Major Depression in Children

What is major depression?

Major depression, also known as clinical depression, is classified as a type of affective disorder (also called mood disorder) that goes beyond the day's ordinary ups and downs. It has become a serious medical condition and important health concern in this country.

Who is affected by major depression?

The National Institute of Mental Health, part of the National Institutes of Health, reports the following:

• Research indicates that depression onset is occurring earlier in life today than in past decades.

• Early-onset depression often persists, recurs, and continues into adulthood. Depression in youth may also predict more severe illness in adulthood.

• There is an increased incidence of depression in children whose parents experience depression.

What are the risk factors for major depression?

The following are the most common risk factors for major depression:

• Family history of depression (especially if a parent experienced depression as a child or adolescent)

• Excessive stress

• Abuse or neglect

• Trauma (physical and/or emotional)

• Other psychiatric disorders

• Loss of a parent, caregiver, or other loved one

• Cigarette smoking

• Loss of a relationship (for example, moving away, loss of boyfriend or girlfriend)

• Other chronic illnesses (for example, diabetes)

• Other developmental, learning, or conduct disorders

What are the symptoms of major depression?

The following are the most common symptoms of major depression. However, each child may experience symptoms differently. Symptoms may include:

• Persistent feelings of sadness

• Feeling hopeless or helpless

• Having low self-esteem

• Feeling inadequate

• Excessive guilt

• Feelings of wanting to die

• Loss of interest in usual activities or activities once enjoyed

• Difficulty with relationships

• Sleep disturbances (for example, insomnia, hypersomnia)

• Changes in appetite or weight

• Decreased energy

• Difficulty concentrating

• A decrease in the ability to make decisions

• Suicidal thoughts or attempts

• Frequent physical complaints (for example, headache, stomachache, fatigue)

• Running away or threats of running away from home

• Hypersensitivity to failure or rejection

• Irritability, hostility, aggression

For a diagnosis of major depression to be made, a child often needs to exhibit a "cluster" (several) of the above symptoms during the same 2-week period. The symptoms of major depression may resemble other problems or psychiatric conditions. Always consult your child's health care provider for a diagnosis.

How is major depression diagnosed?

Because depression has shown to often coexist with other psychiatric disorders, such as substance abuse or anxiety disorders, seeking early diagnosis and treatment is crucial to the recovery of your child.

A child psychiatrist or other mental health professional usually diagnoses major depression following a comprehensive psychiatric evaluation. An evaluation of the child's family, when possible, in addition to information provided by teachers and care providers may also be helpful in making a diagnosis.

Treatment for major depression

Specific treatment for major depression will be determined by your child's health care provider based on:

• Your child's age, overall health, and medical history

• Extent of your child's symptoms

• Your child's tolerance for specific medications or therapies

• Expectations for the course of the condition

• Your opinion or preference

Mood disorders, including major depression, can often be effectively treated. Treatment should always be based on a comprehensive evaluation of the child and family. Treatment may include 1, or more, of the following:

• Antidepressant medications (especially when combined with psychotherapy has shown to be very effective in the treatment of depression in children and teens)

• Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy) for the child (focused on changing the child's distorted views of him- or herself and the surrounding environment; working through difficult relationships; identifying stressors in the child's environment and learning how to avoid them)

• Family therapy

• Consultation with the child's school

Parents play a vital supportive role in any treatment process.

For several reasons, many parents of children or adolescents with depression never seek the appropriate treatment for their child, although many people with major depression who seek treatment improve — usually within weeks. Continued treatment may help to prevent reoccurrence of the depressive symptoms.

Without appropriate treatment, symptoms of depression can persist for weeks, months, or years. In addition to causing interpersonal and psychosocial problems, depression in children and adolescents is also associated with an increased risk for suicide. Further, this risk rises, particularly among adolescent boys, when the depression is accompanied by other mental health disorders (for example, conduct disorder, substance abuse). It is crucial for parents and care providers of children and adolescents to take all depressive and suicidal symptoms very seriously and seek treatment immediately. Suicide is a medical emergency. Consult your child's health care provider for more information.