What Adults Need to Know about Pediatric Depression - Courtesy of Scientific American MIND

What Adults Need to Know about Pediatric Depression

By Deborah Serani | October 9, 2013 |  

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Research shows that children, even babies, experience depression¹. The clinical term is called Pediatric Depression, and rates are higher now than ever before². In the United States alone, evidence suggests that up to 1% of babies, 4 percent of preschool-aged children, 5 percent of school-aged children, and 11 percent of adolescents meet the criteria for major depression³.

According to American Association of Suicidology, Suicide is the 3rd leading cause of death in adolescents ages 15 to 24, and is the 6th leading cause of death in children ages 5 to14⁴. Suicide is significantly linked to depression, so early diagnosis and treatment of Pediatric Depression is not just extremely important – it is life-saving.

History of Pediatric Depression

Pediatric Depression, has weathered a long journey for recognition. Only in the last twenty years has it been accepted by science as a real disorder. Prior to that, only a small group of individuals believed depression existed in children. The majority of others believed children were too cognitively and physically immature to experience depression.

Depression was first noted as an illness by ancient Greeks in 450 BC. Called melancholia, it was seen only seen in adults who displayed a cold and dry disposition – a diagnosis reflected from the theory of an imbalance of black bile in the body. The Father of Western Medicine, Hippocrates, wrote that melancholia involved an “aversion to food, despondency, sleeplessness, irritability, restlessness and fear⁵.” Though later in the 1^st century Greek physician, Aretaeus of Cappadocia, described melancholy as having a relationship between mind and body, little changed in the view of melancholia for thousands of years⁶.

Things started changing in the 19^th and 20th centuries when science began branching off from early Greek theories. Studies took a more serious look at how life experiences affected the symptom of melancholy in adults. Epic research by Robert Burton’s “Anatomy of Melancholy,” Henry Maudsley’s “Physiology and Pathology of Mind” and Sigmund Freud’s essay “On Mourning and Melancholia” furthered the understanding of sadness and melancholy in adults, but also laid the groundwork for considering depression in children⁷.

The fields of neurology, psychology, psychiatry and pediatrics started tracking symptoms of longing, sadness and anxiety in children, which helped launch the official discipline of child psychiatry in 1920. Many pioneers like Melanie Klein, John Bowlby, Anna Freud, D.W. Winnicott, Rene Spitz, and Erick Erickson broadened the field of child depression, detailing theories on trauma, despair and melancholic reactions in children. But it would take almost a century more for science to truly root itself in the belief that children could, without a doubt, have depression.

The 21st century showed a rapid growth of clinical interest in mood disorders in children, influenced by advances in medical technology and the field of neurobiology joining forces with psychology and psychiatry. Evidenced based research studies started streaming in, each one validating aspects of pediatric depression, its symptoms, etiology and methods of treatment. Scientists agreed that though children had immature and underdeveloped affective (emotional) and cognitive (thinking) skills, depression was something they can experience. Children have mood changes, are capable of having negative thoughts, and tend to show depressive symptoms more behavioral ways. Examples like joyless facial responses, listless body posture, unresponsive eye gaze, slowed physical reactions and irritable or fussy mannerisms, just to name a few. Not only did studies confirm the existence of Pediatric Depression, but distinctive symptoms were seen in differing stages of childhood. These results widened the scope of understanding depression in children, and helped highlight that patterns of depression vary with a child’s age⁸.

So, the history of Pediatric Depression began with a steadfast “No way it could ever be” to a more thoughtful “Oh yes it can,” to a postmodern “and it’s intricately unique.” ⁹

Facts Every Adult Should Know

Depression in children is not a passing phase. It is a real illness that is clinically recognized and widely treated. Here are 10 myths every adult should know how to debunk.

1. Myth: Depression looks the same in children as it does in adults.

False. Children don’t have the verbal language or cognitive savvy to express the textures of depression. Instead, body symptoms like aches and pains, fatigue, and slowness present as can tearfulness, unrealistic feelings of guilt, isolation and irritability.

2. Myth: Good parents can always detect if their child is depressed.

False. Most children who suffer with depression keep their thoughts and feelings masked. The only way for parents to understand depression is to be aware of the age specific behaviors and symptoms. More importantly, depression is not a result of bad parenting.

3. Myth: Pediatric Depression will go away on its own.

False: A serious mental illness cannot be willed away or brushed aside with a change in attitude. Ignoring the problem doesn’t give it the slip either. Depression is serious, but treatable illness, with a success rates of upwards of 80% for children who receive intervention.

