Depression, Depression in Childhood by Frederic Flach, M.D.

Cinderella. Snow White. The Wizard of Oz. Barney the Purple Dinosaur. Where the Wild Things Are. Hide-and-seek, scooter tricks, and soccer games. Reading, writing, and 'rithmetic. Childhood is no time to be depressed.

Unfortunately, too often it is. Practically from the time they're born, children can be sad and irritable, feel lost and hopeless, and become disinterested in the very activities they once enjoyed. Their confidence and self-esteem can be undermined. They can fail in school. They can even commit suicide.

Children are no more immune to life's tragedies than anyone else. In fact, they are particularly vulnerable--still small, in many ways helpless, naive, lacking in experience and coping skills that adults have hopefully acquired. Parents can be cruel and abusive.
They can jump ship, abandoning everyone aboard. They can overprotect their children and make them too dependent. They can abuse alcohol and drugs. They can get sick and die young. Under any one or more of such circumstances as these, children get depressed.

But, there is a difference between normal depression and clinical depression. When being depressed lingers on and has a significant effect on a child's behavior, parents must start to consider clinical depression. This is also true when a child seems to be depressed in the absence of any apparent cause.

Manifestations Of Depression In Children

Children manifest depression in some ways like adults and in other ways unique to children. The onset of clinical depression may be sudden or gradual, but it usually involves a noticeable change in behavior.

A six-year-old boy is no longer interested in playing with his friends. He is sleeping terribly. He grows increasingly lethargic, and would spend all day Saturday in bed if his mother allowed it.

An eight-year-old girl is having an unusually difficult time studying and has become short-tempered and visibly sad at home. She gorges herself on cake and chocolate ice cream, and complains of stomach aches for which the pediatrician can find no physical explanation. She is restless and sometimes frankly agitated; her parents can hear her stomping around her room upstairs late into the night. Unbeknownst to any, she thinks about killing herself by taking a fistful of her mother's Valium.

Every depressed child is unique, in his or her own way. While it is important not to read problems into the behavioral changes of normal, healthy youngsters, it is no less important to be ready to recognize when a child may be clinically depressed, what may be causing this change in mood, and what to do about it.

Of course, treatment for clinical depression can be straightforward or very complicated. Parents' problems--such as alcoholism or pathological gambling--and psychiatric illnesses, such as adult schizophrenia, must often be directly addressed, since a child's disturbance is often a mirror for destructive interactions within the family.

At other times, antidepressants, such as the selective serotonin reuptake inhibitors, may be indicated. While studies of these medications in children are still limited, they seem to be relatively free of serious side-effects and no interference with normal growth and development has been reported.

As with any medical procedure, the risk-reward ratio must be kept in mind. Would a particular child's progress be better served by allowing him or her to struggle within the limitations imposed by chronic depression, relying entirely on his own and his parents' psychological therapy to do the job, or by giving him or her an antidepressant that would
improve mood and enable more effective function while other therapies are being carried on? This decision must be made collaboratively between doctor and parents, with the child being encouraged to cooperate in an informed way, mitigating the fear of stigma that both family and patient may experience.

If a child has bipolar illness, the use of medications is even more compelling, considering the key role played by biological and genetic causes. Failure to diagnose and treat these children quickly and effectively carries the serious complication of denying the child the opportunity to experience vital educational and interpersonal growth. It also bears a significantly increased risk of school failure, alcohol and drug abuse, and suicide.

Every depressed child is unique, in his or her own way. In some ways, in Western countries, growing up is easier than it was a hundred years ago--physically, that is. But psychologically it is probably just as difficult if not more so. Two-parent homes and healthy, happy families are increasingly hard to find. It is sometimes hard to tell whether physical and sexual abuse of children is more widespread or just more visible.

Many schools have failed at their missions, not just to educate but also to encourage the development of character and the skills and values necessary to cope with life's challenges. Many parents have lost sight of the genuine spirituality that once served as a beacon to enrich the souls of other generations.

Children are the future of humanity. In all too many instances, they deserve a good deal better than they are getting.

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About The Author:

Frederic Flach, M.D., K.H.S., is an internationally recognized psychiatrist and author whose highly acclaimed books include The Secret Strength Of Depression, Putting The Pieces Together Again; A New Marriage, A New Life; Resilience; Rickie; The Secret Strength Of Angels; and Faith, Healing, And Miracles. In 1996 he was awarded the Maxine Mason award by the National Alliance for the Mentally Ill (NAMI). He has appeared on numerous radio and television programs across the country, including Today, Good Morning America, CBS This Morning, Good Day New York, and Donahue.

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