Depression
Depression is a feeling of intense sadness; it may follow a recent loss or other sad event but is out of proportion to that event and persists beyond an appropriate length of time (see Section 7, Chapter 101).
Sadness and unhappiness are common human emotions, particularly in response to troubling situations. For children, such situations may include the death of a parent, divorce, a friend moving away, difficulty in adjusting to school, and difficulty making friends. Sometimes, however, feelings of sadness are out of proportion to the event or persist far longer than might be expected. In this case, particularly when the negative feelings cause difficulties in day-to-day functioning, the child may have depression. Like adults, some children become depressed even without unhappy life events. This is more common if there is a family history of mood disorders.
Depression occurs in 1 to 2% of children and as many as 8% of adolescents. Doctors do not know exactly what causes depression, but chemical abnormalities in the brain are probably involved. Some tendency to depression is inherited. A combination of factors, both life experience and genetic vulnerability, appear to contribute. Sometimes, a medical disorder, such as an underactive thyroid, is the cause.
Symptoms and Diagnosis
The symptoms of depression in children relate to feelings of overwhelming sadness, worthlessness, and guilt. The child loses interest in activities that normally give him pleasure, such as playing sports, watching television, playing video games, or playing with friends. Appetite may be increased or decreased, often leading to significant weight changes. Sleep is usually disturbed, with either insomnia or excessive sleeping. Depressed children often are not energetic or physically active. However, particularly in younger children, depression is sometimes masked by seemingly contradictory symptoms, such as overactivity and aggressive, antisocial behavior. Symptoms typically interfere with the child's ability to think and concentrate, and schoolwork usually suffers. Suicidal thoughts, fantasies, and attempts are common. The doctor must always assess the risk of suicide in depressed children.
To diagnose depression, a doctor relies on several sources of information, including an interview with the child or adolescent and information from parents and teachers. Sometimes, structured questionnaires (see Section 7, Chapter 101) help distinguish depression from a normal reaction to an unfortunate situation. A doctor tries to find out whether family or social stresses may have precipitated the depression and also determines whether a physical disorder, such as an underactive thyroid, is the cause.
Treatment
As with adults, there is a wide range of severity of depression, and the intensity of treatment depends on the severity of the symptoms.
Antidepressant drugs correct chemical imbalances in the brain. Serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and paroxetine (see Section 7, Chapter 101), are the drugs most commonly prescribed to depressed children and adolescents. The tricyclic antidepressants, such as imipramine, are much less effective in children than adults and have more side effects, and so are rarely used in children.
Treatment of depression requires more than drug therapy. Individual psychotherapy, group therapy, and family therapy may all be beneficial. Suicidal children must be hospitalized, usually briefly until they are no longer at risk to themselves.
 See the sidebar Symptoms of Depression in Children.
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