4. Myth: Talking about depression gives kids ideas and makes things worse.

False. Talking about depression with your child actually helps to reduce symptoms. Support and encouragement through open communication are significantly meaningful. This lets your child know he’s not alone, is loved and cared for.

5. Myth: The risk of suicide for children is greatly exaggerated.

False. Suicide is the 3rd leading cause of death in adolescents ages 15 to 24, and is the 6th leading cause of death in children ages 5 to14. Suicide is significantly linked to depression, so early diagnosis and treatment of Pediatric Depression is extremely important.

6. Myth: There are no proven treatments to treat Pediatric Depression.

False. Volumes of studies show that talk therapy treatments like play therapy, family therapy, and individual therapy offer significant improvements for children who experience depression. Upwards of 80% of children who receive treatment move into remission. The other 20% may require medication to help with their illness – and, though this is often a hot topic for controversy, there are evidenced based studies that support this as a treatment option.

7. Myth: Antidepressants will change a child’s personality.

False. Antidepressants normalize the ranges of moods in children who have a mood disorder – and will not change your child’s personality what-so-ever.

8. Myth: Once a child starts taking antidepressants, he is on it for the rest of his life.

False. The majority of children who take antidepressant medication will stop their prescription in a careful and modified manner when recovery from depression occurs. This clinical state of recovery takes about a year or so to achieve.

9. Myth: When a depressed child refuses help, there’s nothing parents can do.

False. If your child refuses to go to talk therapy or take medication, there are things you can do. You can seek therapy with a trained mental health specialist to learn how to help your child in spite of the fact that he won’t attend sessions. In a crisis situation, you can drive your child to the nearest hospital emergency room, or contact family, friends or the local police for assistance in getting him there.

10. Seriously depressed children CANNOT lead productive lives.

False: Many children with depression can grow up to live full, productive lives. In fact, many high profile people, including President Abraham Lincoln, Writer J.K. Rowlings, Artist Michelangelo, Actor Harrison Ford, Choreographer Alvin Ailey, Actress Courteney Cox, Entrepreneur Richard Branson, Prime Minister Winston Churchill, Rocker Bruce Springsteen and Baseballer Ken Griffey, Jr. have been very successful in their chosen professions – despite struggling with depression in their young lives.

What to Do Next

If you suspect that a child is struggling with depression, immediately contact a physician. Share your concerns and plan for a full medical evaluation to begin this diagnostic process. Once medical tests show no other reason for the fatigue, sadness, aches and pains that often come with depression, a mental health professional will evaluate further for this pediatric mood disorder.

Pediatric Depression is a serious, but treatable disorder. And there is great hope for healing when detected early.

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¹ abcNews, “One in Forty Babies Has Depression.” abcNews, accessed, January 25, 2013, http://abcnews.go.com/Health/OnCall/story?id=2640591&page=1

² American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: 5th Edition. Washington, D.C.: American Psychiatric Association, 2013.

³ Joan Luby et. al. “The Clinical Significant of Preschool Depression: Impairment in Functioning and Clinical Markers of the Disorder. Journal of Affective Disorders 112(2009):111–19.

⁴ Target News Service . “Depression Rates Triple Between the Ages of 12 and 15 Among Adolescent Girls.” Health Reference Center Academic, July 25, 2012.

⁵ Stanley Jackson. Melancholia and Depression: From Hippocratic to Modern Times. New Haven: Yale University Press, 1990.

⁶ Andreas Marnerous & Frederick Goodwin. Bipolar Disorders: Mixed States, Rapid Cycling and Atypical Forms. New York: Cambridge University Press, 2005.

⁷ Jennifer Radden. The Nature of Melancholy: From Aristotle to Kristeva. New York: Oxford University Press, 2002.

⁸ Ian Gotlib & Constance Hammen. Handbook of Depression. New York: Guilford Press, 2009.

⁹ Joan Luby et. al. “Preschool Major Depressive Disorder: Preliminary Validation for Developmentally Modified DSM-IV Criteria.” Journal of the American Academy of Child and Adolescent Psychiatry 41 (2002):928–37.

About the Author: Dr. Deborah Serani is a go-to media psychologist and an award-winning author. She is also an associate professor at Adelphi University where her research interests are in depression and trauma. Her new book Depression and Your Child: A Guide for Parents and Caregivers" is available online and in book stores. Follow on Twitter @DeborahSerani.