Disease: Depression in Children

    Depression in children facts

    • Depression is a condition beyond normal sadness that can significantly interfere with the child's ability to function.
    • Depression affects about 2% of preschool and school-age children.
    • Depression in children does not have one single cause but rather a number of biological, psychological, and environmental risk factors that contribute to its development.
    • General symptoms of depression, regardless of age, include having a depressed or irritable mood for at least two weeks and having at least five clinical signs and symptoms.
    • Suicide is the third leading cause of death in youth 10-24 years of age.
    • In order to diagnose depression, a health-care professional will likely conduct or refer for an extensive medical interview and physical examination and ask standard mental-health questions.
    • Treatment for childhood depression may include addressing any medical conditions that cause or worsen the condition. It can also include lifestyle adjustments, psychotherapy, and, for moderate to severe depression, medication.
    • Interpersonal therapy (ITP) and cognitive behavioral therapy (CBT) are the major approaches commonly used to treat childhood depression.
    • About 60% of children who take antidepressant medications get better. It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better.
    • Childhood depression is a risk factor for developing a number of other mental-health symptoms and disorders.
    • Depression is the leading cause of disability in the United States in people over 5 years of age.
    • Attempts at prevention of childhood depression tend to address risk factors, strengthen protective factors, and use approaches that are appropriate for the child's developmental level.
    • Family members and friends are advised to seek mental-health evaluation and treatment for the depressed child.

    What is childhood depression?

    Clinically significant depression can be broadly understood as depression that is severe enough that it interferes with the person's ability to function in some way. It is quite common in every age group, affecting more than 16% of the populations in the United States at some point in their lifetime. Other statistics about depression include that it tends to occur at a rate of about 2% during childhood prior to the teenage years. This illness is a leading cause of health impairment (morbidity) and death (mortality). About 3,000 youths die by suicide each year in the United States, making it the third leading cause of death in the 10-24 year age group.

    What are the types of depression in children?

    Children may suffer from the episodes of moderate to severe depression of major depressive disorder, or more chronic, mild to moderate depression of dysthymia. Depression may also be part of other mood problems like bipolar disorder, as a consequence of psychosis, as part of a medical condition like hypothyroidism, or the result of exposure to certain medications such as cold medications or drug abuse, like cocaine withdrawal.

    What are causes and risk factors for depression in children?

    Depression in children does not have one single definitive cause. Rather, people with this illness tend to have a number of biological, psychological, and environmental risk factors that contribute to its development. Biologically, depression is associated with a reduced level of the neurotransmitter serotonin in the brain, a decrease in the size of some areas of the brain, as well as increased activity in other areas of the brain. Girls are more likely to be given the diagnosis of depression than boys, but that is thought to be the result of, among other things, a combination of biological differences based on gender, as well as the differences in how girls are encouraged to interpret their environment and respond to it compared to boys. There is thought to be at least a partially genetic contribution to the fact that children and adolescents with a depressed parent are up to four times more likely to develop the illness themselves. Children who develop depression are also more prone to having other biological challenges, such as low birth weight, trouble sleeping, and having a mother younger than 18 years old at the time of their birth.

    Psychological risk factors for depression include low self-esteem, poor body image, a tendency to be highly self-critical, and feeling helpless when dealing with negative events. Children who suffer from conduct disorder, attention deficit hyperactivity disorder (ADHD), clinical anxiety, or who have cognitive or learning problems, as well as trouble relating to others also are at higher risk of developing depression.

    Depression may be a reaction to environmental stresses, including trauma like verbal, physical, or sexual abuse, the death of a loved one, school problems, being the victim of bullying, or peer pressure. Research differs as to whether children that are obese are at higher risk of developing depression.

    The aforementioned environmental risk factors tend to specifically predispose children to depression. Other risk factors tend to predispose people to depression as well as putting them at risk for other problems. Such risk factors to depression include poverty, exposure to violence, being socially isolated, parental conflict, divorce, and other reasons for family dissolution. Children who have low physical activity, poor academic performance, or lose a relationship are at higher risk for depression as well.

    What are the symptoms and warning signs of depression in children?

