Facts about Depression in Children and Adolescents

Depression is a common disorder among children (less than 18 years). Approximately 5% of children at any one time may suffer from serious depression. The prevalence of depression increases with age, especially after the onset of puberty. There is no gender related difference in the prevalence of depression among pre-adolescent children. However, onset of puberty is associated with a marked increase in the rate of depression among females, with a female to male ratio of 2:1. The prevalence of depression may be higher in children with other psychiatric disorders (ADHD, conduct disorder, eating disorders, anxiety disorders) and in those with general medical conditions (diabetes, asthma, cancers and other chronic illnesses). The prevalence may also be higher among children with developmental disorders and mental retardation.

It is often during adolescence that depression first manifests itself in girls, and for the first time girls outnumber boys 2:1 in prevalence of the illness. It is estimated that 4.7% of the teenage population suffers from depression. (Kashani and Sherman 1988) It was long believed that the tumultuous moods of the teenage years were "normal", but we now understand that excessive irritability, moodiness, sleep and appetite change may signal a vulnerability to depression. (Pine et al. 1999) Common symptoms of adolescent depression are irritability, hopelessness, anhedonia, changes in sleep and appetite, academic decline, reduced energy, reduced social interactions, somatic symptoms, and suicidal ideation. We also know that more minor symptoms which might not meet full criteria for Major Depressive Disorder (subsyndromal illness) may predispose girls to full blown episodes later in life. Numerous factors may predispose adolescent girls to depression. These include the increase in hormones associated with puberty, changes in body shape and emerging sexual identity, family stressors such as divorce and peer pressure. Separation associated with leaving for college is another stressor which may predispose to depression. Adolescents who develop depression often have recurrences in adulthood and a more severe course. Early detection is essential to minimize recurrences and morbidity from the illness.

Symptoms of depression in children

Unlike adults, most children deny rather than admit depression. Symptoms of depression vary with the developmental stage of the child. Denial of symptoms, aggression, excessive crying, and physical symptoms may be more common among preadolescent children. Common symptoms of depression among adolescents and older pre-adolescent children include irritability, withdrawal, isolative behavior, loss of interest and/or pleasure in previously enjoyed activities, sleep disturbance (reduced or increased sleep), changes in appetite (reduced or increased appetite), and reduced energy. Physical symptoms such as chronic headaches or stomach aches which cannot be attributed to a physical illness, are common among children with depression. Most young people with depression suffer from academic decline. Some youngsters may use street drugs and alcohol in an effort to alleviate their depression. Conflict with authority may result from irritability. Atypical symptoms such as excessive sleep, increased appetite, an extreme sensitivity to rejection, and irritability are more common among children than among adults. In the most severe forms of depression, distortions of reality such as hallucinations and  delusions may be noted.

Suicide and depression in children

Depression in children is associated with a significant personal loss and a negative impact on the society. One of the most serious outcomes of depression is suicide. Majority of the children who attempt or contemplate suicide are likely to suffer from depression. Prompt identification and treatment of depression is important. Untreated depression may lead to failure to achieve full academic potential, disruption of key relationships within and outside the family, loss of self esteem, and self-harmful behaviors which may include drug use, risk taking behaviors, and suicide.

Associated with the Depression Center, the Youth-Nominated Support Team (YST) is a youth suicide prevention program dedicated to developing, evaluating, and fine-tuning a new intervention for suicidal youth. YST is a psycholeducational, social network intervention for suicidal youths. Its goals are to improve youths' perceptions of social support, adherence with recommended treatments, and mental health outcomes. The YST "idea" grew from both clinical experience with suicidal youths and a careful review of the empirical literature on suicidal youth, prevention science, and treatment research. The YST intervention truly springs from a "scientist-practitioner" approach.

Treatment options for children with depression

Depression in children can be effectively treated with a combination of psychotherapy and antidepressants. Mild depression may be treated with psychotherapy alone. More serious depression requires an antidepressant medication. Many safe and effective antidepressants are currently available. For the treatment to be fully effective, it is critical that the treatment should continue for several months, or longer. However, relapses  are common and almost one half of the children diagnosed with depression are likely to suffer a relapse over a five-year follow-up period. Young people who suffer from depression are also likely to suffer from depression during their adult lives. Therefore, continuity of illness between childhood and adult forms of depression is noteworthy.

Comprehensive treatment of a depressive episode is likely to prevent short-term sequelae (self-harm, academic failure) and prevent long-term negative outcomes (disruption of key relationships, impairment of problem-solving skills, a heightened vulnerability to loss). However, patients and their families should be aware that relapses are common and require prompt professional attention.

Central London Relationship, Marriage Counselling Service WC1 Est 1995