Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings do not go away on their own. They are not necessarily related to a particular life event.
Depression is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved in depression. Nerve impulses cause the release of neurotransmitters from one nerve cell, or neuron, to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression. Some of the neurotransmitters believed to be linked to depression are serotonin, norepinephrine, and dopamine.
Some symptoms are common in people of all ages with depression. These symptoms include the following: appetite problemsdecreased energydifficulty paying attention or making decisionsfeeling very sensitive emotionallyfeelings of irritabilityfeelings of sadness, despair, and emptinessinability to feel pleasureloss of motivation and withdrawal from otherslow self-esteempessimism, negativitysleeping problemsthoughts about suicide and death
Children with depression may have the following additional symptoms: alcohol abusedifficulty with friendships or social outingsdrug abuse and addictionfear of deathfrequent vague physical ailments, such as headachepoor school performance, tardiness, or absencesproblems with authoritiesrecklessnesssensitivity to failure or rejection
Many risk factors for depression have been observed through the years, though how these factors lead to imbalances of neurotransmitters in the brain remains largely a mystery.
All of the following have identified either as underlying risk factors, or as triggers for depression: certain illnessescertain medications, including antibiotics and medicines used to treat acnea family history of depressionhormonal changeslack of sunlightmajor stressesnegative thinking patterns
Other common risk factors for depression in children: abuse or neglectalcohol abusechronic illness, such as diabetescigarette smokingdivorce of parentsdrug abuse and addictionlearning disabilitieslow self-esteemmajor trauma, such as a natural disasterother psychiatric disorders, such as attention deficit disorder or adolescent conduct disorder
Depression may not be preventable. Some steps that may be helpful in preventing depression include the following: avoiding alcohol and illegal drugsavoiding cigarette smokinggetting prompt treatment for other psychiatric disordersseeking effective treatment for chronic diseasestalking with a counselor if the child experiences a major trauma
Depression can lead to suicide. It is important to recognize and treat the condition early. If a parent or other caregiver is concerned that a child may be depressed, the child should be brought to a psychologist, psychiatrist, or other licensed professional for evaluation. In addition, the child should have access to trusted family members and friends, as well as teachers and members of the clergy.
The Children's Depression Inventory, also called CDI 18, may be used to screen a child for depression. A child who screens positively should have a comprehensive evaluation for depression. The evaluation may include a history, physical examination, and laboratory tests.
Most children recover well from a single episode of depression. However, episodes are likely to recur. Children with depression are at risk for further episodes of depression later in life. They are also at risk for adult personality disorders. Children with depression are more likely to commit suicide than other children.
Depression is not contagious in the true sense; however, those around a child with depression, particularly the parents, may experience additional stress and need counseling and care for themselves.
The two most common ways of treating depression in children are with antidepressant medications and psychotherapy. Often a combination is used. Occasionally a person must be hospitalized for intense treatment or for his or her own safety.
Antidepressant medications are effective in the following ways: increasing the child's ability to function in daily lifelowering (but not eliminating) the risk of suicidemaking the child feel better
Fluoxetine (i.e., Prozac) is the only medication approved by the FDA for use to treat depression in children age 8 and older.
The other SSRI medications, such as sertraline (Zoloft), citalopram (Celexa), and paroxetine (Paxil), and the SSRI-related antidepressant venlafaxine (Effexor), have not been approved for treatment of depression in children or adolescents, though they have been prescribed to children by physicians in "off-label use"—a use other than the FDA approved use. In June 2003, the FDA recommended that paroxetine (Paxil) not be used in children and adolescents for the treatment of major depressive disorder.
The FDA has been concerned that the use of antidepressant medications in children or teens may induce suicidal behavior. Following a thorough and comprehensive review of all the available published and unpublished controlled clinical trials of antidepressants in children and adolescents, the FDA warned the public about an increased risk of suicidal thoughts or behavior ("suicidality") in children and adolescents treated with SSRI antidepressant medications.
In addition, the FDA adopted a "black box" label warning that antidepressants were found to increase the risk of suicidal thinking and behavior in children and adolescents with major depressive disorder. A black-box warning is the most serious type of warning in prescription drug labeling.
Nevertheless, studies show that there are substantial benefits from medication treatment for adolescents with moderate and severe depression, including many with suicidal ideation. So, the FDA says, "Anyone considering the use of any other antidepressant in a child or adolescent must balance this risk with the clinical need."
The FDA cautions parents that "Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber."
In August of 2004, findings from the first phase of the NIMH-funded Treatment for Adolescents with Depression Study (TADS) demonstrated a combination of medication and psychotherapy to be the most effective treatment for depression in adolescents.
Psychotherapy can help children: cope better with having depressionfeel less aloneimprove relations with family, friends, and coworkerslearn about depression and how it affects themlearn to recognize and avoid situations that can bring on a depressive episodelearn to view the world and others more positively and more realisticallypositively address problems that they may be facingstop episodes of depression early by recognizing warning signs and symptoms
Antidepressants may cause mild and usually temporary side effects in some people. The most common side effects are as follows: agitationconstipationdizzinessdrowsinessdry mouthnausea
There is an increased risk of suicidal thoughts or behavior ("suicidality") in children and adolescents treated with SSRI antidepressant medications.
An episode of depression in a child usually responds to treatment with medication and psychotherapy. The child can help prevent relapses by living a healthy lifestyle. Following are some important parts of a healthy lifestyle: avoiding alcohol, illegal drugs, and smokingdoing regular exerciseeating a balanced diet, following the food guide pyramidfinding a support system for dealing with depressionfinding ways to manage stressgetting enough rest
Once a child has an episode of depression, he or she is at higher risk for further episodes. Any new or worsening symptoms should be reported to the healthcare provider. The provider may recommend regular visits to monitor symptoms. The provider may also order blood tests to monitor the levels of medications.
Hales, Robert. Textbook of Psychiatry, 2nd edition. Washington, DC: American Psychiatric Press, Inc. 1994.
"Depression Treatment Guide", http://www.anxiety.org.za/deprtguide.htm
"Clinical Depression and Children/Adolescents", http://www.intelihealth.com/specials/depression/htmDeprChildren.htm.
"Childhood Depression", http://www.mirconnect.com/glossary/childhooddepression.html
"Even Kids Get Depressed", http://www.con.com/Health/9906/07/children.depression/
"Depression in Children and Adolescents"http://www.nimh.nih.gov/publicat/depchildresfact.cfm