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Depression
in Children and Teenagers
(This article was first printed in the Special
Health Report from Harvard Medical School "Understanding
Depression". For more information or to order,
please go to http://health.harvard.edu/UD.)
While some idealize
childhood, painting it in rosy hues, children
may feel shaken by developmental changes and
outward events over which they have little or
no control. Depression strikes as many as 2.5%
of children and 8.3% of teens in the United States.
And the number of children and teens in distress
may be rising. Recent research published in Pediatrics examined
psychosocial issues in thousands of children
ages four to 15 during pediatric visits for common
health concerns. The study found significant
increases in reports of emotional problems, including
depression and anxiety, between children studied
in 1979 and those seen in 1996.
While a full-blown
depression most often starts in mid-adulthood,
low-grade depression, or dysthymia, may begin
during childhood or the teenage years. The diagnosis
of dysthymia in adults is based on depressive
symptoms over a two-year period. In children,
a diagnosis is made after one year. When dysthymia
appears before age 21, major depressive episodes
are more likely to emerge later in life.
Among teens as in
adults, bipolar disorder and depression are clearly
connected. Within five years of experiencing
a major depression, 20% to 40% of teenagers develop
bipolar disorder. While rare in early childhood,
this disorder occasionally appears as a child
grows into adolescence, especially in cases where
a family history exists. Bipolar disorder that
emerges during puberty often displays a mixture
of high and low symptoms or rapid cycles of highs
and lows.
Rates Change After Puberty
Before puberty, neither
sex has the edge on major depression, but afterward
girls are two to three times more likely than
boys to suffer from it.
Just as adults differ
in how they feel and express depression, so do
children. Young children are more likely to express
feelings of depression as vague physical ailments,
such as persistent stomach aches, tiredness,
and muscle aches. While they may truly be sad,
depressed children and teens are more likely
to appear irritable. Social withdrawal is common
among children experiencing depression, as it
is among adults, although oversleeping and sluggishness
are less prevalent. Otherwise, the symptoms of
depressive disorders in children, teenagers,
and adults are generally similar (see What
Is Depression?).
Red Flags
If you are a parent
of a teenager, a list of depressive symptoms
may make the hairs on the back of your neck rise.
Storminess, apparent exhaustion, apathy, irritability,
and rapid-fire changes in every realm, including
appetite and sleep habits, are common in adolescents.
You might find yourself wondering whether a sudden
disinterest in the clarinet signals depression
or merely that your teen suddenly perceives playing
in the school band as totally uncool. Staying
up late and sleeping until noon or throwing over
one interest in favor of others probably doesn’t
signal depression. But constant exhaustion and
an unexplained withdrawal from or loss of interest
in friends and activities a child once enjoyed
would be reason for concern.
Because depression
in children and teens often coexists with behavioral
problems, anxiety, or substance abuse, experts
consider a wide range of potential indicators,
such as:
- Poor performance in school or frequent absences
- Efforts or threats to run away from home
- Bursts of unexplained irritability, shouting,
or crying
- Markedly increasing hostility or anger
- Abuse of alcohol, drugs, or other dangerous
substances
- Social isolation or loss of interest in friends
- Hypersensitivity to rejection or failure
- Reckless behavior
You should discuss
any of these problems with your child. If you’re
still concerned, speaking with your child’s
pediatrician or guidance counselor may help.
Signs of Mania
Aside from the typical
signs of manic behavior (see What Is Bipolar
Disorder?), teens who are in a manic episode
may:
- Talk very fast
- Be very easily distracted
- Get much less sleep than usual, but seem
to have the same amount of energy or even more
- Have extreme mood changes, for example, shifting
between irritability, anger, extreme silliness,
or high spirits
- Indulge in, think about, or describe hypersexual
behavior
If you notice these
symptoms, your child’s pediatrician can
help you decide whether to seek professional
help. Of course, this is especially important
if a family history of bipolar disorder exists.
Dealing with Suicidal
Remarks
Children and teenagers
are by nature more impulsive than adults, their
emotions less tempered by experience. In addition
to what experts know about the challenges of
growing up, research suggests that regions of
the brain that govern judgment are not well developed
until later in life. All too often in this age
group, suicidal thoughts translate into action.
It’s important never to ignore or brush
off comments about suicide or even such sweeping,
dramatic statements as “I wish I was dead,” or “I
wish I’d never been born.” Instead,
follow through by talking to your child about
them.
Perhaps these sentiments
reflect nothing more than an isolated, angry
outburst or hyperbole in the middle of an argument.
But you can say, “Tell me what you’ve
been thinking about that,” or “Are
you telling me about your frustration, or do
you really feel like ending your life?” If
the answers you get raise any concerns, if your
child refuses to engage in any conversation,
or if he or she seems to have any of the signs
of depression or mania mentioned earlier in this
section, call his or her pediatrician for advice.
Pediatricians are trained to look for signs of
mental illness and may suggest further evaluation
or treatment, if necessary.
Sadly, research on
children and teens suffering from mental illness
has lagged. But recent studies show that certain
antidepressants, such as fluoxetine (Prozac)
and paroxetine (Paxil), are relatively safe and
do help, particularly when coupled with certain
types of psychotherapy. Depending on where the
problems are—in the child’s development,
in social situations, or at school—therapy
can counter negative thoughts and behaviors,
help with relationship problems, or provide other
forms of support. (See Psychotherapy for Depression.)
More information should
become available in the next few years as findings
filter in from a multisite study, sponsored by
the National Institute of Mental Health, on long-term
treatment for depressed adolescents.
(This article was first printed in the Special
Health Report from Harvard Medical School "Understanding
Depression". For more information or to
order, please go to http://health.harvard.edu/UD.)
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