Major depression

Major depression, also known as clinical depression or unipolar depression, is classified as a type of affective disorder (also called mood disorder) that goes beyond the day's ordinary ups and downs, and has become a serious medical condition and important health concern in this country. It can affect and disrupt eating, sleeping, or thinking patterns and is not the same as being unhappy or in a "blue" mood, nor is it a sign of personal weakness or a condition that can be willed or wished away. Children with a depressive illness cannot merely "pull themselves together" and get better. Treatment is often necessary and many times crucial to recovery.

There are three primary types of depression, including:

• Major depression (clinical depression)
• Bipolar disorder (manic depression)
• Dysthymic disorder dysthymia)

Who is affected?

The National Institute of Mental Health, part of the National Institutes of Health, reports the following:

• Research indicates that depression onset is occurring earlier in life today than in past decades.
• Early-onset depression often persists, recurs, and continues into adulthood. Depression in youth may also predict more severe illness in adulthood.
• There is an increased incidence of depression in children whose parents experience depression.

Risk factors

The following are the most common risk factors for major depression:

• Family history of depression (especially if a parent experienced depression as a child or adolescent)
• Excessive stress
• Abuse or neglect
• Trauma (physical and/or emotional)
• Other psychiatric disorders
• Loss of a parent, caregiver, or other loved one
• Cigarette smoking
• Loss of a relationship (i.e., moving away, loss of boyfriend/girlfriend)
• Other chronic illnesses (i.e., diabetes)
• Other developmental, learning, or conduct disorders

Symptoms

The following are the most common symptoms of major depression. However, each child may experience symptoms differently. Symptoms may include:

• Persistent feelings of sadness
• Feeling hopeless or helpless
• Having low self-esteem
• Feeling inadequate
• Excessive guilt
• Feelings of wanting to die
• Loss of interest in usual activities or activities once enjoyed
• Difficulty with relationships
• Sleep disturbances (i.e., insomnia, hypersomnia)
• Changes in appetite or weight
• Decreased energy
• Difficulty concentrating
• A decrease in the ability to make decisions
• Suicidal thoughts or attempts
• Frequent physical complaints (i.e., headache, stomach ache, fatigue)
• Running away or threats of running away from home
• Hypersensitivity to failure or rejection
• Irritability, hostility, aggression

For a diagnosis of major depression to be made, a child often needs to exhibit a "cluster" (several) of the above symptoms during the same two-week period. The symptoms of major depression may resemble other problems or psychiatric conditions. Always consult your child's physician for a diagnosis.

Diagnosis

Because depression has shown to often co-exist with other psychiatric disorders, such as substance abuse or anxiety disorders, seeking early diagnosis and treatment is crucial to the recovery of your child.

A child psychiatrist or other mental health professional usually diagnoses major depression following a comprehensive psychiatric evaluation. An evaluation of the child's family, when possible, in addition to information provided by teachers and care providers may also be helpful in making a diagnosis.

Treatment for major depression:

Specific treatment for major depression will be determined by your child's physician based on:

• Your child's age, overall health, and medical history
• Extent of your child's symptoms
• Your child's tolerance for specific medications or therapies
• Expectations for the course of the condition
• Your opinion or preference

Mood disorders, including major depression, can often be effectively treated. Treatment should always be based on a comprehensive evaluation of the child and family. Treatment may include one, or more, of the following:

• Antidepressant medications (especially when combined with psychotherapy has shown to be very effective in the treatment of depression in children and teens)
• Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy) for the child (focused on changing the child's distorted views of themselves and the environment around them; working through difficult relationships; identifying stressors in the child's environment, and learning how to avoid them)
• Family therapy
• Consultation with the child's school

Parents play a vital supportive role in any treatment process.

For several reasons, many parents of children or adolescents with depression never seek the appropriate treatment for their child, although many people with major depression who seek treatment improve - usually within weeks. Continued treatment may help to prevent reoccurrence of the depressive symptoms.

Without appropriate treatment, symptoms of depression can persist for weeks, months, or years. In addition to causing interpersonal and psychosocial problems, depression in children and adolescents is also associated with an increased risk for suicide. Further, this risk rises, particularly among adolescent boys, when the depression is accompanied by other mental health disorders (i.e., conduct disorder, substance abuse). It is crucial for parents and care providers of children and adolescents to take all depressive and suicidal symptoms very seriously and seek treatment immediately. Suicide is a medical emergency! Consult your child's physician for more information.