However, sorting through the often conflicting information has left many people more confused than ever about this important subject. On September 13, the Food and Drug Administration will be holding hearings to review all of the research currently available. David Fassler, M.D., clinical associate professor of psychiatry at the University of Vermont and local child and adolescent psychiatrist, will be testifying at the hearings. To help clarify the issue, Dr. Fassler has provided a list of information and suggestions for parents of children dealing with depression.

NATIONAL INCIDENCE OF CHILDHOOD DEPRESSION AND SUICIDE

- About five percent of children and adolescents in the general population suffer from depression at any given point in time, according to the American Academy of Child and Adolescent Psychiatry.

- Many children and adolescents who struggle with depression have thoughts about hurting themselves, and each year over 500,000 young people attempt suicide. Approximately 2,000 children and adolescents die as a result of a suicide attempt each year. This number has declined steadily in recent years.

DIAGNOSIS OF CHILDHOOD DEPRESSION

- Depression is not always an easy disorder to recognize. Many children and adolescents with signs and symptoms of depression will also have signs and symptoms of a second psychiatric condition. A comprehensive evaluation and an accurate diagnosis are essential to the development of an appropriate and effective treatment plan.

- Parents need to be advocates for their children, asking lots of questions about the diagnosis and any proposed course of treatment. If they are not satisfied with the answers or the information they receive, they should seek a second opinion.

TREATMENT OF CHILDHOOD DEPRESSION

- Treatment should be individualized to the needs of the child and family. Treatment will often include individual therapy and may also include family therapy or work with the child’s school. Medication, including SSRI antidepressants, can also be an important component of treatment, but alone, is rarely an appropriate intervention alone.

- All treatments have potential risks and benefits. Parents need and deserve access to as much information as possible in order to make fully informed decisions about treatment options.

- Not all young people with depression need to be treated with medication. In fact, research suggests that many children and adolescents with milder cases of depression respond well to psychotherapy. This is another reason why it is so important to get a comprehensive evaluation and to carefully consider the full range of treatment options.

- Children and adolescents who are taking antidepressant medication should be monitored closely by a physician, especially early in the course of treatment, or when medications are being changed or dosages adjusted.

RESEARCH ON THE USE OF SSRI ANTIDEPRESSANTS IN CHILDREN AND TEENS

- While some studies suggest that the use of SSRI anti-depressants may increase the risk of certain suicide-related thoughts and/or behaviors in some children and adolescents, the data are far from conclusive. Research also suggests that this phenomenon may not be specific to these medications. Nonetheless, it is important and appropriate for parents and patients to receive comprehensive information explaining that such a reaction, although unlikely, is a potential risk with any form of treatment.

- A National Institutes of Health-funded study published recently in the Journal of the American Medical Association demonstrates that medication plus psychotherapy is the most effective treatment for depression in adolescents. Research also suggests that psychotherapy may also help reduce the risk of suicidal thoughts and/or behaviors in children and adolescents.

- Research also indicates that between 30 and 40 percent of children and adolescents with depression will not respond to an initial medication. However, many of these young people will ultimately respond to a different medication. Therefore, it is important for physicians to be able to utilize the full range of medications in this class.

CONSEQUENCES OF CHILDHOOD DEPRESSION

- Follow-up studies have demonstrated that, without treatment, the consequences of childhood and adolescent depression are extremely serious. Children are likely to have ongoing problems in school, at home and with their friends, and 40 percent will go on to have a second episode of depression within two years. These children are also at increased risk for such problems as substance abuse, eating disorders and adolescent pregnancy.

- Over half of children diagnosed with depression will eventually attempt suicide, and seven percent will ultimately die as a result. Depression is estimated to increase the risk of a first suicide attempt by at least 14 fold.

Dr. Fassler, is the author of “Help Me, I’m Sad,” (Penguin, 1997), and serves as a Trustee of the American Psychiatric Association, a Fellow of the American Academy of Child and Adolescent Psychiatry, and a member of the Board of the Federation of Families for Children’s Mental Health.