    Clinical depression, also called major depression, is more than sadness that lasts for a day or two before feeling better. In true depressive illnesses, the symptoms last weeks, months, or sometimes years if no treatment is received. Depression often results in the sufferer being unable to perform daily activities, such as getting out of bed or getting dressed, performing well at school, or playing with peers. General symptoms of major depression, regardless of age, include having a depressed or irritable mood for at least two weeks and have at least five of the following clinical signs and symptoms:

    • Feeling sad or blue and/or irritable
    • Loss of interest or pleasure in usual activities
    • Significant increase or decrease in appetite, with or without significant weight loss, failing to gain weight appropriately or gaining excessive weight
    • Change in sleep pattern: inability to sleep or excessive sleeping
    • Physical agitation or retardation (i.e., restlessness or feeling slowed down)
    • Fatigue or loss of energy
    • Trouble concentrating
    • Feelings of worthlessness or excessive guilt
    • Thoughts of death or suicide

    Children with depression may also experience the classic symptoms but may exhibit other symptoms as well, including

    • poor school performance,
    • persistent boredom,
    • quickness to anger,
    • frequent complaints of physical symptoms, such as headaches and stomachaches,
    • more risk-taking behaviors and/or showing less concern for their own safety.

    Examples of risk-taking behaviors in children include unsafe play, like climbing excessively high or running in the street.

    Parents of children with depression often report noticing the following behavior changes in the child:

    • Crying more often or more easily
    • More irritable mood than usual or compared to others their age and gender
    • Eating habits, sleeping habits, or weight change significantly up or down, or the child fails to gain weight appropriately for their age
    • Unexplained physical complaints (for examples, headaches or abdominal pain)
    • Spending more time alone, away from friends and family
    • Becoming more "clingy" and more dependent on certain relationships. This is less common than social withdrawal.
    • Overly pessimistic or exhibits excessive guilt or feelings of worthlessness
    • Expressing thoughts about hurting him or herself or exhibiting reckless or other harmful behavior
    • Young kids may act younger than their age or than they had previously (regress).

    How is depression in children diagnosed?

    Many providers of health care can help make the diagnosis of clinical depression in children, including licensed mental-health therapists, pediatricians, other primary-care providers, specialists seen for a medical condition, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers. These professionals will likely conduct or refer for an extensive medical interview and physical examination as part of establishing the diagnosis. Depression is also associated with a number of other mental-health problems, like attention deficit hyperactivity disorder (ADHD), Asperger's syndrome and other autism-spectrum disorders, bipolar disorder, posttraumatic stress disorder (PTSD), and other anxiety disorders, so the evaluator will likely screen for signs of manic depression, a history of trauma, and other mental-health symptoms. Childhood depression also may be the result of a number of medical conditions, or it can be a side effect of various medications, or exposure to drugs of abuse. For this reason, routine laboratory tests are often performed during the initial evaluation to rule out other causes of symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed. As part of this examination, the sufferer may be asked a series of questions from a standardized questionnaire or self-test to help assess the risk of depression and suicide.

    What should parents do if they suspect that their child is depressed?

    Family members and friends are advised to seek mental-health evaluation and treatment for the depressed child. Family members may consult with the child's primary-care doctor or seek mental-health services by contacting one of the resources identified below. Once the depressed child is in treatment, family members can help encourage good mental health by gently encouraging him or her to adopt a healthy lifestyle. Examples of that include encouraging the child to maintain a healthy diet, get adequate sleep, regular exercise, remain socially engaged and to participate in appropriate stress-management activities. Family can be helpful to the depressed child by discouraging their loved one from engaging in risky behaviors.

    What is the treatment for depression in children?

    If symptoms indicate that your child is suffering from clinical depression, the health-care professional likely will recommend treatment. Treatment may include addressing any medical conditions that cause or worsen depression. For example, an individual who is found to have low levels of thyroid hormone might receive hormone replacement with levothyroxine (Synthroid). Other components of treatment may be supportive therapy, such as changes in lifestyle and behavior, psychotherapy, complementary therapies, and may include medication for moderate to severe depression. If symptoms are severe enough to warrant treatment with medication, symptoms tend to improve faster and for longer when medication treatment is combined with psychotherapy.

    Most practitioners will continue treatment of major depression for six months to a year in order to prevent a reoccurrence of symptoms. Treatment for children with depression can have a significantly positive effect on the child's functioning with peers, family, and at school. Without treatment, symptoms tend to last much longer and may not improve. In fact, they may get worse. With treatment, the chances of recovery are much more likely.

