Depression among children is a serious problem. One out of every 20 adolescents suffers from clinical depresion. When depression begins during the teenage years, the risks are significant, interrupting both learning and the development of those parts of the brain where decisions are made.
Among depressed teens, suicide is a significant risk. Suicide is responsible for more than 10 percent of the deaths in the 15-to-19 age group.
There are many reasons for depression. Suffering loss such as the death of a parent or a friend, or experiencing extreme trauma can trigger depression, of course. Other well-known links to childhood depression include physical and sexual abuse, neglect, inappropriate criticism, conflict in the family, divorce, addiction in the family, violence in the family, racism, and poverty. Some depression may be genetic at core and be caused by a chemical imbalance in the brain. But even then, the genetic predisposition must be triggered by a trauma or stressful event of some sort.
The most troubling aspect of depression in children is that it often goes undiagnosed. Parents must be on the lookout for signs of depresion. Sometimes the signs are obvious. The child always seems sad, lacks energy, and has no interest in activities he or she once considered fun. Other signs may include a sudden change in sleeping or eating habits--either sleeping too much or too little, or eating too much or too little. The child may also display increased irritability, anger, or hostility. He or she may not want to go to school, may have falling grades, may have difficulty getting along with others, or may exhibit low self-esteem.
Depression is a persistent condition; it's more than just having the "blues" now and then. But if you feel that your child is truly depressed, don't brush it off, thinking that it will go away by itself. Deal with it immediately.
The most important thing parents must do with a depressed child is to break the barrier of communication. Begin by telling your child that you care about how he or she feels. I realize that telling a child how you feel about him or her can be very difficult. But to me, the words "I love you" are absolutely fundamental in establishing a good relationship with your child. It's incredibly important for parents to let their children know how they feel, to use the words, "I love you; I want you to feel better."
Be sure your child knows that you are concerned. If I, as a doctor, attempt to treat depression by saying, "Take this pill and go home," I won't have accomplished anything. It's like treating a fever with Tylenol; the fever will go down but if I haven't found out what caused the fever, I haven't rendered a cure. It's the same with depression. You need to know where it's coming from to be able to treat it.
Try to find out why it is that your child feels unenergetic, why he or she is moping around all day; but don't make the mistake of asking straight out, "Why are you sad all the time?" If you do, you won't get a coherent answer. It's better to deal with the half-full part of the glass rather than the half-empty part. In other words, ask your child what he or she is into lately, what gets the mojo working. You must express interest in what he or she is doing. And you have to learn to read between the lines of any response you get.
Kids are sometimes more sensitive to their parents feelings than we think. They can sense when their parents are worried, when their parents are not getting along, when their parents are having trouble at work, and even when the parents themselves are depressed. So it is fundamental for parents to be open about their own feelings as well.
Emotions are the beauty of our soul, and if we don't share them, if we don't teach our children how to share them, then once again we fall into that trap of not leading by example. You cannot expect a child to talk to you about his or her feelings when you don't express your own feelings. It's okay to tell a child, "Look, I've got problems, but don't worry. I'm strong. I know that life is not perfect, and I'll get through it."
Once you share your feelings, maybe your child will begin sharing his or her feelings with you. At that point, one of the first messages you should get across to the depressed child is that if he or she shares whatever it is that is causing the sadness, you can help him or her get through it. That will give the child hope.
In more severe cases, when you feel that professional help is needed, be sure to involve the child in this decision. Don't suddenly take your child to your primary care doctor, the pediatrician, or a mental health specialist. That action will simply label your child as "the problem," and nothing positive will be gained.
There is no quick fix to depression. Your child must be involved in any solution that's needed to resolve the depression. If you feel a doctor is needed, before you make that appointment, explain to your child that the doctor, psychologist, or mental health worker is a fundamental part of the healing process. You might share your own personal experience, how such people have helped you, or cite any example you know of that might be of help in getting the child to understand how doctors are there to help us, whatever our problems may be.
The first step in the treatment of depression must address any environmental or family problems. If the child is being sexually abused, for instance, obviously the child cannot continue to have contact with the abuser. Any poor relationship with parents, siblings, teachers, and friends must be repaired, as a supportive social network prevents the isolation and loneliness that often leads to or exacerbates depression. If there are adults in the family who are depressed, their depression must also be addressed and treated. In fact, a new study has found that treating a other's depresion can help prevent depression and anxiety disorders in her children.
There are many ways other than medication to treat depression. Exercise and daily walks have both proven to be excelent therapy for children as well as adults. Meditation, prayer, relaxation, and yoga are also very effective. Two big-ticket items in the arsenal of simple treatments for depression are nature and pets. Studies have found that the more time you spend outdoors with nature, the less depressed you tend to be. Also true is that families with pets are families with a lower incidence of childhood depression.
Food can also play an important role in improving moods and fighting depression. The foods you eat should provide a continuous supply of the nutrients you need to keep your brain chemically balanced. Deficiencies of vitamin B-12, vitamin B-6, vitamin C and folic acid have all been linked with depression. Research has also confirmed the antidepressant-like effects of omega-3 fatty acids, which are found in cold-water fish like sardines, tuna and Atlantic salmon, and some plant sources such as canola oil and walnuts.
Apparently uridine, a compound found in sugar beets and molasses, has similar antidepressant effects. On the other hand, you want to avoid simple carbohydrates such as candy and sugar; these foods can cause quick highs and lows that may actually contribute to depression.
Depression can also be controlled with medication. But this is a difficult issue: should children and adolescents be given antidepressants? The problem is that the information available for treating depressed children with antidepressants can be both confusing and frightening. Studies indicate that antidepressants are not always effective in improving depression in children and adolescents. Debate also continues on the optimal length of treatment. And some studies have shown that the use of antidepressants may increase the risk of suicidal thoughts and behaviors.
But when psychotherapy doesn't help, or when children are having serious depression-related difficulties functioning at home and school, antidepressants may be the only alternative. The bottom line is that antidepressants are potent drugs that should be avoided unless absolutely necessary, and then should be used only under the supervision of a well-trained child psychiatrist.
Once a child or adolescent starts on an antidepressant, the FDA recommends the following frequency of doctor visits:
--Once a week for four weeks
--Every two weeks for the next month
--At the end of the twelth week taking the drug
--More often if problems or questions arise.
Depressingly Wrong
MYTH: It's normal for teenagers to be moody. It eventually just goes away.
FACT: Depression is more than just being moody. It can affect people at any age.
MYTH: A kid who really needs help will ask for it.
FACT: Depresion interferes with a person's ability or desire to get help. IF a friend is depressed, tell an adult. That's not betraying a trust; in fact, you might be saving a life.
MYTH: A person who talks about suicide doesn't do it.
FACT: Suicidal thoughts, remarks or attempts are always serious. Get help for someone talking about suicide immediately.
MYTH: Talking about depression only makes it worse.
FACT: Talking about your feelings is the first step toward beating depression. A depressed person needs someone to talk to for support and encouragement.
MYTH: Few teenagers actually commit suicide.
FACT: About 2,000 teens kill themselves every year in the United States. It is the leading cause of death among teenagers. Five of every 25 teenagers have seriously considered suicide, and two of those are likely to have tried to kill themselves in the past year.
We must remember that depression itself can be a dangerous disease and that antidepressants, if you used properly, can save lives.
Click here to check out Dr. Manny's book The Check List (Harper Collins, 2007).
Dr. Manny Alvarez is the managing editor of health news at FOXNews.com, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.
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