Although it is often hard to believe, children experience depression. Many parents are concerned about signs of depression in their child, or worried that depression might develop since it is present in other family members.  We will address this complicated and controversial topic, and hopefully will be helpful to parents with concerns about this issue.

What causes depression?: The current understanding is that many - and perhaps most - people with depression have some degree of genetic predisposition. Genetic predisposition can be so powerful that some individuals are probably destined to develop depression. However, many children (and adults) who develop depression have a genetic heritage that provides the potential - but not the necessity - for depression.

An individual's psychology plays a critical role in the development of depression and may be the most important factor in many situations. Professionals disagree about the relative importance of nature (genetics) and nurture (psychology) in the development of depression. Lucy Daniels Center clinicians are among those who emphasize the role of an individual's psychology in most situations. Although there is a greater-than-average chance that children with other close family members who suffer from depression have some genetic potential for depression themselves, in our opinion, their life experiences, the way that they understand their life, and the coping skills they develop to deal with painful emotions are likely to be the most important factors that determine whether they ultimately cope with depression.

Signs of childhood depression: Children tend to show depression in different ways at different ages. To understand why, parents should keep three issues in mind. First, depression is extremely painful, often associated with other painful states such as loneliness and anxiety. Second, children, like adults, will protect themselves using unconscious, self-protective processes called defense mechanisms. Third, defense mechanisms can be either internalizing or externalizing.

The younger the child, the more likely he or she is to rely on externalizing defenses, locating the source of distress outside the child. These patterns of self-protection are more often associated with action and acting out. The child may tend to blame others for problems, becoming excessively stubborn, overactive and impulsive, or even bullying. These attempts to protect against pain are sometimes misunderstood as behavior problems or ADHD.

However, some children respond to depressive feelings with internalizing defenses, handling these feelings and thoughts inside. They seem depressed in ways that are more familiar to adults. Their view of themselves, rather than of other people, is more likely to be affected. Internalizing children may make many negative statements about themselves and events, have low self-confidence and lack initiative. They may have periods of low mood or diminished energy, cry easily and have bursts of excessive anger. Other internalizing defenses include distractibility or inattentiveness.

Some children may make vague suicidal references, for example saying, "I wish I was dead" or "Everyone would be better off without me." Sometimes children say these things when angry, but depressed children will say such statements when they are more reflective. Children rarely act on these thoughts until early adolescence, although they may act on them "unconsciously" though negligent behaviors that put them at physical risk.

Adolescents often show their depression in ways similar to adults, particularly with low mood, self-critical thoughts, loss of energy and even appetite, and loss of interest in the world. Suicidal impulses can be strong and particularly worrisome in view of characteristic adolescent impulsivity.

Adolescents often deal with their depression with internalizing defenses that manifest as symptoms, some of which can be alarming. These include eating disorders and self-mutilation. By no means do all adolescents respond to depressive feelings with internalizing defenses; many use externalizing mechanisms that involve extreme acting out, such as promiscuity, drug use or participation in marginal groups.

Treatment options: Children should receive carefully tailored and individualized assistance for depression. Lucy Daniels Center clinicians believe that appropriate care usually includes parent counseling, a well-chosen psychotherapy for the child and assistance to others who have key roles in the child's life, such as teachers.

The professional community does not agree on whether children should be treated with antidepressant medication. It is clear that antidepressant medications help adolescents more than younger children. It also is evident that medication helps for certain types of severe types of depression in children prior to adolescence. However, there is abundant data indicating that antidepressant medication is no better than placebo in most cases of childhood depression before adolescence.

Given the limited efficacy (if any) of antidepressant medications for treatment in children prior to adolescence, and considering that these medications have side effects, Lucy Daniels clinicians generally do not prescribe antidepressant medications for children who have not yet reached adolescence. However, the issue remains controversial, and there are many mental health professionals who believe that antidepressants have more of a place in the treatment of childhood depression.

The big picture: Depression is a highly individualized condition that develops for different reasons and is manifested in different ways by each child. It can show itself in many ways, sometimes exhibiting its true colors, but often appearing in another guise. Children who may be experiencing depression need proper assessment and assistance. With dedication from parents, the child and those professionals who are helping, depression should be a treatable condition that needn't limit a child's potential for a fulfilling life.

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