The National Institute of Mental Health estimates that at least 2.5
percent of children under the age of 18 (1.8 million children) are
“severely depressed.” The American Academy of Child and Adolescent
Psychiatry places the number at 5 percent (3.4 million). Some
published authorities believe that depression remains severely
under-diagnosed and that one in four children will experience a
severe episode of depression by their 18th birthday. (Fassler &
Dumas, Help Me, I’m Sad: Recognizing, Treating and Preventing
Childhood and Adolescent Depression, p. 2). Depression can be a
very dangerous illness:
A number of epidemiological studies have reported that up to 2.5
percent of children and up to 8.3 percent
of adolescents in the U.S.
suffer from depression . An NIMH-sponsored study of 9- to
17-year-olds estimates that the prevalence of any depression is more
than 6 percent in a 6-month period, with 4.9 percent having major
depression . In addition, research indicates that depression onset
is occurring earlier in life today than in past decades. A recently
published longitudinal prospective study found that early-onset
depression often persists, recurs, and continues into adulthood, and
indicates that depression in youth may also predict more severe
illness in adult life . Depression in young people often co-occurs
with other mental disorders, most commonly anxiety, disruptive
behavior, or substance abuse disorders, and with physical
illnesses, such as diabetes
Suicide. Depression in children and adolescents is associated with
an increased risk of suicidal behaviors . This risk may rise,
particularly among adolescent boys, if the depression is accompanied
by conduct disorder and alcohol or other substance abuse . In 1997,
suicide was the third leading cause of death in 10- to 24-year-olds
. NIMH-supported researchers found that among adolescents who
develop major depressive disorder, as many as 7 percent may commit
suicide in the young adult years. Consequently,
it is important for
doctors and parents to take all threats of suicide seriously.
National Institutes of Mental Health, “Depression in Children and
Adolescents.”
Research reveals “that children with mood disorders like
depression are more than five times more likely to attempt suicide
than children not affected by such problems.” (Fassler, David G.,
M.D. and Dumas, Lynne S., Help Me, I’m Sad: Recognizing, Treating
and Preventing Childhood and Adolescent Depression, p. 103; Cytryn,
Leon, M.D. and McKnew, Donald, M.D., Growing Up Sad: Childhood
Depression and Its Treatments, p. 75; Jamison, Kay Redfield, Night
Falls Fast: Understanding Suicide, p. 114). Psychopathology is
necessary for serious suicidal behaviors to occur. Psychological
autopsy studies have consistently found that over 90 percent of all
completed suicides in all age groups are associated with
psychopathology, with mood disorder the most frequently reported in
both men and women. (Jacobs, Brewer & Klein-Benheim, “Suicide
Assessment,” pp. 9, 45, Chapter 1 of The Harvard Medical School
Guide to Suicide Assessment and Prevention, Douglas G. Jacobs, M.D.,
editor. Hereinafter the Harvard Guide; Jamison, p. 245).
Nevertheless, depression among suicide victims has been
frequently found to be undiagnosed, untreated or undertreated. One
study found that only 29 percent of suicide victims who were
depressed were receiving adequate antidepressant or lithium
treatment at the time of their suicide. (Id.). Untreated,
depression often has an accelerating course in which episodes become
more frequent and severe. (NIMH).
Of course, the "good news" is that most people suffering
from depression, including children and adolescents, do not commit
suicide. But because suicide is irreversible, and is not always
clearly telegraphed in advance by either words or behavior (threats
or attempts), any seriously depressed person should be considered at
risk. In any event, depression can be a crippling illness at any
age and, even if a victim is functional, limits enjoyment and darkly
colors life. Depression is a treatable illness. Society should
view it as such.
According to the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (“DSM-IV”), the symptoms of major
depression are:
1. Persistent sad or empty mood, either by patient’s
report or by observation of others. In children and adolescents,
this can be irritable mood.
2. Markedly diminished interest or pleasure in all, or
almost all, activities most of the day, nearly every day (again, as
either reported by the patient or as observed by others).
