Depression is dangerous. It distorts normal perceptions, causes behavior changes and can result in self-mutilation or suicide. It is not uncommon in children, but, for many reasons, it often escapes diagnosis. Depression was not even recognized as a childhood disease by the psychiatric profession until 1980. Before that time, it was commonly believed that children could not suffer from depression. What, after all, could a child in a healthy family and community environment be depressed about?
DSM-IV, the “Bible” of the psychiatric profession, which identifies symptoms of mental illnesses, recognizes that children can be depressed. Nevertheless, depression is frequently overlooked as a diagnosis by the health care profession. Among possible reasons are these:
-- The historic denial that depression exists in children. Twenty years is not a long time. Many medical practitioners, especially those who do not specialize in mental health treatment, may not have been trained to recognize depression in children, or are prone to recognize other possibilities first when presented with a depressed child.
-- A reluctance to diagnose mental illness in children because mental illness still is a badge of shame in many areas of the country. Parents may exert subtle and not-so-subtle pressures on a physician to find another cause of a child’s behavior, or the physician may simply be reluctant to “badge” the child.
-- Depression’s symptoms share some of the symptoms of attention deficit disorder. ADD and ADHD might mask the more dangerous illness.
-- Depressed behavior may be mistaken for normal developmental problems. Childhood development is complex. Children develop and change their personalities. The beginning of adolescence causes changes that may be normal, but difficult for parents to cope with. It may be difficult even for professionals to identify when the line is crossed from normal development, or problems arising from growth, and depression.
-- Health care economics cuts against a diagnosis of chronic depression because treatment can be expensive (drugs and counseling) and long-term. Lack of health insurance or very limited mental health coverage (often covering only acute episodes requiring hospitalization) are practical (if dangerous) reasons for diagnosing more treatable illnesses, such as ADHD, before seriously assessing the possibility of chronic depression. Insurance limits on fees also encourage mental health care professionals to increase their patient loads, thus diminishing the time and attention provided any one patient. This is especially troublesome in the case of children, who often are unable or unwilling to give voice to their own mental problems and, therefore, require even more extensive observation and counsel than adults.
-- Competition between psychologists and psychiatrists may sometimes influence prescribed treatment, which usually should include both medication and counseling. Some psychologists are reluctant to refer a patient to a psychiatrist for antidepressants either because of a misplaced trust in their own field of counseling or -- presumably rarely -- because if the medication is effective, a patient may decide he or she no longer needs counseling.
-- Confusion over the safety of drug therapy may be a new disincentive to seek treatment. The FDA warns that antidepressants may pose risks that are not worth the benefits when prescribed for children. The drug companies keep some of their testing data a secret and spend little on testing on children. But suicide rates among adolescents have dropped since the advent of the current generation of drugs, leading many physicians to argue the FDA (and its British counterpart) have overreacted. Add to the confusion that it is very difficult to know if "talk therapy" is effective with children, and there are few ways to gauge the talent or record of many child psychologists.
While recognition of childhood depression is growing, much of the attention and focus is on teenagers 15 years and above. This is fair because the risk of suicide is high in this age group. Far less attention is paid to the plight of children and early adolescents, although all the symptoms, including suicide, do occur in this age group, too. Further, it is fair to assume that in many cases the depressed 18-year-old suffered undiagnosed episodes of depression at an earlier age, when treatment might have been more effective and more timely.
Publicity to sensitize the population about the symptoms of depression at any age barely exists, and there seems to be nearly no information about depression available at elementary and middle schools, where depressed children spend their days. (A program announced by the Surgeon General in May 2001 is intended to raise public awareness of suicide and depression and to encourage teaching about suicide and depression in schools). Parents may not even think of depression as a possible cause of their child’s sudden trouble in school or with friends, or as a reason why their child is so confrontational. If it does occur to them, parents may be reluctant to voice their fears and may find little practical information about depression in young children.
Depressed Child.Org is intended to be a forum in which anyone concerned about childhood depression may participate. We invite you to submit advice and counsel based on your own experiences, identify information sources which you found helpful, and to visit the pages of this site to find out information which might help a depressed child you know.
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