    Psychotherapy

    Psychotherapy ("talk therapy") is a form of mental-health counseling that involves working with a trained therapist to figure out ways to solve problems and cope with depression. It can be a powerful intervention, even producing positive biochemical changes in the brain. Two major approaches are commonly used to treat childhood depression: interpersonal psychotherapy and cognitive behavioral therapy. In general, these therapies take weeks to months to complete. Each has a goal of alleviating the symptoms. More intensive psychotherapy may be needed for longer when treating very severe depression or for depression with other psychiatric symptoms.

    Interpersonal therapy (IPT): This helps to alleviate depressive symptoms by helping a child who suffers from depression develop more effective skills for coping with their emotions and relationships. IPT employs two strategies to achieve these goals:

    • The first is educating the child and family about the nature of depression. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.
    • The second is defining problems (such as abnormal grief or interpersonal conflicts). After the problems are defined, the therapist is able to help set realistic goals for solving these problems and work with the depressed child and his or her family using various treatment techniques to reach these goals.

    Cognitive behavioral therapy (CBT): This has been found to be effective as part of treatment for childhood depression. This approach helps to alleviate depression and reduce the likelihood it will come back by helping the child change his or her way of thinking about certain issues. In CBT, the therapist uses three techniques to accomplish these goals.

    • Didactic component: This phase helps to set up positive expectations for therapy and promote the child's cooperation with the treatment process.
    • Cognitive component: This helps to identify the thoughts and assumptions that influence the child's behaviors, particularly those that may predispose the sufferer to being depressed.
    • Behavioral component: This employs behavior-modification techniques to teach the child more effective strategies for dealing with problems.
    Medications

    The major type of antidepressant medications prescribed for children is the selective serotonin reuptake inhibitors (SSRIs). SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group of medicines. Examples of these medications are listed here. The generic name is first, with the brand name in parentheses.

    • Fluoxetine (Prozac)
    • Sertraline (Zoloft)
    • Paroxetine (Paxil)
    • Fluvoxamine (Luvox)
    • Citalopram (Celexa)
    • Escitalopram (Lexapro)

    Only Prozac and Lexapro are approved by the Food and Drug Administration (FDA) for the treatment of childhood depression and only in ages 8 years and above. Any other medications used to treat this illness in children, or the use of an antidepressant in younger children, is therefore considered to be being used "off label."

    Although FDA approved for use in teens with schizophrenia rather than for the treatment of depression, atypical neuroleptic medications like aripiprazole (Abilify) and risperidone (Risperdal) are sometimes prescribed in addition to an antidepressant in children who either suffer from severe depression, fail to improve after receiving trials of different antidepressants in addition to, or instead of, an antidepressant in children who suffer from bipolar disorder.

    Non-neuroleptic mood-stabilizer medications are also sometimes used with an antidepressant to treat children with severe unipolar depression who do not improve after receiving trials of different antidepressants. These medications might also be considered in addition to or instead of an antidepressant in children who suffer from bipolar disorder. Examples of nonneuroleptic mood stabilizers that are used for this purpose include divalproex acid (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal). Of the non-neuroleptic mood stabilizers, lamotrigine (Lamictal) seems to be unique in its ability to also treat unipolar depression effectively by itself as well as in addition to an antidepressant. However, it is only used in people 16 years of age or older due to potentially serious side effects.

    Atypical antidepressant medications work differently than the commonly used SSRIs. The following medications might be prescribed when SSRIs have not worked: buproprion (Wellbutrin), venlafaxine (Effexor), duloxetine (Cymbalta), or desvenlafaxine (Pristiq).

    About 60% of children who take antidepressant medication get better and are thought to be highly suggestible to improve (placebo effect). It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better. The prescribing physician will likely assess the depressed child that is receiving the medication soon after it is started to see if the medication is being well tolerated and if symptoms have begun to improve. If not, the doctor may adjust the dose of the medication or prescribe a different one.

    After symptoms begin to improve, the prescribing doctor will likely encourage the family of the depressed child to continue administering the medication for six months to a year since stopping the medication too soon may cause symptoms to return or worsen. Some people need to take the medication for longer periods of time to keep the depression from returning. Stopping abruptly may cause the depression to return or for withdrawal effects to occur, depending on the medication that is being taken.

    The side effects of antidepressant medications vary considerably from drug to drug and from person to person.

