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Child Depression

Dear Dr. Lanny:
How do you know when your child is depressed—not just with “the blues,” but something that won’t go away and that needs to be treated?

My 11-year-old son has started sleeping a lot. He never seems to talk to his friends anymore.

How is clinical depression treated in children? Do we have to find a child psychiatrist (which I’ve heard are pretty rare in this area)?

© Melanie Jensen | Dreamstime.com

A: Is it a reasonable possibility that your 11-year-old son is depressed? What would a young child have to be depressed about? Unfortunately, this is hardly a perfect world and even young children can feel the stress of poverty, familial health problems, parental strife, cultural bigotry, school isolation and a host of other issues too numerous to list. It seems more remarkable that so many children and adults manage to navigate the stresses of life without becoming clinically depressed.

Before considering your son’s case, let’s define depression. There is not a person alive who does not, as you state, feel the blues from time to time. Clearly this is not depression. While there are many different definitions of depression, the following is that of the American Academy of Child and Adolescent Psychiatry: “When feelings of depression persist and interfere with ability to function.”

Yes, this definition is extremely simple, but it contains two important concepts: persistence, and interference with function. This means you can feel depressed, but if it is brief and doesn’t interfere with daily functioning you are not clinically depressed. Persistence is a vague word, but most commentaries suggest that it means at least two weeks of symptoms.

Your description does suggest this has been going on a while (persistence), and is affecting his daily life (interference with function). The symptoms you describe certainly are consistent with depression.

There are many symptoms that fit with depression, and it is unlikely that any one child will show all, or even most of them. A partial list is as follows:

• Frequent sadness, tearfulness or crying.
• Decreased interest in activities.
• Increased, and often vague, physical complaints.
• Persistent boredom.
• Sleep disturbances—either increased or decreased.
• Hopelessness.
• Social isolation.
• Poor concentration.
• Irritability or anger.
• Decreased school performance.

The cause of the change in your child may be obvious, such as the death of a close relative, severe illness in a friend or moving to a new community. Short-term support, and possibly counseling, may be undertaken with a strong expectation of improvement.

Sometimes, however, there may be no obvious precipitating event and the changes in your child may be more gradual. Changes in adolescents may be difficult to gauge, as normal development makes discussion with parents less frequent. While understanding that individual responsibilities may make family meals difficult, it is easy to see how eating together can give you a clearer look into how your children are doing.

Presuming that your son is depressed there are indeed treatments. A not-infrequent problem is the perceived stigma associated with any type of mental condition. There is no shame in becoming sick from a bacterial infection, but somehow emotional distress is viewed as a character fault. Clearly this is folly. Avoiding therapy because of this perception is not uncommon, and it is a great mistake. Depression can be a life- threatening illness and needs to be addressed. I am not ignoring the facts that treatment may be expensive, or difficult to obtain. As your question noted, child psychiatrists are difficult to find, with or without insurance. This is a national, not a local, problem.

Before seeking mental health therapy, it is appropriate to visit your primary care provider. Physical illnesses can mimic depression and should be considered, prior to assuming your child is depressed.

Treatment is often by counseling. Depression does not necessarily require a psychiatrist. Counseling can be provided by psychologists, behavioral social workers or clergy. Psychiatrists are, however, the only counselors who can prescribe medication. Your pediatrician and counselor may work in conjunction. This partnership can provide the counseling and ability to prescribe that might otherwise require a pediatric psychiatrist.

Working together also allows your pediatrician to continue to be more closely involved in your child’s care.

Medication, if needed, can be extremely helpful, and need not be thought of as lifelong. Anti-depressants are usually taken only once a day, and have few side effects. In recent times there have been reports that anti-depressants increase the chance of suicide. The actual reports state that patients may have increased thoughts of suicide, but actual suicides are not increased. Careful monitoring in the first weeks of a new medication greatly diminishes the risk of a terrible outcome.

News reports of deception or dishonesty, combined with staggering prices for medications, have fueled public skepticism about the pharmaceutical industry, and about organized medicine as well. This seems quite understandable to me. I cannot speak for the drug industry, but I would still argue that your doctor is trying his or her best to sort out the facts from the hype to help you and your child.

Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at editorial@familytimes.biz.

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