3. Significant change in appetite or body weight.
4. Difficulty sleeping or oversleeping (“insomnia” or
“hypersomnia”).
5. Physical slowing or agitation as observed by others.
6. Fatigue or loss of energy.
7. Feelings of worthlessness or inappropriate guilt.
8. Difficulty thinking or concentrating, or
indecisiveness (again, as either reported by the patient or as
observed by others).
9. Recurrent thoughts of death or suicide.
Id. at p. 327.
The DSM-IV recommends a diagnosis of major depressive
disorder if an individual has five or more of the above symptoms
during the same two-week period. Another prominent authority
suggests that “clinical depression is a combination of these
symptoms which persist for longer than three weeks and cause failure
in the person’s environments of home, work (school) or play.”
(Weinberg, M.D., Harper, M.D., Emslie, M.D. & Brumback, M.D.,
“Depression and Other Affective Illnesses as a Cause of School
Failure and Maladaption in Learning Disabled Children, Adolescents
and Young Adults,” Chapter 15, Secondary Education and Beyond.
The two most important symptoms of depression are a
dysphoric mood and anhedonia. In a dysphoric mood, a child feels
sad, blue, hopeless, worried and irritable. A child suffering
anhedonia lacks interest or takes no pleasure in most usual
activities, such as sports, hobbies or interactions with friends of
family. (Cytryn & McKnew, p. 147). This view reflects the DSM-IV
criterion that diagnosis of depression requires the presence of at
least one of these two symptoms.
Weinberg, et al., agrees that a dysphoric mood is required
for depression, but believes that self-deprecatory ideation, rather
than anhedonia, is essential for a diagnosis of depression.
Self-deprecatory ideation is feelings of being worthless, useless,
or guilty. Weinberg would, in addition, require the patient to
exhibit four or more other symptoms among agitation, sleep
disturbance, change in school performance, diminished socialization,
change in attitude toward school, somatic complaints, loss of usual
energy and unusual change in appetite of weight. (Weinberg, et
al., p. 2). Agitation includes irritability, sudden anger and
difficulty getting along with others. The most common sleep
disturbance is trouble falling asleep. Change in school performance
is characterized by complaints from teachers of daydreaming, poor
concentration, inattentiveness, incomplete homework, and consequent
drop in grades. “Diminished socialization” is defined the same as
anhedonia. (Id.)
Most depressed young people will be failing in school, will
be difficult to live with at home, and will drop out of
extra-scholastic pursuits. The depressed individual’s judgment
deteriorates, interests wane, and failure occurs. Weinberg, et al.,
p. 2.
Another very strong link to childhood depression and to
suicide is a history of depression in the family,
FAMOUS PEOPLE WHO WERE DEPRESSEDMany people have achieved great things while battling depression. A list of some follows. Some people wrongly romanticize depression, pointing to people such as these and crediting their depression as giving them special insights. This is wrong. Instead, we should ask: How much more could these talented people have done if depression had not drained some of their energy and enthusiasm? Could Lincoln have won the Civil War in three years instead of four? How many more symphonies or great books could the composers and authors have created? We will never know. But we do know depression robs people of talent, ambition and time. It is no blessing. Abraham Lincoln: Civil War president Mike Wallace: 60 Minutes correspondent |
especially in the
mother. Researchers are increasingly certain that genes play an
important role in vulnerability or predisposition to depression and
other severe mental disorders. (NIMH; Cytryn & McKnew, pp. 74,
116). The risk of depression among children of a depressed parent
is as high as 30 percent by the end of adolescence (Weinberg, et
al., places the range at 30-40 percent). That means nearly one in
three children of depressed parents are likely to suffer
depression. (Cytryn & McKnew, pp. 109-110; Weinberg, et al., p.
5). Alcoholism is often present in the extended families of
depressed children. (Ingersoll & Goldstein, p. 74). Major
psychological disorders, which are associated with genetic
transmission, also increase the risk of suicidal behavior. These
include mood disorders and alcoholism. (Mann & Arango, “The
Neurobiology of Suicidal Behavior,” Chapter 6, p. 99, Harvard
Guide). “For those individuals with a high genetic load for
depression little or no environmental stressors are needed. These
individuals will have spontaneous episodes of affective illness
throughout their lives.” (Weinberg, et al., p. 7).
