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Childhood Depression: What It Looks Like, What To Do? Article

Childhood Depression: What It Looks Like, What To Do?

Parents often mistake depression in children for moodiness
Sometimes, it isn't just a phase kids are going through. Sometimes it's depression.
Sometimes kids get sad. They may act depressed. Most kids get over the worst of these symptoms in a couple of days. Some don't.
Parents, if they know to look, can tell the difference, says Marilyn B. Benoit, MD, immediate past president of the American Academy of Child and Adolescent Psychiatry and clinical professor at Georgetown University, in Washington.
"Parents know in their heart of hearts something has changed in their child and it is not going away," Benoit says. "A child who is unhappy about a friend who treated them badly, they normally will get over that in a couple of days. But parents know when something is sticking and not going away. Most kids bounce back from an adverse experience in just a few days. Depressed children are still sad after a couple of weeks."

Childhood Depression

How common is it? That depends on your definition. Benoit and Dolgan note that most children with depressive disorders also suffer from anxiety. Some experts, however, see the anxiety as the underlying problem for the vast majority of these kids. One of them is Harold S. Koplewicz, MD, founder and director of the New York University Child Study Center, and director of child and adolescent psychiatry at NYU/Belleview Hospital Center.
Koplewicz, Benoit, and Dolgan agree that childhood depression is -- like adult depression -- a brain disorder brought on by changes in the chemistry of the brain. These changes often have their roots in the hormonal changes of the teen and young adult years.

Childhood Depression, Childhood Anxiety

Whether a child suffers from true depression or a kind of anxiety, the condition is serious.
In fact, kids who have anxiety as children are more likely to have teen depression. About half of depressed teens had a childhood anxiety disorder. And 85% of teens who have both anxiety disorders and depression had their anxiety disorder first.

"So anxiety in children is serious, and we tend to minimize it," Koplewicz says. "Anxiety is probably toxic to the brain. We tend to think it is all within the normal range of childhood behavior, and it is not."
Childhood anxiety disorders are persistent symptoms that center on a single theme. They cause children a great deal of distress and disrupt their daily lives. These disorders fall into three categories:
"Hoping it is a phase, hoping the child will grow out of it, is a very big mistake," Koplewicz says. "All these disorders cause distress and dysfunction. It makes people feel hopeless. And hopelessness is what makes people want to hurt themselves. It isn't depression, it is hopelessness."
"Go with your gut feelings. If you have a worry, let's get it checked out," Dolgan says. "Good parents are tuned in to their kids, but they don't always know what the signals mean."

Most parents begin by taking their child to a pediatrician, although some go directly to a child psychologist or child psychiatrist.

Treating Childhood Depression

What happens when a child is treated for depression?
"Parent must be given a lot of information about what the options are, and a sense that it is they, the parents, who choose how they would like treatment to start," Benoit says. "I tell people about medication, I talk about providing psychotherapeutic support, and what I might want to do first. I never do anything at that first session, unless the child is suicidal. I say, "I want you to think about it, then come back. As long as a child is not suicidal, we have some time to think and talk to the pediatrician."

Antidepressant medication can be an important part of treatment. But it can't be the only treatment.
But when properly prescribed, antidepressant medication can be very helpful.

"People worried about the side effects of psychiatric medications should know that there is a side effect to not taking medications, too -- kids remain sick," Koplewicz says. "Medications for these disorders shouldn't be controversial -- if a teen or child or adult has been properly diagnosed with this disorder. Then it is effective and remarkably safe if properly monitored. But first, you have to have the disorder. You need someone to really clarify and say this is not a response to a bad life situation, this is acute clinical depression."
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