Major Depressive Disorder

What is it?

Major depressive disorder is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer. Unhappiness triggered by events is not uncommon in children, but it normally goes away when circumstances change. A child with depression doesn’t recover when events change; her dark mood and lack of interest in things she used to enjoy continues.

Signs and Symptoms

A major sign of depression is mood change: unusual sadness and a reduced interest in activities—sports, friends, school—the child once enjoyed. Other signs of depression are unexpected changes in weight; major shifts in sleep patterns; and sluggishness. A depressed child may express inappropriate guilt or be unusually harsh on herself—I’m ugly, I’m no good, nobody likes me. In the most extreme cases, depressed kids may have thoughts of, or attempt, suicide.

Depression interferes with all aspects of a child’s life: school, peer problems, and, in severe cases, thoughts of suicide. Onset is usually in adolescence and it is diagnosed twice as often in girls than in boys.

Diagnosis and Treatment

Depression is diagnosed when negative feelings, lack of interest in previous activities, and physical symptoms like fatigue and insomnia persist for at least 2 weeks. Symptoms must be a distinct shift from previous functioning, including marked weight loss or gain; sleeping too much or too little; restlessness or lethargy; fatigue; feelings of worthlessness or excessive guilt; indecisive thinking; and a preoccupation with death, suicide or an actual suicide attempt. Other causes for these symptoms must be ruled out, including substance abuse, medical conditions, and other psychiatric disorders. The depression must significantly interfere with daily activities.

Mild cases of depression are treatable with specialized psychotherapy, but experts agree that in most cases a combination of psychological and pharmacological therapies is the best approach. Childhood and adolescent depression is often treated with interpersonal therapy, when a therapist focuses on a young person’s relationships with peers and family, and how they can positively (and negatively) impact the child’s the inner life. Cognitive behavioral therapy is also used to treat depression.

Many medications are also effective in combating depression. A course of therapy usually begins with one of the reuptake inhibitors, medications that increase the supply of certain neurotransmitters—chemicals parts of the brain use to communicate with each other—a shortage of which has been associated with depression. These drugs include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and norepinephrine and dopamine reuptake inhibitors (NDRIs). The federal government requires that all antidepressants carry a label indicating that the medications can cause thoughts of suicide. The benefits of these drugs are well documentend and incidence of suicide is low. Untreated depression is a greater risk to a teenager’s health and happiness. These medications, while still having some significant side effects, are safe if properly managed.

What are the risk factors for children?

Children with negative temperaments are at higher risk for major depressive disorder. A child with family members who’ve experienced depression and children with adverse experiences are also more at risk. Having another major disorder or a chronic or disabling medical condition also makes children more likely to develop depression.

Depression is very often diagnosed alongside anxiety disorders like generalized anxiety disorder (GAD) and panic disorder. Depressed adolescents are also more at risk than the general population to develop alcohol and substance dependencies.

Children and adolescents with major depressive disorder are at increased risk of committing suicide—the third leading cause of death among adolescents and young adults aged 15 to 24. Never ignore signs of suicidal behavior or ideation, which include: drastic changes in eating habits, sleep patterns, or personality; marked neglect of personal appearance; giving away personal belongings; sudden happiness after a period of depressed mood; and, of course, talk of suicide or of “going away” or “not being a problem anymore.”

If you think your child or adolescent is suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255 or 911 if there is an emergency.