    • Common side effects include dry mouth, upset stomach, nausea, tremor, insomnia, blurred vision, constipation, and dizziness.
    • In rare cases, some people of all ages have been thought to have become acutely more depressed once on the medication, even attempting or completing suicide or homicide. Children and teenagers are thought to be particularly vulnerable to this rare possibility. However, when considering this risk, it is important to also consider the risk of the potential serious outcomes that can result from untreated depression.
    Alternative treatments

    Several nonprescription herbal supplements like St. John's wort and dietary supplements like vitamin C are used to treat depression. Little is known about the safety, effectiveness, or appropriate dosage of these remedies, although they are taken by thousands of people around the world.

    • A few of the best-known alternative remedies continue to be studied scientifically to see how well they work, but to date, there is little evidence that herbal remedies effectively treat moderate to severe clinical depression.
    • Medical professionals usually are hesitant to recommend herbs or dietary supplements, particularly in children, because they are not regulated by the U.S. Food and Drug Administration (FDA), as prescription drugs are, to ensure their purity and quality.

    What are complications of depression in children?

    Childhood depression is a risk factor for developing a number of other mental-health symptoms and disorders. Children with depression are also at risk of having poor academic performance and engaging in alcohol and other drug abuse. As adults, people who suffered from depression during childhood and adolescence are at risk for job disruptions, as well as family and other social upheaval during adulthood.

    What is the prognosis of depression in children?

    Depression can be quite chronic, in that 85% of people who have one episode of the illness will have another one within 15 years of the first episode. Children with depression are at higher risk of developing severe mental illness as adults compared to children who do not experience depression. Depression is the leading cause of disability in the United States in people over 5 years of age. Childhood depression is associated with a number of potentially negative outcomes, including the child having problems at school, interpersonally, with drugs, and attempting suicide.

    Can depression in children be prevented?

    Attempts at prevention of childhood depression tend to address both specific and nonspecific risk factors, strengthen protective factors, and use an approach that is appropriate for the teen's developmental level. Such programs often use cognitive behavioral and/or interpersonal approaches, as well as family-based prevention strategies because research shows that these interventions are the most helpful.

    Protective factors for teen depression include having the involvement of supportive adults, strong family and peer relationships, healthy coping skills, and emotional regulation. Children of a depressed parent tend to be more resilient when the child is more able to focus on age-appropriate tasks in their lives and on their relationships, as well as being able to understand their parents' illness. For depressed parents, their children seem to be more protected from developing the illness when the parent is able to demonstrate a commitment to parenting and to relationships.

    What is childhood depression?

    Clinically significant depression can be broadly understood as depression that is severe enough that it interferes with the person's ability to function in some way. It is quite common in every age group, affecting more than 16% of the populations in the United States at some point in their lifetime. Other statistics about depression include that it tends to occur at a rate of about 2% during childhood prior to the teenage years. This illness is a leading cause of health impairment (morbidity) and death (mortality). About 3,000 youths die by suicide each year in the United States, making it the third leading cause of death in the 10-24 year age group.

    What are the types of depression in children?

    Children may suffer from the episodes of moderate to severe depression of major depressive disorder, or more chronic, mild to moderate depression of dysthymia. Depression may also be part of other mood problems like bipolar disorder, as a consequence of psychosis, as part of a medical condition like hypothyroidism, or the result of exposure to certain medications such as cold medications or drug abuse, like cocaine withdrawal.

    What are causes and risk factors for depression in children?

    Depression in children does not have one single definitive cause. Rather, people with this illness tend to have a number of biological, psychological, and environmental risk factors that contribute to its development. Biologically, depression is associated with a reduced level of the neurotransmitter serotonin in the brain, a decrease in the size of some areas of the brain, as well as increased activity in other areas of the brain. Girls are more likely to be given the diagnosis of depression than boys, but that is thought to be the result of, among other things, a combination of biological differences based on gender, as well as the differences in how girls are encouraged to interpret their environment and respond to it compared to boys. There is thought to be at least a partially genetic contribution to the fact that children and adolescents with a depressed parent are up to four times more likely to develop the illness themselves. Children who develop depression are also more prone to having other biological challenges, such as low birth weight, trouble sleeping, and having a mother younger than 18 years old at the time of their birth.

    Psychological risk factors for depression include low self-esteem, poor body image, a tendency to be highly self-critical, and feeling helpless when dealing with negative events. Children who suffer from conduct disorder, attention deficit hyperactivity disorder (ADHD), clinical anxiety, or who have cognitive or learning problems, as well as trouble relating to others also are at higher risk of developing depression.

