Childhood Depression: Symptoms, Diagnosis, and Treatment

Depression is not only a condition that affects adults. Children and teens can suffer from depression as well. Unfortunately, many depressed children go undiagnosed and untreated because adults don't recognize the signs of depression in children.

It is essential for parents, teachers, and other adults to educate themselves about childhood depression. By understanding the symptoms of depression in children and the factors that contribute to its development, you can offer support and intervene appropriately.

Signs and Symptoms

Depression in children and teens often manifests differently than it does in adults. Irritability and/or anger are common signs of depression in children. Young children may have difficulty expressing their feelings, while teens may try to hide their emotional distress for fear of being judged.

Because typical behaviors vary as children grow, it can be challenging to determine if your child is going through a phase or if it’s something more serious. The first step towards assisting your child in overcoming depression is learning how to identify it.

Common signs of depression in children and teens, lasting longer than two weeks according to the American Academy of Child and Adolescent Psychiatry, include:

• Changes in appetite or weight
• Feeling or appearing depressed, sad, tearful, or irritable
• Fatigue or perceived lack of energy
• Feelings of guilt or shame
• Increased difficulty concentrating
• Loss of interest or pleasure in previously enjoyed activities
• Psychomotor slowing or agitation
• Recurrent thoughts of suicide or death
• Sleep disturbance: Insomnia or hypersomnia nearly every day

In addition to these symptoms, some children experience physical complaints such as stomachaches, headaches, substance use, and poor school performance.

Moreover, children may not always meet the criteria for depression as defined in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). As they age, the presentation of symptoms becomes more aligned with the DSM-5 criteria.

Causes

While stressful life events like divorce may contribute to depression, they are just one piece of the puzzle. Genetics and other factors play a role as well.

Some contributing factors to childhood depression include:

• Brain chemistry: Imbalances in certain neurotransmitters and hormones can affect brain function, influencing moods, emotions, and the risk of developing depression.
• Environmental factors: A stressful, chaotic, or unstable home environment, rejection and bullying at school, and other challenging circumstances can contribute to depression.
• Family history: Children with a family history of mood disorders such as depression are at an increased risk of experiencing symptoms of depressive disorders themselves.
• Stress or trauma: Significant life changes, such as moving or divorce, or traumatic events like abuse or assault, can also contribute to feelings of depression.

It's essential to remember that anyone can develop depression, and it's not a sign of weakness or a parent's fault.

Diagnosis

If you suspect that your child is showing signs of depression, schedule an appointment with their pediatrician to discuss your concerns.

Before making a diagnosis, the child will undergo a comprehensive physical and medical evaluation to rule out any underlying medical conditions that may be causing the symptoms. For example, thyroid problems, anemia, and vitamin deficiency can mimic depression symptoms.

While there is no specific test for depression, a doctor may use psychological assessments to evaluate the type and severity of depression your child is experiencing.

Classification of Depression

When a child is diagnosed with a depressive disorder, it is typically classified by severity:

• Mild
• Moderate
• Severe (also called "major" or "clinical")

According to the DSM-5, this classification is based on the number, type, and severity of symptoms and the degree to which they interfere with daily life.

Treatment Options

The treatment approach for childhood depression depends on the severity of the condition.

Psychotherapy

Psychotherapy, also known as talk therapy, is a first-line treatment for children with depression. A mental health professional helps the child develop skills to manage their depressive symptoms, enabling them to function well at home and school.

Two types of psychotherapy are commonly used for children with depression:

• Cognitive behavioral therapy (CBT): CBT helps the child identify negative thought and behavior patterns and replace them with positive ones to improve their mood.
• Interpersonal therapy (IPT): IPT focuses on helping adolescents address relationship issues that may be contributing to or resulting from their depression.

Psychotherapy is generally recommended as a component of treatment for childhood and adolescent depression.

Medications

Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line medication option for young people with depression. However, only two SSRIs—Prozac (fluoxetine) and Lexapro (escitalopram)—are FDA-approved for use in young people with depression.

In some cases, a doctor may prescribe a different SSRI or a serotonin-norepinephrine reuptake inhibitor (SNRI) if they believe it is in the child's best interest. This is referred to as off-label use, which is relatively common.

Antidepressants and Suicidal Thinking

While antidepressants can effectively treat childhood depression, their use has been linked to serious side effects, including suicidal thinking in individuals under age 25. Although this side effect is rare, the Food and Drug Administration (FDA) requires all antidepressants to carry a black box warning about this increased risk of suicide. This does not mean that antidepressants should not be used by this age group. It emphasizes the importance of careful monitoring by doctors and caregivers, especially in the first few weeks after starting an antidepressant.

If your child experiences suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, refer to the National Helpline Database.

Coping Strategies

For mild cases of depression, lifestyle changes can sometimes be effective in addressing depressive feelings. Encouraging healthy habits like managing stress, engaging in regular physical exercise, practicing relaxation techniques, and building a strong social support system can improve a child's well-being.

Here are some proactive steps you can take to promote healthy coping skills and support mental health:

• Emphasize the Connection Between Physical and Mental Health: Explain how taking care of the body, including nutritious food and physical activity, benefits mental health.
• Establish a Consistent Sleep Schedule: Ensure your child goes to bed and wakes up at the same time each day, even on weekends. Encourage them to power down electronic devices before bedtime to promote restful sleep.
• Foster a Rich Social Life: Help your child develop a healthy social life without over-scheduling their time. Assign responsibilities and reward them for being responsible.
• Teach Problem-Solving Skills: Equip your child with problem-solving strategies and emotional regulation techniques. Encourage them to talk about their feelings and develop strategies for dealing with setbacks and failures.
• Prioritize Mental Health in the Family: Discuss mental health openly with your family and make staying healthy a priority.

Ultimately, the decision about treatment options rests with the guardians. It is important for parents and children to educate themselves about treatment options, potential risks, and the benefits of each approach.

Conclusion

Childhood depression can significantly impact a child's life. Recognizing warning signs, offering support, and seeking professional help are crucial steps towards recovery. Early intervention can help children get back on track before depression takes a severe toll on their life and ability to function.