By Dr David Sauceda M.D.
The U.S. Preventative Services Task Force (2009) recommends that primary care providers screen adolescents for depression annually from 12 through 18 years of age during routine visits. If the provider notes any symptoms of depression, parental concerns about their child’s mood or a family history of mood disorders, or concerns about substance use, younger children should be screened and evaluated. In the United States, it is estimated that up to 3 percent of children and up to 8 percent of adolescents suffer from depression. Depression is the leading cause of disability in the United States in people over 5 years of age. Estimates of lifetime prevalence are significantly higher at 18-20%. As a parent it is also scary to report that suicide is the third leading cause of death in youth 10-24 years of age.
Symptoms of depression in children include:
-Sadness
-Irritability
-Change in appetite
-Change in sleeping patterns (too much or too little)
-Loss of interest in activities
-Fatigue
-Feeling slowed down or “burned out”
-Excessive feelings of guilt
-Inability to concentrate
-Indecisiveness
-Feelings of hopelessness and helplessness
-Recurring thoughts of death and suicide
-Physical complaints (stomachaches, headaches)
-Behavioral changes
-Conflicts with family and friends
-Decline in school performance
-Inappropriate sexual activity
-Use of alcohol or drugs
As a parent there are things you can look out for to help spot signs of depression. It is important to recognize that anxiety and depression in children do not necessarily manifest the same as in adult. A depressed child may not be sad, but irritable and angry. A child who appears withdrawn or acting out may have some anxiety issues.
Kids who are acting out are, most likely, expressing an outward clue to an underlying emotional problem. For instance, if a child is bullying a sibling, he may be getting bullied himself at school. One way to get at issues with older children is to ask if they are feeling happy, mad, sad, or scared. Even adolescents will give you a specific answer to this question, which helps them categorize how they’re feeling. This then opens the door for more discussion.
If you suspect depression, it is also important that you assess suicidality. Just ask the question: “Have you thought about hurting yourself?” Kids are generally inclined to give an honest answer. And the question will not make the child think about suicide; there are years of data showing that asking about suicide doesn’t trigger the act. Family members and friends are advised to seek mental-health evaluation and treatment for a depressed child. Family members may consult with the child’s primary-care doctor or seek mental-health services.
In many instances, your pediatrician may be able to assess and treat the child themselves. Components of treatment may be supportive therapy, such as changes in lifestyle and behavior, psychotherapy, complementary therapies, and may include medication for moderate to severe depression. If symptoms are severe enough to warrant treatment with medication, symptoms tend to improve faster and for longer when medication treatment is combined with psychotherapy.
Most practitioners will continue treatment of major depression for six months to a year in order to prevent a reoccurrence of symptoms. Treatment for children with depression can have a significantly positive effect on the child’s functioning with peers, family, and at school. Without treatment, symptoms tend to last much longer and may not improve. In fact, they may get worse. With treatment, the chances of recovery are much more likely.
