The Depressed Child

Not only adults become depressed. Children and teenagers also may have
depression, which is a treatable illness. Depression is defined as an illness when the
feelings of depression persist and interfere with a child or adolescents ability to function.
About 5 percent of children and adolescents in the general population suffer from
depression at any given point in time. Children under stress, who experience loss, or who
have attentional, learning, conduct or anxiety disorders are at a higher risk for depression.
Depression also tends to run in families.
The behavior of depressed children and teenagers may differ from the behavior of
depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs
of depression in their youngsters.

If one or more of these signs of depression persist, parents should seek help:

• Frequent sadness, tearfulness, crying
• Difficulty with relationships
• Hopelessness
• Frequent complaints of physical illnesses such as headaches and stomachaches
• Decreased interest in activities; or inability to enjoy previously favorite activities
• Frequent absences from school or poor performance in school
• Persistent boredom; low energy
• Poor concentration
• Social isolation, poor communication
• A major change in eating and/or sleeping patterns
• Low self esteem and guilt
• Talk of or efforts to run away from home
• Extreme sensitivity to rejection or failure
• Thoughts or expressions of suicide or self destructive behavior
• Increased irritability, anger, or hostility

A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way to feel better.

Children and adolescents who cause trouble at home or at school may actually be depressed but not know it. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad. Early diagnosis and medical treatment are essential for depressed children. This is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. It may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a child and adolescent psychiatrist, who can diagnose and treat depression in children and teenagers.

Also see the following Facts for Families:#8 Children and Grief, #10 Teen Suicide, #21 Psychiatric Medication for Children, and #38 Manic-Depressive Illness in Teens. See also: Your Child (1998 Harper Collins)/Your Adolescent (1999 Harper Collins).

Bipolar Disorder (Manic Depressive Illness) in Teens

Teenagers with Bipolar Disorder may have an ongoing combination of extremely high (manic) and low (depressed) moods. Highs may alternate with lows, or the person may feel both extremes at the same time. Bipolar Disorder usually starts in adult life. Although less common, it does occur in teenagers and even rarely in young children. This illness can affect anyone. However, if one or both parents have Bipolar Disorder, the chances are greater that their children will develop the disorder. Family history of drug or alcohol abuse also may be associated with Bipolar Disorder in teens. Bipolar Disorder may begin either with manic or depressive symptoms.

The manic symptoms include:

• severe changes in mood compared to others of the same age and background – either unusually happy or silly, or very irritable, angry, agitated or aggressive
• unrealistic highs in self-esteem – for example, a teenager who feels all powerful or like a superhero with special powers
• great increase in energy and the ability to go with little or no sleep for days without feeling tired
• increase in talking – the adolescent talks too much, too fast, changes topics too quickly, and cannot be interrupted
• distractibility – the teen’s attention moves constantly from one thing to the next
• repeated high risk-taking behavior; such as, abusing alcohol and drugs, reckless driving, or sexual promiscuity

The depressive symptoms include:

• irritability
• depressed mood
• persistent sadness
• frequent crying
• thoughts of death or suicide
• loss of enjoyment in favorite activities
• frequent complaints of physical illnesses such as headaches or stomach aches
• low energy level
• fatigue
• poor concentration
• complaints of boredom
• major change in eating or sleeping patterns, such as oversleeping or overeating

Some of these signs are similar to those that occur in teenagers with other problems such as drug abuse, delinquency, attention-deficit hyperactivity disorder, or even schizophrenia. The diagnosis can only be made with careful observation over an extended period of time. A thorough evaluation by a child and adolescent psychiatrist can be helpful in identifying the problems and starting specific treatment. Teenagers with Bipolar Disorder can be effectively treated. Treatment for Bipolar Disorder usually includes education of the patient and the family about the illness, mood stabilizing medications such as lithium and valproic acid, and psychotherapy. Mood stabilizing medications often reduce the number and severity of manic episodes, and also help to prevent depression. Psychotherapy helps the teenager understand himself or herself, adapt to stresses, rebuild self-esteem and improve relationships. For additional information see Facts for Families: # 3 Teens: Alcohol and Other Drugs, #4 The Depressed Child, #6 Children Who Can’t Pay Attention (ADHD), #33 Conduct Disorder, and #52 Comprehensive Psychiatric Evaluation. See also: Your Child (1998 HarperCollins)/Your Adolescent (1999 Harper Collins).

The Development of the Facts for Families series is a public service of the AACAP. If you would like to support expanded distribution of the series, please make a tax deductible contribution to the AACAP Campaign for America’s Kids. By supporting this endeavor, you will support a comprehensive and sustained advocacy effort on behalf of children and adolescents with mental illnesses.

Please make checks payable to AACAP, and send to: AACAP, Campaign for America’s Kids, P.O. Box 96106, Washington, D.C. 20090

The American Academy of Child and Adolescent Psychiatry (AACAP) represents over 6,000 child and adolescent psychiatrists who are physicians with at least five years of additional training beyond medical school in general (adult) and child and adolescent psychiatry.

Facts for Families is developed and distributed by the American Academy of Child and Adolescent Psychiatry (AACAP). Facts sheets may be reproduced for personal or educational use without written permission, but cannot be included in material presented for sale. To purchase full sets of FFF, contact the AACAP Publications Clerk at: 1.800.333.7636, ext. 131.

Nelson A. Tejada, American Academy of Child & Adolescent Psychiatry, Operations Department, Phone: 202-966-7300 ext. 131, Main Fax: 202-966-2891, Publication Fax: 202-464-9980