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Childhood Depression

What Parents Should Know

Have you noticed your child struggling in social settings? Maybe they are becoming more withdrawn or irritable? They could be sleeping more or losing appetite.

While some of these behaviors are common as children grow, when these behaviors are frequent and persistent it could be a sign of clinical depression.

Grandhi_Preetham_MyChart

Preetham Grandhi, MD

Psychiatrist

At Lakeland Regional Health, we believe in treating each individual both physically and mentally. Our providers are dedicated to breaking the stigma around mental wellness and offer expert care for all ages and stages of life. We know depression, especially in children, is a difficult subject. That’s why we sat down with Child and Adolescent Psychiatrist, Dr. Preetham Grandhi, to learn about the symptoms, diagnosis, and treatments for childhood depression.

“I have treated children in many different psychiatric settings including inpatient hospital, intensive day treatment programs, school-based day treatment programs, and the outpatient setting to ensure the best outcomes”.

How do you diagnose childhood depression?

The diagnosis and treatment of childhood depression begins with a thorough evaluation with someone who specializes in childhood mental health problems.

Experts that provide such evaluations include psychiatrists, psychologists and other professionals like social workers. Often, depression can be caught early when screened during well health checkups at primary care providers such as pediatrics and family medicine practitioners.

How common is depression?

At any given time, nearly 3% of the youth worldwide are reported to have a depressive disorder. An estimated lifetime prevalence of major depressive disorder in the United States is around 11%. The rates of depression in younger children is lower than that of adolescents. Nearly 30% of youth report some form of suicidality in the previous year and more than 10% report having a suicide attempt. Only 35% of children received treatment from the mental health sector.

Can you describe common signs of depression in children and adolescents?

We have to remember that children are people too, and like adults can be affected by depression. Depression can manifest along a spectrum of symptoms ranging from subsyndromal to very severe. There is some difference in symptoms between younger children and those of older tweens and teenagers. For example, in preschool children absence of joyful play observed by caregivers may be a prominent sign. In school-aged children and adolescents’ irritability, temper tantrums, low frustration tolerance and other somatic symptoms may be predominant. They may also commonly present with a sad mood, suicidality and neurovegetative symptoms such as anhedonia and poor motivation.

Common symptoms of depression in children and adolescents include:

  • Feeling or appearing depressed, sad, tearful, or irritable and grumpy.
  • Not enjoying things as much as they used to and losing interest quickly.
  • Spending less time with friends, family or in after school activities.
  • Changes in appetite with weight gain or loss.
  • Feeling like everything is their fault or they are not good at anything, often extremely sensitive to perceived criticism.
  • Having more trouble concentrating which can look like ADHD.
  • Caring less about school or not doing as well in school or school avoidance.
  • Having thoughts of suicide or wanting to die, self-injury and abuse, suicide intents and plans.
  • Sleeping more or less than usual and disrupted sleep patterns.
  • Feeling tired, having less energy and feeling unmotivated.

What “types” of depression can exist in children?

 There are many mood disorders that depressive symptoms can be a part of. These include disorders such as:

  • Major depressive disorder
  • Persistent depressive disorder
  • Substance or medication induced depressive disorders
  • Depression secondary to other medical conditions
  • Bipolar disorder

Often there is a high possibility of having other comorbid disorders like anxiety disorders, ADHD, oppositional defiant disorder and other behavioral disorders along with depression. Clinical depression will have to be distinguished from everyday sadness and irritability which is a universal human experience that can be a normal part of life. The common features of depressive disorders are having a sad or irritable mood accompanied by somatic, cognitive and behavioral changes that significantly affect the child’s capacity to cope or function.

Can physical conditions exist alongside depression?

Sometimes, there are medical conditions which are associated with depression. These include conditions such as:

  • Hypothyroidism
  • Anemia
  • Autoimmune diseases
  • Chronic fatigue syndrome
  • Migraines
  • Epilepsy
  • Asthma
  • Inflammatory bowel diseases like Crohn’s disease
  • Cancers

Sometimes medications used to treat medical and psychiatric disorders can cause depressive symptoms as unintended effects such as chemotherapy medicines, ADHD medications like dextroamphetamine and methylphenidate, corticosteroids like prednisone and immunosuppressants like methotrexate.

 

How can depression affect children during their daily life in school, social settings, and at home?

