What is Depression?

Depression can strike a child at any age. A mood disorder, depression is characterized by a persistent sad or empty feeling, irritability, and a loss of interest in everyday activities. Unlike normal sadness or grieving, most bouts of depression last for weeks, months, or even years. A smaller number of children and adolescent suffer from bipolar disorder-bouts of depression interspersed with periods of elevated (manic) mood (bipolar disorder).

Although depression is usually not considered life-threatening, it can lead to thoughts of and attempts at suicide.

Symptoms

• Persistent feelings of sadness, apathy, or hopelessness lasting more than two weeks.

• Diminished interest in most daily activities, particularly pleasurable ones.

• Decreased appetite and subsequent weight loss; increased appetite and weight gain.

• Lack of sleep (insomnia), frequent awakening throughout the night, or conversely, an increased need for sleep.

• Anxiety; diminished ability to think or concentrate.

Diagnosis

Because there are no reliable laboratory tests to diagnose depression, physical examination and psychological evaluation are essential.

• Expression of either of the first two symptoms of depression (see Symptoms box), in conjunction with other symptoms, for a period of two or more consecutive weeks.

• A positive family history of depression or a prior depressive episode helps establish the diagnosis.

Treatment

• Psychotherapy is as effective as drug treatment in mild cases. Psychotherapy may also be used in conjunction with drug therapy.

• Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), are mainstays of treatment.

• Exposure to bright light, known as light therapy, may be effective, particularly when depression is related to seasonal changes (seasonal affective disorder).

• In secondary depression, the underlying cause is addressed, although antidepressant therapy may also be prescribed.