Trillian's Depression Page

Childhood and adolescent depression:

There is emerging evidence that major depression can develop in prepubertal children and that it is a significant clinical occurrence among adolescents. Recent epidemiologic studies have shown that a large proportion of adults experience the onset of major depression during adolescence and early adulthood.

Myrna M. Weissman, Ph.D. of Columbia University (a NARSAD Established Investigator and 1994 Selo Prize Co-Winner) has found an increased prevalence of major depression as well as a variety of other psychiatric problems in the children of depressed parents compared with those of normal parents. Specifically, she has discovered that the onset of major depression was significantly earlier in both male and female children of depressed parents (mean age of 12.7 years) compared with those of normal parents (mean age, 16.8 years). She has also observed sex differences in rates of depression to begin in adolescence. Before 10 years of age, she found a low frequency and equal sex ratio, however by 16 years of age, there was a marked increase in major depression in girls, as compared to boys of the same age. The essential features of mood disorders are the same in children as in adults, although children exhibit the symptoms differently. Unlike adults, children may not have the vocabulary to accurately describe how they feel and, therefore may express their problems through behavior. The following behaviors may be associated with mood disorders in children:

In Preschool Children:

Somber Appearance, almost ill-looking; they lack the bounce of their nondepressed peers. They may be tearful or spontaneously irritable, not just upset when they do not get their way. They make frequent negative self-statements and are often self-destructive.

In School-Aged Children and Adolescence:

Disruptive behavior, possible academic difficulties, and peer problems. Increased irritability and aggression suicidal threats, and worsening school performance. Parents often say that nothing pleases the children, that they hate themselves and everything around them.

Causes of Childhood Depression

As with adult depression, diagnosis of depression in children is not as clear-cut as it is for other ailments. There is no test that can be given which will positively say that an individual has depression, much less pinpoint the causes). The medical community still knows relatively little about the brain, how it works, and what makes it malfunction. In fact, anti-depressant properties of certain medications were discovered by accident in the 1950s while seeking a cure for tuberculosis.

We do know that certain children have risk factors in their lives which could predispose them to depression or could "trigger" depression. Among these are a family history of mental illness or suicide, abuse (physical, emotional or sexual), chronic illness and the loss of a parent at an early age to death, divorce or abandonment. However, some infants exhibit depressive symptoms at an early age before most of these factors come into play, so there is an argument to be made for depression being wholly chemical in some children. Each child's depression is individual, and causes will be different for each one. The depression could be wholly chemical, wholly due to psychological factors, or a combination of the two. More important than the cause is identifying the illness and treating it.

Many researchers believe that mood disorders in children and adolescents represent one of the most under-diagnosed group of illnesses in psychiatry. This is due to several factors:

1. children are not always able to express how they feel.
2. the symptoms of mood disorders take on different forms in children than in adults.
3. mood disorders are often accompanied by other psychiatric disorders which can mask depressive symptoms, and many physicians tend to think of depression and bipolar disorder as illnesses of adulthood.

How Prevalent are Mood Disorders in Children and Adolescents?

7-14% of children will experience an episode of major depression before the age of 15.

20-30% of adult bipolar patients report having their first episode before the age of 20. Out of 100,000 adolescents, two to three thousand will have mood disorders out of which 8-10 will commit suicide.

Suicide

An estimated 2,000 teenagers per year commit suicide in the United States, making it the leading cause of death after accidents and homicide. According to David Schaffer, M.D., of Columbia University ( a NARSAD Established Investigator), suicidal behavior is uncommon before puberty, with the incidence of suicide attempts reaching its peak at around age 15 and becoming less common by the late teens. Studies of adolescent suicides in New York, Pittsburgh and Finland indicate that approximately 90 percent of the teenagers who commit suicide have a psychiatric diagnosis, most often a form of mood disorder and/or alcohol or substance abuse. As in adults, suicide attempts occur more often in females (a ratio of 9 to 1), with overdose and wrist-cutting the most common means. Completed suicide occurs more often in males (a ratio of 3 to 1), usually white males, with shooting (62 percent) and hanging (19 percent) the most common means.

Treatments

It is important for children suffering from mood disorders to receive prompt treatment because early onset places children at a greater risk for multiple episodes of depression throughout their life span. Children who experience their first episode of depression before the age of 15 have a worse prognosis when compared with patients who had a later onset of the disorder.

At the present time, there is no definitive treatment for the spectrum of mood disorders in children, although some researchers believe that children respond well to treatment because they readily adapt and their symptoms are not yet entrenched. Treatment consists of a combination of interventions.

Medications can be useful for cases of major depression or childhood onset mania, and psychotherapy can help children express their feelings and develop ways of coping with the illness. Some other helpful interventions that may be used are educational and family therapy.

Children suspected of mood disorders should be evaluated by a child psychiatrist, or if one is not available an adult psychiatrist who has experience in treating children. It is important that the clinician has had special training in speaking with children, utilizing play therapy, and can treat children in context of a family unit.

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