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Depression in Childhood

Depression is characterized in children by sad or irritable mood or loss of interest or pleasure lasting a week or more. Children may be mopey and sad, and may become more clingy. They may withdraw from playing with other children and from other social activities and complain of feeling unloved. Problems with sleep and appetite may be present and they may have suicidal thinking or behavior.

What should I do if I suspect my child has a Mood Disorder?

A careful evaluation is critical. Untreated depression increases the risk of future episodes and may make future treatment less effective. Depression in childhood is also a risk factor for Bipolar Disorder in Adolescence and Adulthood. (Please see the Bipolar Disorder page). An evaluation is important to determine not only the correct diagnosis but also what contributed to the development of the depression (genetic components, medical illness, family stress, school problems, social problems, etc).

What treatments are available for Depression?

It is important to consider the source of the child's depression. Often the most effective interventions for children address the underlying cause. For example the child with depression caused by school stress from learning disabilities should be provided with appropriate education services and parental guidance as the initial intervention. Children who are depressed in the context of family problems will likely respond to interventions aimed at resolving family conflict.

Cognitive Behavioral Psychotherapy (CBT) has been shown to be an effective treatment for depression in adolescents (as long as there are not other factors such as family conflict). Please see the Psychotherapy link on this site for additional information about CBT.

Medication is rarely the initial intervention required for childhood depression. The limited number of studies of antidepressants, in children, show that they are no more effective than placebo. There is just one study that shows Prozac to help depression in adolescents with depression. However, when other appropriate interventions are not sufficient an anti-depressant may be indicated. Recently there has been concern raised about anti-depressants causing suicidal ideation and behavior in children. This is another good reason to try other interventions first. It is not a good reason, however, to withhold medication from a child who continues to suffer when other appropriate interventions have not worked. Children who have bonified psychotic symptoms (hear voices or see things) when depressed will need medication to address those distressing symptoms (in addition to a careful pediatric evaluation for possible underlying medical problems).

Your child's psychiatrist should set aside ample time to talk with you about the diagnosis and treatment. You should understand the risks presented by the treatments proposed. You should also understand the risks associated with not taking medication for this potentially very disruptive illness. Psychotherapy aimed at helping the child and family to reduce conflict, face the developmental challenges all children face, and to learn about this illness in their life plays an important role in maximizing the child's adaptation and emotional growth.

Warren J. Steinmuller, M.D. 225 E. Kingston Avenue Charlotte, North Carolina 28203 (704) 376-7654 Child, Adolescent, and Adult Psychiatry

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