How to tell if your child is actually depressed and not

Dear New Shrink,

After reading your article about depression in men, I couldn't help but wonder if my son could be depressed. He is only 7, but he is irritable and has a lot of stomach aches. I know children are moody and unmanageable but can they actually get depressed?

Signed,
Curious Mom

 
Dear Curious Mom,

Absolutely your son could be depressed. We love kids for their openness and honesty, it is refreshing. But while they have a sense of what is going on around them and have reactions to experiences, they do not always know what they know and they generally do not know how to communicate what they are feeling.

Stomach aches, crying, temper tantrums, and irritability are definitely signs that something is wrong and if it persists, it is something that parents should pay attention to. Because young children have not yet learned to articulate their feelings, they tend to have symptoms of anxiety such as phobias or separation anxiety, somatic complaints, auditory hallucinations and increased irritability. Instead of verbalizing their feelings, children often express their frustration and irritability through temper tantrums and behavioral problems. Unfortunately, this is often mistakenly referred to as a brat, or the difficult child, without any recognition of the very real possibility of an underlying depression.

While there are definitely spoiled children who will manipulate us with their tantrums, often these are a sign that something might be seriously wrong. This is especially true if it seems to come on for no apparent reason (from your perspective) or is a departure from normal behavior and the personality of your child.

In young children, girls and boys experience depression equally, a ratio of 1:1 but as a child ages into adolescence, the ratio changes to 1:2, it is twice as likely in girls. But it is often more deadly in boys or men. This is precisely due to the fact that they do not express their feelings. Suicide starts to become a real threat in the adolescent population but while girls may attempt it more, males are more likely to succeed at it.

In adolescents, the symptom picture begins to change slightly. Because of their new found cognitive abilities, teenagers are often more aware of the difference between what could be and what is; they tend to have more hopelessness, guilt for new and emerging feelings and/or behaviors, and problems with low self-esteem. Adolescents tend to experience more sleep and appetite disturbances than younger children and they tend to have more difficulty functioning. But much like children, they externalize their depression in the form of behavioral problems.

Beyond suicide risk, engaging in drug abuse is a major risk for teenagers with depression. Research has clearly shown that drug or alcohol use during the teen years leads to a life-long struggle with it.

The emotional signs of depression can include sadness, low self-esteem, self critical thoughts, inability to experience pleasure, losing interest in things, loss of ambition, inability to concentrate or make a decision, irritability, anxiety, anger, pessimism and hopelessness, excessive guilt, feeling helpless and having fantasies of death or suicide. Just one of these may indicate depression in a child or adolescent.

The good news is that there are a number of things that can be done and the earlier you catch something and take care of it, the better the outcome. Try talking with them to see if they know something is bothering them. Take them to a physician for a complete exam and evaluation for the possibility of depression.

Certain types of psychotherapy have been shown to be quite effective with children and adolescents as well as adults. Prozac is a medication that is FDA approved for the treatment of childhood depression but while effective, it must be closely monitored. There is definitely help but you must start with the recognition that your child may not just be a brat who is trying to manipulate you. Your child may be depressed.

We never know for sure what may have happened to our children. Various forms of abuse are often hidden for years because of shame or embarrassment. Or a child might be predisposed to depression due to a family history; even if a child is reacting to problems in your own home or family, don't let guilt stop you from getting help.

Whatever the case, yes children do get depression, just like adult men and women do. It just looks a little different.

Dr. Barge
**Originally published in the Santa Monica Daily Press SMDP Dr. Barge