Depression in Adolescents

by Ellen S. Mullen M.D.

Many people tend to think of children as little adults. Children are even sometimes mistakenly treated by physicians as “small grown ups.” This definitely should not be the case with depression. Children show different signs of depression when compared to adults and react to depression differently than adults do. We should all be aware of the signs and symptoms of childhood and adolescent depression because suicide is the third leading cause of death in persons younger than 20 years old.

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What makes a child or adolescent at increased risk for depression? A family history of depression increases the chances that a child may develop depression. Other risk factors include previous depressive episodes, history of anxiety or attention deficit disorder or learning disabilities. Also if a child is in a dysfunctional family or has caregiver conflicts this may contribute to depression. Peer problems, academic difficulties and chronic illness may also play a part in causing depression to begin.

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You may read the above paragraph and feel that these are things that many children deal with. You are correct, but it is how the child copes with these difficulties that determines if they are depressed. So how can we tell if a child is becoming depressed?  Children express their feelings differently than adults. A child may exhibit depression by being more irritable or cranky than usual. They may listen to songs about death and dying repeatedly or lose interest in activities that were enjoyable previously. Other signs and symptoms include weight loss or gain, complaints of physical illnesses such as headache or stomach ache or inability to go to sleep or awaken in the morning. Depressed children may talk of running away from home or attempt to do so. Persistent boredom, negative behavior, and doing poorly in school may be a clue that a child is suffering from depression.  Frequent absences from school may also occur. In more serious situations a child may express thoughts of suicide or suicidal behavior.  These should always be taken seriously and never dismissed.

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Treatment for childhood depression should always begin with a visit to a physician to decide what type of treatment is appropriate. Counseling with a certified counselor has been found to reduce symptoms of mild and moderate depression in children and adolescents. The American Academy of Child and Adolescent Psychiatry recommends a multimodal approach to treatment including education of the patient and family, initial psychotherapy and medication if the depression is severe. Medications have been found to be beneficial but the child must be continually monitored for suicidal thoughts.  

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Depression has been found to be genetic. There is no way thus far to prevent depression but being aware of the signs and symptoms will help with earlier diagnosis.