School-Depression can interfere in many areas of a child’s life. In school, depression can cause isolation from peers and friends thereby leading to interpersonal issues and fights. This can lead to being bullied or becoming the bully. There is often a lowering of self-esteem, belief in oneself and one’s capacity thus leading to poor academic performance and grades. A loss of motivation can lead to the inability to complete homework and other tasks causing further frustration and disappointment in having to go to school. This can lead to school refusal, truancy and other oppositional behaviors in order to avoid going to school. Teachers may not realize that bad attitudes in class might be stemming from anger and depression.

Home– Depression can cause poor family dynamics and increased stressors between parents and children. This can lead to high emotional states at home with constant arguing and fighting both verbally and sometimes physically. This can break relationships between siblings and other family members causing even further isolation of the child and distancing from others. Often, child development is affected thereby causing regression in behaviors, attitudes and lowering the ability to complete age-appropriate expectations. Many times, the mental health of the child affects the mental health of the whole household.

Social settings- This behavior can lead to being with the wrong peer group, experimentation with different drugs and alcohol as a coping method to deal with stress, and mood issues and conflict. Substance use then worsens preexisting mood and anxiety disorders and sometimes can lead to the emergence of bigger problems such as psychosis and trouble with the law. Children can become impulsively desperate in their actions from suicidal thoughts stemming from a vicious cycle of depression, fear, anger, self-blame and real or perceived blame from others leading to suicide plans and suicide attempts.

What are common treatment options for children experiencing depression?

Psychological Therapy- “Therapy, therapy, therapy’” should always be the first intervention. A change in functioning mindset is required to reverse the course and effects of depression. There are various forms of psychological therapy that can be used effectively to treat depression and children as a first line of treatment.

Cognitive Behavioral Therapy-Also known as CBT, a type of therapy that helps children identify and change negative thought patterns that may be contributing to depression. CBT also teaches children coping strategies for managing their symptoms.

Play Therapy- A form of therapy that uses play to help children express their feelings and work through difficult experiences. This type of therapy can be particularly effective for younger children who may have difficulties expressing themselves verbally.

Interpersonal Therapy– Also known as IPT, focuses on improving a child’s relationship with others as a way of improving her overall mental health. This therapy is particularly helpful for children who may be experiencing depression as a result of conflicts or problems in their relationships.

Family therapy-Involves working with the child’s family to improve communication and relationships within the family unit. This type of therapy can be particularly effective for children whose depression may be related to family issues or conflicts.

Medications-Can be prescribed to help manage a child’s depression. This form of treatment will need to be done in conjunction with a child and adolescent psychiatrist after a full assessment has been done. Neuropsychological testing for diagnostic clarification can sometimes help assist in understanding the various comorbid issues that occur along with depression. The first step to considering medications is usually having a discussion with the professional in order to understand the reasoning as to why and how medications can help with childhood depression. For example, a child who is depressed may no longer be able to do what is in their best interest for themselves if their thoughts and actions are clouded by sad feelings stemming from the emotional division of the mind.

Combination treatment-This typically involves using medication and psychotherapy together which is often the most effective in terms of response and long-term relapse prevention. It is always best to take medications as prescribed and not to miss any doses given that symptoms can always reemerge, and medications can sometimes become less effective if not taken properly.

Alternative therapies- Sometimes other types of therapy like art therapy, music therapy, pet therapy can be beneficial for certain types of children and are more available in some residential and inpatient psychiatric programs.

 

In summary, if you think that you have a child that might be suffering from depression, please do not hesitate to make your first step by contacting an expert to help evaluate, guide and treat your child. It is important to understand that a child with a well-balanced calm mindset can lead a peaceful, productive and happy life.

harrell family center for behavioral wellness

Harrell Family Center for Behavioral Wellness

A place of hope, connection, recovery, and support-close to home. At Lakeland Regional Health, we know that not every need a person has is physical, and we understand the powerful connection of mind and body. If you are facing mental health challenges, we are here to care for you. Our incredible behavioral wellness team at Lakeland Regional Health will partner with you through each step.

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If you or a loved one are experiencing a mental health crisis, there are resources to help.

 In the event of a life-threatening emergency, always call 911.

To reach National Suicide Prevention Lifeline call 1-800-273-8255.

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