    Depression may be a reaction to environmental stresses, including trauma like verbal, physical, or sexual abuse, the death of a loved one, school problems, being the victim of bullying, or peer pressure. Research differs as to whether children that are obese are at higher risk of developing depression.

    The aforementioned environmental risk factors tend to specifically predispose children to depression. Other risk factors tend to predispose people to depression as well as putting them at risk for other problems. Such risk factors to depression include poverty, exposure to violence, being socially isolated, parental conflict, divorce, and other reasons for family dissolution. Children who have low physical activity, poor academic performance, or lose a relationship are at higher risk for depression as well.

    What are the symptoms and warning signs of depression in children?

    Clinical depression, also called major depression, is more than sadness that lasts for a day or two before feeling better. In true depressive illnesses, the symptoms last weeks, months, or sometimes years if no treatment is received. Depression often results in the sufferer being unable to perform daily activities, such as getting out of bed or getting dressed, performing well at school, or playing with peers. General symptoms of major depression, regardless of age, include having a depressed or irritable mood for at least two weeks and have at least five of the following clinical signs and symptoms:

    • Feeling sad or blue and/or irritable
    • Loss of interest or pleasure in usual activities
    • Significant increase or decrease in appetite, with or without significant weight loss, failing to gain weight appropriately or gaining excessive weight
    • Change in sleep pattern: inability to sleep or excessive sleeping
    • Physical agitation or retardation (i.e., restlessness or feeling slowed down)
    • Fatigue or loss of energy
    • Trouble concentrating
    • Feelings of worthlessness or excessive guilt
    • Thoughts of death or suicide

    Children with depression may also experience the classic symptoms but may exhibit other symptoms as well, including

    • poor school performance,
    • persistent boredom,
    • quickness to anger,
    • frequent complaints of physical symptoms, such as headaches and stomachaches,
    • more risk-taking behaviors and/or showing less concern for their own safety.

    Examples of risk-taking behaviors in children include unsafe play, like climbing excessively high or running in the street.

    Parents of children with depression often report noticing the following behavior changes in the child:

    • Crying more often or more easily
    • More irritable mood than usual or compared to others their age and gender
    • Eating habits, sleeping habits, or weight change significantly up or down, or the child fails to gain weight appropriately for their age
    • Unexplained physical complaints (for examples, headaches or abdominal pain)
    • Spending more time alone, away from friends and family
    • Becoming more "clingy" and more dependent on certain relationships. This is less common than social withdrawal.
    • Overly pessimistic or exhibits excessive guilt or feelings of worthlessness
    • Expressing thoughts about hurting him or herself or exhibiting reckless or other harmful behavior
    • Young kids may act younger than their age or than they had previously (regress).

    How is depression in children diagnosed?

    Many providers of health care can help make the diagnosis of clinical depression in children, including licensed mental-health therapists, pediatricians, other primary-care providers, specialists seen for a medical condition, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers. These professionals will likely conduct or refer for an extensive medical interview and physical examination as part of establishing the diagnosis. Depression is also associated with a number of other mental-health problems, like attention deficit hyperactivity disorder (ADHD), Asperger's syndrome and other autism-spectrum disorders, bipolar disorder, posttraumatic stress disorder (PTSD), and other anxiety disorders, so the evaluator will likely screen for signs of manic depression, a history of trauma, and other mental-health symptoms. Childhood depression also may be the result of a number of medical conditions, or it can be a side effect of various medications, or exposure to drugs of abuse. For this reason, routine laboratory tests are often performed during the initial evaluation to rule out other causes of symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed. As part of this examination, the sufferer may be asked a series of questions from a standardized questionnaire or self-test to help assess the risk of depression and suicide.

    What should parents do if they suspect that their child is depressed?

    Family members and friends are advised to seek mental-health evaluation and treatment for the depressed child. Family members may consult with the child's primary-care doctor or seek mental-health services by contacting one of the resources identified below. Once the depressed child is in treatment, family members can help encourage good mental health by gently encouraging him or her to adopt a healthy lifestyle. Examples of that include encouraging the child to maintain a healthy diet, get adequate sleep, regular exercise, remain socially engaged and to participate in appropriate stress-management activities. Family can be helpful to the depressed child by discouraging their loved one from engaging in risky behaviors.

    What is the treatment for depression in children?