Poor coping skills have been associated with suicide in
school-age children. Such children “are unable to produce
alternative problem-solving strategies, resulting in diminished
flexibility in meeting life’s challenges. Decreased problem solving
and poor social skills have also been associated with suicidal
behavior in adolescents.” Although poor school performance is a
risk factor (for suicide and depression), low IQ is not. “This
suggests that it is the level of functioning rather than the
underlying capacity that connotes risk.” (Goldman & Beardslee,
“Suicide in Children and Adolescents,” Chapter 24, p. 427, Harvard
Guide; Shamoo, Tania K. and Patros, Philip, I Want to Kill Myself:
Helping Your Child Cope with Depression and Suicidal Thoughts, p.
82). Suicide-vulnerable individuals lack self-regulating capacities
and have difficulty keeping a sense of internal composure. (Jacobs,
Brewer & Klein-Bonhem, “Suicide Assessment,” Chapter 1, p. 14,
Harvard Guide).
The depressed child often will be unable to tolerate
frustration and may respond to even minor provocations with angry
outbursts. “Irritable mood is usually more apparent at home than in
other settings: many depressed youngsters who are explosive at home
and seem to go out of their way to pick fights with family members
are able to control themselves in school and other public
settings.” Children with such Oppositional Defiant Disorder can be
quite obedient and controlled outside the home. (Ingersoll &
Goldstein, pp. 5, 35).
Puberty, which generally begins between the ages of twelve
and fourteen, coincides with the first significant rise in the rate
of suicide. “It brings with it a whirlpool of hormones and a steady
increase in the prevalence of major psychiatric disorders.
(Jamison, p. 202).
Depression may appear as ADHD, but should be treated with an
antidepressant rather than a stimulant drug such as Ritalin (or
Adderall). “The link between learning disabilities and depression
is strong. These disorders share many symptoms, such as decline in
school grades, a short attention span, difficulty paying attention
in class, and a lack of interest in school. What’s more, learning
disabilities can lead to depression.” (Fassler & Dumas, pp. 62,
71). ADHD “seems to be a high risk for depressive illness.” Cytryn
& McKnew, p. 113). Twenty to 30 percent of youngsters diagnosed
with depression also are diagnosed with ADHD. (Ingersoll and
Goldstein, p. 35). Weinberg, et al., puts the number at 60 to 80
percent. (p. 7). DSM-IV agrees that ADHD and other disorders are
frequently associated with major depression. (DSM-IV, pp. 324-25).
Some authorities opine that ADHD usually is an inappropriate
diagnosis for children who have average to good academic records
before the age of seven, and that later learning problems typical of
ADHD actually are mainly symptomatic of depression. (Shamoo &
Patros, p. 17; Ingersoll & Goldstein, p. 35).
We have reproduced a short test for depression which can be
administered to your child. See the
Depression Test for Children
by clicking here. We also have provided a test for ADHD,
which is frequently mistaken for depression or bipolar disease.
Click here.
We especially welcome submissions to be posted to the site,
including more information about childhood depression, personal
stories that might help others addressing this difficult subject,
and news and political developments on children's mental health.
Send them to webmaster@depressedchild.org.
[1] Weinberg, et al., recommend first generation antidepressants,
tricyclics, for children and young adolescents, although third
generation antidepressants (SSRIs) may also be used. They also
recommend use of SSRIs and tricyclics in combination. Prior
treatment response of family members suffering depression is one
factor in selection of the proper medication. The Weinberg article
was written in 1995 and therefore fails to account for more recent
testing. (Weinberg, et al., pp. 8-9).
DISCLAIMER: Unless otherwise indicated, all commentary and
information on this web site is provided by persons who have no
formal training in medicine or mental health. You should weigh the
information and comment on this site in consultation with a mental
health professional.
