What should parents look for? Depressed youngsters may become despondent, irritable or anxious. They may withdraw from friends, fall behind in school and lose interest in things they’ve enjoyed. Parents may also notice a loss of energy, concentration or motivation, a dwindling appetite or a change in sleep patterns. Some depressed kids complain of vague aches and pains. Others are overcome by guilt or self-criticism. Depressed adolescents often turn to drugs or alcohol to ease their despair. Some turn to suicide. In the United States alone, some 4,000 people under 25 kill themselves each year.
Fortunately, there are effective treatments for childhood depression. The first hurdle is overcoming your discomfort or embarrassment about the problem. Talk calmly with your child about it. Your pediatrician can offer guidance and, if necessary, refer the child to a mental-health practitioner. The practitioner’s evaluation may include discussions with teachers and family members.
Psychotherapy, in particular cognitive behavioral therapy, should be part of every treatment plan and may be all that the child requires. When the condition is more serious, or doesn’t improve with psychotherapy alone, medication may be needed. If a child’s depression is particularly severe, debilitating or self-endangering, even hospitalization may be required.
Medication can be a potent weapon against depression. Prozac and the other selective serotonin reuptake inhibitors (SSRIs) have been found effective in adolescents. They usually provide quick, safe relief, but they require careful monitoring because they don’t work for everyone and make some depressed kids feel worse. With preteen children the benefits are less clear. Prozac is the only SSRI approved for use in this group. Though physicians can legally prescribe other SSRIs to children, the Food and Drug Administration now advises them not to start anyone under 18 on paroxetine (Paxil). The agency made that recommendation this summer, after British researchers reported an increase in suicidal thoughts and behavior among children who took the drug.
Further studies may help clarify the effects of SSRIs in preteens. For now, these medicines should be prescribed only by experienced practitioners in close consultation with family members. The physician should explain the rationale for every treatment decision, and parents shouldn’t hesitate to ask questions. Families are crucial allies in the treatment of childhood depression. Given the right kind of support, your child can feel better and get back to the task of successfully growing up.