    If symptoms indicate that your child is suffering from clinical depression, the health-care professional likely will recommend treatment. Treatment may include addressing any medical conditions that cause or worsen depression. For example, an individual who is found to have low levels of thyroid hormone might receive hormone replacement with levothyroxine (Synthroid). Other components of treatment may be supportive therapy, such as changes in lifestyle and behavior, psychotherapy, complementary therapies, and may include medication for moderate to severe depression. If symptoms are severe enough to warrant treatment with medication, symptoms tend to improve faster and for longer when medication treatment is combined with psychotherapy.

    Most practitioners will continue treatment of major depression for six months to a year in order to prevent a reoccurrence of symptoms. Treatment for children with depression can have a significantly positive effect on the child's functioning with peers, family, and at school. Without treatment, symptoms tend to last much longer and may not improve. In fact, they may get worse. With treatment, the chances of recovery are much more likely.

    Psychotherapy

    Psychotherapy ("talk therapy") is a form of mental-health counseling that involves working with a trained therapist to figure out ways to solve problems and cope with depression. It can be a powerful intervention, even producing positive biochemical changes in the brain. Two major approaches are commonly used to treat childhood depression: interpersonal psychotherapy and cognitive behavioral therapy. In general, these therapies take weeks to months to complete. Each has a goal of alleviating the symptoms. More intensive psychotherapy may be needed for longer when treating very severe depression or for depression with other psychiatric symptoms.

    Interpersonal therapy (IPT): This helps to alleviate depressive symptoms by helping a child who suffers from depression develop more effective skills for coping with their emotions and relationships. IPT employs two strategies to achieve these goals:

    • The first is educating the child and family about the nature of depression. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.
    • The second is defining problems (such as abnormal grief or interpersonal conflicts). After the problems are defined, the therapist is able to help set realistic goals for solving these problems and work with the depressed child and his or her family using various treatment techniques to reach these goals.

    Cognitive behavioral therapy (CBT): This has been found to be effective as part of treatment for childhood depression. This approach helps to alleviate depression and reduce the likelihood it will come back by helping the child change his or her way of thinking about certain issues. In CBT, the therapist uses three techniques to accomplish these goals.

    • Didactic component: This phase helps to set up positive expectations for therapy and promote the child's cooperation with the treatment process.
    • Cognitive component: This helps to identify the thoughts and assumptions that influence the child's behaviors, particularly those that may predispose the sufferer to being depressed.
    • Behavioral component: This employs behavior-modification techniques to teach the child more effective strategies for dealing with problems.
    Medications

    The major type of antidepressant medications prescribed for children is the selective serotonin reuptake inhibitors (SSRIs). SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group of medicines. Examples of these medications are listed here. The generic name is first, with the brand name in parentheses.

    • Fluoxetine (Prozac)
    • Sertraline (Zoloft)
    • Paroxetine (Paxil)
    • Fluvoxamine (Luvox)
    • Citalopram (Celexa)
    • Escitalopram (Lexapro)

    Only Prozac and Lexapro are approved by the Food and Drug Administration (FDA) for the treatment of childhood depression and only in ages 8 years and above. Any other medications used to treat this illness in children, or the use of an antidepressant in younger children, is therefore considered to be being used "off label."

    Although FDA approved for use in teens with schizophrenia rather than for the treatment of depression, atypical neuroleptic medications like aripiprazole (Abilify) and risperidone (Risperdal) are sometimes prescribed in addition to an antidepressant in children who either suffer from severe depression, fail to improve after receiving trials of different antidepressants in addition to, or instead of, an antidepressant in children who suffer from bipolar disorder.

    Non-neuroleptic mood-stabilizer medications are also sometimes used with an antidepressant to treat children with severe unipolar depression who do not improve after receiving trials of different antidepressants. These medications might also be considered in addition to or instead of an antidepressant in children who suffer from bipolar disorder. Examples of nonneuroleptic mood stabilizers that are used for this purpose include divalproex acid (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal). Of the non-neuroleptic mood stabilizers, lamotrigine (Lamictal) seems to be unique in its ability to also treat unipolar depression effectively by itself as well as in addition to an antidepressant. However, it is only used in people 16 years of age or older due to potentially serious side effects.

    Atypical antidepressant medications work differently than the commonly used SSRIs. The following medications might be prescribed when SSRIs have not worked: buproprion (Wellbutrin), venlafaxine (Effexor), duloxetine (Cymbalta), or desvenlafaxine (Pristiq).

