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 estimated that 4.7% of the teenage population suffers from depression. It was long believed that the tumultuous moods of the teenage years were "normal," but we now understand that excessive irritability, moodiness, and sleep and appetite changes may signal a vulnerability to depression. Common symptoms of adolescent depression are irritability, hopelessness, loss of interest, sleep and appetite disturbances, academic decline, reduced energy, reduced social interactions, somatic symptoms, and suicidal ideation. We also know that minor symptoms which might not meet full criteria for Major Depressive Disorder may predispose girls to full blown episodes later in life. Numerous factors may increase the vulnerability of adolescent girls to depression. These include the increase in hormones associated with puberty, changes in body shape and emerging sexual identity, and 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 and adolescents

Unlike adults, most children have difficulty describing depressive symptoms. Denial of symptoms, aggression, excessive crying, and physical complaints, such as chronic headaches or stomach aches which cannot be attributed to a physical illness, 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. Common associated features in adolescent depression include academic decline and the use of street drugs and alcohol in an effort to alleviate the depression. Conflict with authority is common and may result from depression and irritability or give rise to these symptoms. Atypical symptoms such as excessive sleep, increased appetite, an extreme sensitivity to rejection, and irritability are more common among children and adolescents than among adults. In the most severe forms of depression, distortions of reality such as hallucinations and delusions may be noted, although this occurs much less commonly than with adult patients.

Suicide and depression in children and adolescents

Youth suicide has a devastating impact in families, schools, and communities.  The majority of the children who attempt or contemplate suicide are likely to suffer from depression. Thus, prompt identification and treatment of depression is important. In addition to the lethal outcome of suicide, 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 and risk taking behaviors.

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 often requires an antidepressant medication. Many safe and effective antidepressants are currently available, although these agents are less well studied in children and adolescents. 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.

There is increasing evidence that strengthening attachment relationships in families can serve as a  protecting factor against depression. Families are perhaps the major protective factor for children at risk for depression. Treatments must take into account family strengths which mitigate depression (e.g., nurturance and availability) and family problems (e.g., parental substance abuse; parental impulse control problems).

Comprehensive treatment of a depressive episode is likely to reduce the risk for short-term negative effects (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.

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Adapted with permission from the University of Michigan Depression Center Web site.