Can children have depression?

CEBU, Philippines - Depression is a common experience of people. There is hardly a person who has not had experienced it at one time or another. In most cases, people just get by it.

What is the problem is when the person turns from simply being depressed to being depressive. When the depression is habitual or runs for a long time, it is already a mental health issue. Interventions are then necessary, either therapy or medication.

The general belief is that depression only strikes adult persons. But, in reality, some symptoms of depression, such as occasionally feeling low in mood, sad and tearful, are common in young people as well. And, again, it is mostly temporary.

But depressive illness is different in scale, notes Ciaran Mulholland at www.netdoctor.net.uk. The symptoms are occurring most of the time, he says, during most days and over several weeks. Mulholland also cites other symptoms accompanying the illness, such as: losing interest and motivation to do things that used to be enjoyable, withdrawing socially and not wanting to see people, difficulty concentrating on schoolwork, leading to falling grades; tiredness, aches and pains; changes in sleeping pattern (difficulty sleeping or sleeping more than usual), changes in appetite and weight (feeling more hungry or less hungry); feeling useless, worthless and unloved; dark, pessimistic thoughts about the future; and thoughts of death and acts of self-harm.

These symptoms in young people, Mulholland says, can cause distress, or difficulty coping with schoolwork or affect relationships with friends and family. He explains that other people usually notice the young person being not his usual self, although parents are not always aware of how unwell their child is – often adolescents will open up to friends first.

After the age of about eight years, the symptom patterns of depression in children are similar to those of adults and include many or most of the serious symptoms of the illness, Mulholland points out. However, children and adolescents may seem irritable rather than sad, which can be confusing, he explains, particularly if the young person withdraws and shuts himself away.

Depressive symptoms can also occur as part of other psychiatric disorders, or in physical illness, Mulholland explains, stressing that depressed children and adolescents often have other psychiatric problems as well, such as behavior problems or anxiety, which may mask the underlying depression.

Some youngsters, particularly boys, deny feeling sad; the only observable complaint will be of irritability, moodiness and boredom, he says; and as a result, they may get in fights or other trouble at school, interact less socially and lose friends. They may also ‘act out’ suicidal feelings, Ciaran Mulholland warns. He cites as example some of these children cutting themselves, which can be misinterpreted by parents and teachers as manipulative rather than as a communication of distress. All these things can worsen a depressed state.

Mulholland adds that the affected young person may also need help for these problems, as well as treatment for depression. Sometimes a parent is also depressed and it’s vital that they also get the appropriate help, he says. If there are conflicts and rows in the family, Mulholland suggests family therapy or counseling.

Depressive illness occurs in 2 to 4 percent of children, Mulholland reveals, although it is rare under the age of eight. It becomes more common after puberty, rising to 4 to 8 percent of adolescents, he adds, and that in adolescents depression is more common in girls.

The number of children and adolescents being diagnosed with a depressive illness is increasing, according to Mulholland. He proposes that this may be because of advances in mental health services and treatment with the symptoms being recognized earlier, or it could be that the illness is actually occurring earlier compared to the previous generation.

The tendency to develop depressive illness involves a complex mixture of factors, such as inherited (genetic) factors and life experiences, he says, but there are observed generalities:

• Children and adolescents who get depressed have often had adverse experiences, such as, losing a parent or being abused as a child. Such early life experiences set a person up for later depression.

In addition recent life events often precipitate an episode of depression. A life event is simply a stressful occurrence. Friendship difficulties and disappointments are common triggers for depression in children and adolescents.

• Having a family history of depression can also put individuals more at risk as there is some genetic contribution to depression.

Although there is no evidence that family difficulties actually cause depression, when there is a lot of family conflict, this can interfere with a person’s recovery.

• From puberty onwards, depression is more common in girls. This gender difference is probably due to a variety of reasons, including biological (eg hormonal changes), psychological and social factors.

• Most episodes of depression in children and adolescents last less than nine months. And after one year, 70 to 80 percent of children will have recovered, but 1 in 10 will remain persistently depressed.

• Around half of young people will relapse (that is the depression returns quickly), within two months of getting better.

• Depression recurs (that is, a new bout of depression begins) in 70 percent of children and adolescents over five years. Around a third of children and adolescents who have depressive illnesses will have recurrent episodes, even into adulthood.

Recurrence of depression is more likely the earlier in life it starts, the more times it recurs and the more severe it is.

• Up to 30 percent of children and adolescents who have a depressive illness will go on to have bipolar affective disorder, though it may take 5 to 10 years before this becomes clear.

• Adolescents with depression are just as likely to develop recurrent depression as an adult who is depressed. Depressive episodes may get longer and more severe with recurrences. This can cause huge disruption to young people’s social lives and schooling, and there’s a risk of suicide.

Mulholland recommends that adolescents with depression get properly treated and helped to get well and stay well.

The family can help or has a role to do with a depressive young member. First and foremost, it is important for everyone in the family to be keenly observant for signs of depression among themselves. The most important thing for a depressed young person to do, according to Mulholland, is to tell a family member or a professional such as a doctor or the school counselor.

Mulholland has this advice for parents and other adults in the family: If you’re concerned that a child or adolescent in your family might have a depressive illness, discuss it with your doctor and ask a referral to a local child and adolescent mental health service. (FREEMAN)