Facts about Depression in Children and Adolescents
Depression is a common disorder among children
(less than 18 years). Approximately 5% of
children at any one time may suffer from
serious depression. The
of depression increases with age, especially
after the onset of puberty. There is no
gender related difference in the prevalence
of depression among pre-adolescent children.
However, onset of puberty is associated
with a marked increase in the rate of depression
among females, with a female to male ratio
of 2:1. The prevalence of depression may
be higher in children with other psychiatric
disorders (ADHD, conduct disorder, eating
disorders, anxiety disorders) and in those
with general medical conditions (diabetes,
asthma, cancers and other chronic illnesses).
The prevalence may also be higher among
children with developmental disorders and
mental retardation.
It is often during adolescence that depression
first manifests itself in girls, and for
the first time girls outnumber boys 2:1
in prevalence of the illness. It is estimated
that 4.7% of the teenage population suffers
from depression. (Kashani and Sherman 1988)
It was long believed that the tumultuous
moods of the teenage years were "normal",
but we now understand that excessive irritability,
moodiness, sleep and appetite change may
signal a vulnerability to depression. (Pine
et al. 1999) Common symptoms of adolescent
depression are irritability, hopelessness,
anhedonia, changes in sleep and appetite,
academic decline, reduced energy, reduced
social interactions, somatic symptoms, and
suicidal ideation. We also know that more
minor symptoms which might not meet full
criteria for Major Depressive Disorder (subsyndromal
illness) may predispose girls to full blown
episodes later in life. Numerous factors
may predispose adolescent girls to depression.
These include the increase in hormones associated
with puberty, changes in body shape and
emerging sexual identity, family stressors
such as divorce and peer pressure. Separation
associated with leaving for college is another
stressor which may predispose to depression.
Adolescents who develop depression often
have recurrences in adulthood and a more
severe course. Early detection is essential
to minimize recurrences and morbidity from
the illness.
Symptoms
of depression in children
Unlike adults, most children deny rather than admit depression.
Symptoms of depression vary with the developmental stage of
the child. Denial of symptoms, aggression, excessive crying,
and physical symptoms may be more common among preadolescent
children. Common symptoms of depression among adolescents
and older pre-adolescent children include irritability, withdrawal,
isolative behavior, loss of interest and/or pleasure in previously
enjoyed activities, sleep disturbance (reduced or increased
sleep), changes in appetite (reduced or increased appetite),
and reduced energy. Physical symptoms such as chronic headaches
or stomach aches which cannot be attributed to a physical
illness, are common among children with depression. Most young
people with depression suffer from academic decline. Some
youngsters may use street drugs and alcohol in an effort to
alleviate their depression. Conflict with authority may result
from irritability. Atypical symptoms such as excessive sleep,
increased appetite, an extreme sensitivity to rejection, and
irritability are more common among children than among adults.
In the most severe forms of depression, distortions of reality
such as
and
may be noted.
Suicide
and depression in children
Depression in children is associated with a significant personal
loss and a negative impact on the society. One of the most
serious outcomes of depression is suicide. Majority of the
children who attempt or contemplate suicide are likely to
suffer from depression. Prompt identification and treatment
of depression is important. Untreated depression may lead
to failure to achieve full academic potential, disruption
of key relationships within and outside the family, loss of
self esteem, and self-harmful behaviors which may include
drug use, risk taking behaviors, and suicide.
Associated with the Depression Center, the Youth-Nominated
Support Team (YST) is a youth suicide prevention program
dedicated to developing, evaluating, and fine-tuning a new
intervention for suicidal youth. YST is a
, social network intervention for suicidal youths.
Its goals are to improve youths' perceptions of
social support, adherence with recommended treatments,
and mental health outcomes. The YST "idea"
grew from both clinical experience with suicidal
youths and a careful review of the empirical literature
on suicidal youth, prevention science, and treatment
research. The YST intervention truly springs from
a "scientist-practitioner" approach.
Treatment
options for children with depression
Depression in children can be effectively treated with a combination
of psychotherapy and antidepressants. Mild depression may
be treated with psychotherapy alone. More serious depression
requires an antidepressant medication. Many safe and effective
antidepressants are currently available. For the treatment
to be fully effective, it is critical that the treatment should
continue for several months, or longer. However,
are common and almost one half of the children diagnosed with
depression are likely to suffer a relapse over a five-year
follow-up period. Young people who suffer from depression
are also likely to suffer from depression during their adult
lives. Therefore, continuity of illness between childhood
and adult forms of depression is noteworthy.
Comprehensive treatment of a depressive
episode is likely to prevent short-term sequelae
(self-harm, academic failure) and prevent long-term
negative outcomes (disruption of key relationships,
impairment of problem-solving skills, a heightened
vulnerability to loss). However, patients and
their families should be aware that relapses are
common and require prompt professional attention.
