Depression is dangerous. It
distorts normal perceptions, causes behavior changes and can result
in self-mutilation or suicide. It is not uncommon in children, but,
for many reasons, it often escapes diagnosis. Depression was not
even recognized as a childhood disease by the psychiatric
profession
until 1980. Before that time, it was commonly believed that
children could not suffer from depression. What, after all, could a
child in a healthy family and community environment be depressed
about?
DSM-IV, the “Bible” of the psychiatric profession,
which identifies symptoms of mental illnesses, recognizes that
children can be depressed. Nevertheless, depression is frequently
overlooked as a diagnosis by the health care profession. Among
possible reasons are these:
The historic denial that depression exists in
children. Twenty years is not a long time. Many medical
practitioners, especially those who do not specialize in mental
health treatment, may not have been trained to recognize
depression in children, or are prone to recognize other
possibilities first when presented with a depressed child.
A reluctance to diagnose mental
illness in children because mental illness still is a badge of
shame in many areas of the country. Parents may exert subtle
and not-so-subtle pressures on a physician to find another cause
of a child’s behavior, or the physician may simply be reluctant
to “badge” the child.
Depression’s
symptoms share some of the symptoms of attention deficit
disorder. ADD and ADHD might mask the more dangerous illness.
Depressed behavior may be mistaken for normal
developmental problems. Childhood
development is complex.
Children develop and change their personalities. The beginning
of adolescence causes changes that may be normal, but difficult
for parents to cope with. It may be difficult even for
professionals to identify when the line is crossed from normal
development, or problems arising from growth, and depression.
Health care economics cuts against a diagnosis of
chronic depression because treatment can be expensive (drugs and
counseling) and long-term. Lack of health insurance or very
limited mental health coverage (often covering only acute
episodes requiring hospitalization) are practical (if dangerous)
reasons for diagnosing more treatable illnesses, such as ADHD,
before seriously assessing the possibility of chronic
depression. Insurance limits on fees also encourage mental
health care professionals to increase their patient loads, thus
diminishing the time and attention provided any one patient.
This is especially troublesome in the case of children, who
often are unable or unwilling to give voice to their own mental
problems and, therefore, require even more extensive observation
and counsel than adults.
Competition between psychologists and psychiatrists may sometimes influence prescribed treatment, which usually should include both medication and counseling. Some psychologists are reluctant to refer a patient to a psychiatrist for antidepressants either because of a misplaced trust in their own field of counseling or -- presumably rarely -- because if the medication is effective, a patient may decide he or she no longer needs counseling.
Confusion
over the safety of drug therapy may be a new disincentive to
seek treatment. The FDA warns that antidepressants may pose
risks that are not worth the benefits when prescribed for
children. The drug companies keep some of their testing data a
secret and spend little on testing on children. But suicide
rates among adolescents have dropped since the advent of the
current generation of drugs, leading many physicians to argue
the FDA (and its British counterpart) have overreacted. Add to
the confusion that it is very difficult to know if "talk
therapy" is effective with children, and there are few ways to
gauge the talent or record of many child psychologists.
While recognition of childhood depression is growing,
much of the attention and focus is on teenagers 15 years and above.
This is fair because the risk of suicide is high in this age group.
Far less attention is paid to the plight of children and early
adolescents, although all the symptoms, including suicide, do occur
in this age group, too. Further, it is fair to assume that in many
cases the depressed 18-year-old suffered undiagnosed episodes of
depression at an earlier age, when treatment might have been more
effective and more timely.
Publicity to sensitize the population about the
symptoms of depression at any age barely exists, and there seems to
be nearly no information about depression available at elementary
and middle schools, where depressed children spend their days. (A
program announced by the Surgeon General in May 2001 is intended to
raise public awareness of suicide and depression and to encourage
teaching about suicide and depression in schools). Parents may not
even think of depression as a possible cause of their child’s sudden
trouble in school or with friends, or as a reason why their child is
so confrontational. If it does occur to them, parents may be
reluctant to voice their fears and may find little practical
information about depression in young children.
The Depressed Child is intended to be a forum in which
anyone concerned about childhood depression may participate. We
invite you to submit advice and counsel based on your own
experiences, identify information sources which you found helpful,
and to visit the pages of this site to find out information which
might help a depressed child you know.
At this site we provide information and commentary
about:
Symptoms of Child Depression
Treatment of Child Depression
Other Child and
Adolescent Mental Health Symptoms (brief summaries)
Living with Child Depression (personal stories)
News About Depression
Developments
A list of accessible resources
Excerpts and Contents of Good
Books on Child Depression
We at the Depressed Child hope you find this material
useful. In any event, please take hope in the fact that many
parents are dealing with the same issues you are facing. Because
this site also attracts the attention of many unhappy or depressed
adolescents, we offer you the same hope -- you are not alone. You,
in fact, have much company.
Responsible comment is encouraged and
welcomed. We also welcome longer commentaries, personal
experiences, recommendations, reading suggestions and other
information which can be posted to a website page. If you have a
website contribution, please e-mail it to the Website
Administrator, James A. Kidney, at webmaster@depressedchild.org for
posting. You should list your name , as well as your e-mail
address. This information will not be posted on the web unless you
wish for it to be. We will contact you by e-mail to thank you for
your submission and, if necessary, with questions about your
submission for web publishing purposes We don't ask for anything
and we don't accept contributions and your privacy will be totally
respected. If you are a health care professional, please tell us
your profession, such as internist, nurse, psychiatrist, mental
health counselor or psychologist, when you submit something to the
Website Administrator to publish. It is important for readers to
know if an author is a professional in the health care system so
that information can be taken into account in weighing the comment
or advice.
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.