People of all ages can develop depression or other mood disorders, and that includes children and adolescents.
According to statistics from the National Institutes of Health and the Centers for Disease Control and Prevention, 3.7 percent of children ages 8 to 15 have a mood disorder. When the ages are skewed higher, 14 percent of 13- to 18-year-olds develop a mood disorder, and 4.7 percent have a "severe" disorder. Girls have a higher risk than boys at all ages, and risk increases as age increases for both sexes.
Yet, the prevalence may be even higher than previously thought. A recent study in the journal Translational Psychiatry examined data from six consecutive years of a national survey of U.S. adolescents ages 12 to 17; it found that the cumulative incidence of depression among girls is a stunning 36.1 percent. (Boys were at 14 percent.)
Another study published in Pediatrics has attributed this recent spike in depression in female adolescents and young adults to the rise of social media. "Adolescent girls may have been exposed to a greater degree to depression risk factors in recent years. For example, cyberbullying may have increased more dramatically among girls than boys. As compared with adolescent boys, adolescent girls also now use mobile phones with texting applications more frequently and intensively and problematic mobile phone use among young people has been linked to depressed mood," the authors wrote.
But diagnosing these disorders is more challenging in children. "Accurately recognizing a mood disorder in a child can be quite difficult," says Dr. Robert Findling, director of child and adolescent psychiatry at the Johns Hopkins School of Medicine. For one thing, the moods that are most frequently noted in children with mood disorder are sadness, irritability or even extreme happiness, which are, of course, normal; it's the degree of those moods that counts. Second, external circumstances and life events can impact a child's mood, and "delineating what is expected and what is outside of usual, based on a child's life circumstances, can be challenging," he says. And other factors can lead to changes in a child's mood, such as medications, drug abuse and medical conditions.
Given the high rates of mood disorders in children, he stresses the need for vigilance on the part of parents and health care providers. "There is evidence to suggest that mood disorders are leading causes of childhood disability, more than many general medical conditions," Findling says. "Since there are evidence-based interventions for children with mood disorders, it is important that these vulnerable youths are accurately diagnosed and treated."
Symptoms in Children
For a mood disorder to be diagnosed, the child will be experiencing a sustained and pronounced mood that cannot be adequately explained by other factors and is causing negative impacts on behavior and daily life, Findling says.
Children experience many of the same symptoms of depression or other mood disorders as adults, including persistent feelings of sadness or hopelessness, low self-esteem, sleep or appetite changes, low energy and difficulty concentrating. But they also may exhibit different clues that something is wrong. According to Stanford Children's Health, these symptoms may include:
-- Frequent physical complaints, such as headache, stomachache or fatigue.
-- Running away or threats of running away.
-- Hypersensitivity to failure or rejection.
-- Irritability, hostility or aggression.
-- Difficulty in school.
-- Constant anger.
-- Rebellious behaviors.
-- Trouble with family, friends and peers.
"Irritability is the predominant symptom in children," says Dr. Janet Wozniak, director of the Pediatric Bipolar Disorder Clinical and Research Program at Massachusetts General Hospital and an assistant professor of psychiatry at Harvard Medical School. "Another is having behavioral or physical symptoms. There is a tremendous overlap between depression and gastrointestinal issues."
In adolescence, the child may suddenly change behaviors or routines, says Dr. Kimberly Gordon, medical director of the Berkeley and Eleanor Mann Residential Treatment Center and School of the Sheppard Pratt Health System in Baltimore, and a member of the American Psychiatric Association's Council on Children, Adolescents and Families. "For example, they are not interested in sports or school anymore, or are associating with a different peer group or showing signs of substance abuse," she says.
Or they may simply become quieter or surlier and demand more privacy and independence. That's typical of almost all teens, of course, and usually not a sign of depression -- but it can be. "Mild and moderate depression in adolescents often goes undetected and untreated because people attribute their moodiness as appropriate to adolescence," Wozniak says. "Any time you are dealing with children and adolescents, the symptoms need to be seen in a developmental perspective. Symptoms that might be depression should be evaluated developmentally for an accurate diagnosis."
Where to Get Help
If you suspect your child may be depressed, the first step is to meet with his or her school counselor or pediatrician, Gordon says. "There are not enough child psychiatrists in the world, unfortunately, so we rely heavily on parents to use school counselors and pediatricians, who triage what kids need more extensive treatment."
For children ages 6 to 10, the typical treatment for mild depression is a form a psychotherapy like cognitive behavioral therapy, she says. Younger children can be prescribed antidepressant medication, but usually therapy is the first line of defense. For adolescents, medications are more commonly used, along with therapy, but these medications may have different and dangerous effects on teens, so they should be prescribed and monitored only by a physician trained to treat childhood mental illness.
Gordon also offers counsel to parents of depressed children. "I remind parents that there could be no identifiable cause," she says. Or it could be triggered by outside stressors like divorce, grieving or bullying. One of the best ways to prevent depression in children is to maintain strong social bonds. "Connect kids to family, social groups, sports," she says. "Parental warmth is really important. Kids have stressors, and parents who are warm and praise their kids make them more resilient."
David Levine is a freelance health reporter at U.S. News. He is a contributing writer for athenaInsight.com and Wainscot Health Media, a former health care columnist for Governing magazine and a regular contributor to many other health and wellness publications. He also writes about lifestyle and general interest topics, from history and business to beer and baseball, as a contributing writer for Westchester, Hudson Valley and 914INC magazines. His work has appeared in The New York Times, Sports Illustrated, American Heritage and dozens of other national publications, and he is the author or co-author of six books on sports. You can connect him on LinkedIn.