or tiredness
• Frequent absences from school or poor performance in school
• Talk of or efforts to run away from home
• Outbursts of shouting, complaining, unexplained irritability, or crying
• Being bored
• Lack of interest in playing with friends
• Alcohol or substance abuse
• Social isolation, poor communication
• Fear of death
• Extreme sensitivity to rejection or failure
• Increased irritability, anger, or hostility
• Reckless behavior
• Difficulty with relationships

While the recovery rate from a single episode of major depression in children and adolescents is quite high, episodes are likely to recur. In addition, youth with dysthymic disorder are at risk for developing major depression. Prompt identification and treatment of depression can reduce its duration and severity and associated functional impairment.

Risk Factors
In childhood, boys and girls appear to be at equal risk for depressive disorders; but during adolescence, girls are twice as likely as boys to develop depression. Children who develop major depression are more likely to have a family history of the disorder, often a parent who experienced depression at an early age, than patients with adolescent- or adult-onset depression. Adolescents with depression are also likely to have a family history of depression, though the correlation is not as high as it is for children.

Other risk factors include:

• Stress
• Cigarette smoking
• A loss of a parent or loved one
• Break-up of a romantic relationship
• Attentional, conduct or learning disorders
• Chronic illnesses, such as diabetes
• Abuse or neglect
• Other trauma, including natural disasters