A few days after the death of comedian Robin Williams I happened to view the classic Woody Allen movie, Annie Hall. A good art film but the scene that struck me most happened only two minutes in. This introduction had Woody Allen’s character, Alvy Singer, offering a soliloquy which ends with his stating that “I’m not a depressive character…I was a reasonably happy kid, I guess.” Cut to young Alvy, with his impatient mother, in the doctor’s office. He is depressed, says his mother, and she complains he won’t do anything; he won’t do his homework. Alvy explains to his doctor, “What’s the point?” And he asks this because he read the universe is expanding, and eventually it will expand to the point it breaks apart and that will be the end of the world. Mom finds this ridiculous, and bellows:
“What has the universe got to do with it? You’re here in Brooklyn (where they live)…Brooklyn is not expanding!!!”
The doctor offers shallow reassurances and laughs, effectively blowing off young Alvy and validating his mother.
Given the timing, this scene struck a particular chord. Robin Williams had being coping with depression for some time prior and up to the time of his suicide (recently his widow stated in a interview that he was also suffering from Lewy Body dementia). What if at some point, whether as an adult or even as a child (like Alvy), his feelings had been blown off?
It’s likely true, as only in the last twenty years has childhood depression has been taken seriously, many years past young Alvy’s and young Robin Williams’ time. Statistics have shown that not only does clinical depression occur in children, it can occur in as many as 3 percent. And the risk only grows for teens: up to 1 in 8. For boys, depression is more common at age 10 or younger; girls are more at risk during the teen years.
Emotional ups and downs are a part of childhood, and certainly result from the hormonal and physical changes of adolescence. So we parents need to be alert for signs that can indicate the possibility of more serious problems, such as childhood/teen depression.
- The hallmark of depression (in children and adults alike) includes three symptoms, sadness, feeling hopeless and mood changes. Some more specific examples that can pertain to children include:
♦getting into trouble at school
♦a new pattern of dreading school and not wanting to go
♦new/increased complaints of physical illness
♦observations that your child “is not acting like herself.”
♦any behavioral changes that interfere with your child’s school or extracurricular performance, home life or interest in hobbies
Kidshealth.org lists common symptoms of depression:
~a feeling of being down in the dumps or really sad for no reason
~a lack of energy, feeling unable to do the simplest task
~an inability to enjoy the things that used to bring pleasure
~a lack od desire to be with friends or family members
~feelings of irritability (especially common in kids and teens), anger, or anxiety
~an inability to concentrate
~a marked weight gain or loss (or failure to gain weight as expected), and too little or too much interest in eating
~a significant change in sleep habits, such as trouble falling asleep or getting up
~feelings of guilt or worthlessness
~aches and pains even thought nothing is physically wrong
~a lack of caring about what happens in the future
~frequent thoughts about death and suicide
Keep in mind that some children may continue to function well in some situations and not in others. For example, a child may have a normal social and physical ability at soccer practice but may have difficulty functioning in the school lunchroom. Also, symptoms may be fleeting, with one being replaced by another.
2) Significant life changes, particularly those occurring at home can trigger what is commonly known as situational depression. A death of a loved one, a divorce or a parental illness can cause a child to become depressed.
3) Family health history. A family history of depression puts a child at risk for developing depression himself. And it can cause the first episode of depression to occur at an earlier age than in children who do not have a family history of depression.
So when to seek help? If any of the above symptoms last for two weeks or longer, take your child to see his pediatrician, who can do a thorough history and examination to determine if there are physical reasons for your child’s feelings and behavior. His doctor may explore risk factors such as stressors and family history, as well as ask a battery of questions that relate to diagnosing depression. If your pediatrician suspects your child is depressed, a visit to a mental health specialist may be arranged. This may be a psychologist, psychiatrist or a clinical social worker.
If your child is diagnosed with depression, the good news is there are effective treatments to help your child. Psychotherapy (talk) therapy is the backbone of treatment and can include several strategies. Play therapy is is a common approach for younger children, and is a way to help children articulate their feelings. Cognitive behavioral therapy (CBT) evaluates how a child’s thoughts impact her behavior and helps alter thoughts to produce positive behavior. CBT is effective in treating depression and also the anxiety that can come with it, Family talk sessions and sessions with a peers (group therapy) may also be beneficial.
Medications can help as well, but have been subject to scrutiny in recent years. Prozac, a common antidepressant medication, is approved for children as young as age 8. However, there has been serious concern over the safety of this medication, and other medications in the SSRI family, for use in children with depression. There are concerns that these antidepressants can increase the risk of suicide attempts. As a result, any SSRI medication use in children must be carefully considered and monitored, especially during the first month of treatment. Most children experience few side effects from taking Prozac and similar antidepressants and it’s not known why certain children are most susceptible to increased anxiety, depressive symptoms and suicidal thoughts when taking these medications.**
It’s difficult to even think about, but it is important for parents, teachers and others close to a child diagnosed with depression to be on the alert for the signs of attempted suicide. Any of these behaviors warrant immediate attention from a child’s mental health provider:
Many depressive symptoms (changes in eating, sleeping, activities)
Social isolation, including isolation from the family
Talk of suicide, hopelessness, or helplessness
Increased acting-out of undesirable behaviors (sexual/behavioral)
Increased risk-taking behaviors
Focus on morbid and negative themes
Talk about death and dying
Increased crying or reduced emotional expression
Giving away possessions
It’s not uncommon for parents to feel guilty about a child’s depression or feel in denial as depression, unfortunately, still holds a social stigma. But it is important to know that parents can and must play a role in helping their child now. The hard news is that depression can recur as a child gets older, but the good news is that treatments are effective. And there are several things parents themselves can do to support their child’s recovery:
♥Teachers and school counselors should be in the loop. Give consent for mental health professionals to send updates to those persons.
♥Provide a healthy diet, as this can help with moods.
♥As well as good food, helping a child to remain or get active can release endorphins in the body that can also help with mood and outlook.
♥Stick to the advised treatment plan and appointment schedule. If a child’s depressive symptoms seem to worsen, seek help right away.
♥Be supportive and loving, never say things like, “Oh, you’ll get over it…” Take a child’s feelings and behaviors seriously. Know that these children hurt and need to be reassured their feelings are valid.
[**the FDA reviewed the cases of 2,200 children taking SSRI’s for depression and found no completed suicide attempts. However, 4% of these children did have thoughts of suicide and some also attempted to take their lives. This is twice the number of children who took a sugar pill, or placebo, in place of an SSRI.]