Major Depression in Children
Dr. Jekyll or Mr. Hyde?
Susie is in the third grade and is so sad that she never speaks above a whisper. Ben cries
about everything and won’t even play his favorite game of baseball. Eight-year old Bob
storms angrily around the house shouting at everyone, including the dog.
Moody children create constant challenges. One minute they display outbursts of
unexplained rage. The next minute they slump in hopelessness and sadness. They
frustrate parents. They can be impossible to live with. Mood disorders impact children of
all ages and in all places. Their moods disrupt life at home and at school. They tend to
alienate both family and friends. If these behaviors don’t go away, childhood depression
may be the problem.
What is childhood depression?
Childhood depression is one of the two major mood disorders that create significant
problems in the lives of children. The U.S. Surgeon General’s Report on Mental Health
shows this disorder affects close to 5 percent of all children and adolescents. Once a child
experiences major depression, they are likely to have another episode within 5 years.
This report also states that 20-50% of depressed children have a family history of this
disorder. This is important to know because childhood depression can be hard for parents
to detect. Family history is helpful and can speed up the evaluation process. Ignoring the
signs and hoping the “bad mood” will disappear is not the best approach. There are
treatments available that may help.
How do I know my child really has a mood disorder?
As with any illness, parents want to know how bad the problem is. They wonder how
urgently their child needs medical attention. Literature written on children’s depression
offers a simple rule. Behavior is a problem when it’s a problem. Behaviors are symptoms.
Parents play a key role in describing these symptoms. They must understand how
clinicians evaluate a child’s moods.
Moods are evaluated using three measures: (1) how often the behavior happens
(frequency); (2) how long the behavior lasts (duration); and how disruptive the behavior
is when it happens (severity).
When should I get help for my child?
The National Institute of Mental Health (NIMH) recommends that parents seek an
evaluation for their child when five or more of the following symptoms last longer than
two weeks. Or, if any of these symptoms become so overwhelming that daily routines
cannot possibly be followed.
Symptoms include:
1. The child feels sad or cries a lot and the feeling of unhappiness does not go away
2. The child feels guilty for no reason and has lost all confidence
3. Life seems meaningless and the child has a negative attitude most of the time
4. The child doesn’t feel like doing activities that used to be fun. They want to be left
alone most of the time
5. The child finds it hard to make up his/her mind. They forget things and have trouble
concentrating.
6. The child gets irritated often and overreacts to little things by losing their temper
7. The child’s sleep patterns change, either more or less
8. The child’s eating pattern changes, either no appetite or over eating
9. The child feels restless and tired most of the time
10. The child thinks about death, or thinks they are dying. May have thoughts of suicide
For additional information, refer to NIMH website at:
www.nimh.gov/healthinformation/depchildmenu.cfm
What evidence-based therapies are effective for childhood depression?
There are certain “treatment families” with good research support for treating childhood
depression. A treatment family means a group of therapies known to improve a symptom
or behavior. An example of a treatment family is Cognitive Behavior Therapy (CBT).
Under the umbrella of CBT, there are two individual treatments (called practice
elements) that are used frequently by researchers. The first therapy is called
Maintenance/Relapse Prevention therapy. It works by reinforcing skills a child has
already learned. A child is taught to anticipate future challenges. They practice coping
skills that are familiar. These skills are used to offset the challenge. The goal is to help
the child stay mentally healthy when they have fewer appointments with professionals.
The second therapy is called Psychoeducational-Child therapy. In this treatment, a
therapist educates the child about what behavior or symptom is causing a problem for the
child. The child is taught how the behavior can be changed. An example might be having
the child view a video that illustrates their illness and shows how it is treated.
Conclusion
Even with increased awareness of childhood depression, questions remain on the best
way to treat it. Children are often resistant to treatment. They don’t feel better fast
enough and tend to lose hope. It is important to get depressed children to do more. They
need to get out of their house and stay in touch with the world around them. Parents as
participants in therapeutic activities have a critical role in their child’s recovery.