    About 60% of children who take antidepressant medication get better and are thought to be highly suggestible to improve (placebo effect). It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better. The prescribing physician will likely assess the depressed child that is receiving the medication soon after it is started to see if the medication is being well tolerated and if symptoms have begun to improve. If not, the doctor may adjust the dose of the medication or prescribe a different one.

    After symptoms begin to improve, the prescribing doctor will likely encourage the family of the depressed child to continue administering the medication for six months to a year since stopping the medication too soon may cause symptoms to return or worsen. Some people need to take the medication for longer periods of time to keep the depression from returning. Stopping abruptly may cause the depression to return or for withdrawal effects to occur, depending on the medication that is being taken.

    The side effects of antidepressant medications vary considerably from drug to drug and from person to person.

    • Common side effects include dry mouth, upset stomach, nausea, tremor, insomnia, blurred vision, constipation, and dizziness.
    • In rare cases, some people of all ages have been thought to have become acutely more depressed once on the medication, even attempting or completing suicide or homicide. Children and teenagers are thought to be particularly vulnerable to this rare possibility. However, when considering this risk, it is important to also consider the risk of the potential serious outcomes that can result from untreated depression.
    Alternative treatments

    Several nonprescription herbal supplements like St. John's wort and dietary supplements like vitamin C are used to treat depression. Little is known about the safety, effectiveness, or appropriate dosage of these remedies, although they are taken by thousands of people around the world.

    • A few of the best-known alternative remedies continue to be studied scientifically to see how well they work, but to date, there is little evidence that herbal remedies effectively treat moderate to severe clinical depression.
    • Medical professionals usually are hesitant to recommend herbs or dietary supplements, particularly in children, because they are not regulated by the U.S. Food and Drug Administration (FDA), as prescription drugs are, to ensure their purity and quality.

    What are complications of depression in children?

    Childhood depression is a risk factor for developing a number of other mental-health symptoms and disorders. Children with depression are also at risk of having poor academic performance and engaging in alcohol and other drug abuse. As adults, people who suffered from depression during childhood and adolescence are at risk for job disruptions, as well as family and other social upheaval during adulthood.

    What is the prognosis of depression in children?

    Depression can be quite chronic, in that 85% of people who have one episode of the illness will have another one within 15 years of the first episode. Children with depression are at higher risk of developing severe mental illness as adults compared to children who do not experience depression. Depression is the leading cause of disability in the United States in people over 5 years of age. Childhood depression is associated with a number of potentially negative outcomes, including the child having problems at school, interpersonally, with drugs, and attempting suicide.

    Can depression in children be prevented?

    Attempts at prevention of childhood depression tend to address both specific and nonspecific risk factors, strengthen protective factors, and use an approach that is appropriate for the teen's developmental level. Such programs often use cognitive behavioral and/or interpersonal approaches, as well as family-based prevention strategies because research shows that these interventions are the most helpful.

    Protective factors for teen depression include having the involvement of supportive adults, strong family and peer relationships, healthy coping skills, and emotional regulation. Children of a depressed parent tend to be more resilient when the child is more able to focus on age-appropriate tasks in their lives and on their relationships, as well as being able to understand their parents' illness. For depressed parents, their children seem to be more protected from developing the illness when the parent is able to demonstrate a commitment to parenting and to relationships.

    Source: http://www.rxlist.com

    Many providers of health care can help make the diagnosis of clinical depression in children, including licensed mental-health therapists, pediatricians, other primary-care providers, specialists seen for a medical condition, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers. These professionals will likely conduct or refer for an extensive medical interview and physical examination as part of establishing the diagnosis. Depression is also associated with a number of other mental-health problems, like attention deficit hyperactivity disorder (ADHD), Asperger's syndrome and other autism-spectrum disorders, bipolar disorder, posttraumatic stress disorder (PTSD), and other anxiety disorders, so the evaluator will likely screen for signs of manic depression, a history of trauma, and other mental-health symptoms. Childhood depression also may be the result of a number of medical conditions, or it can be a side effect of various medications, or exposure to drugs of abuse. For this reason, routine laboratory tests are often performed during the initial evaluation to rule out other causes of symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed. As part of this examination, the sufferer may be asked a series of questions from a standardized questionnaire or self-test to help assess the risk of depression and suicide.

    Source: http://www.rxlist.com

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