Current research suggests that young people’s symptoms are similar to those in adults: persistent sadness, irritability, crying, poor sleep, doing poorly at school and distance from one-time friends. [12]

Hope and Caution

Parents may find a depressed child daunting, but treatment can be very effective. Psychotherapy can help, and one antidepressant drug (fluoxetine, or Prozac) has proved successful in clinical trials and is approved for use with children. “Depression has serious consequences and results,” says child psychiatrist David Fassler, M.D. “The most dangerous thing we can do is not treat these kids.”

Potential Dangers

Reports of suicidal behavior in children who are taking SSRI antidepressants have moved the Food and Drug Administration to commission a study. Suicidal or self-destructive behavior early in drug treatment may be due to the drugs or the severity of the disease, or it may represent an interim effect as depressed people gain renewed energy and take action on suicidal thoughts as medication begins to work. The FDA recommends close monitoring of patients who start or change antidepressant medications. [13]

The Facts:

-- A recent evidence-based review of several psychotherapeutic approaches concluded that cognitive-behavioral therapy, which seeks to adjust the patient’s thoughts, feelings and behaviors, is “currently the treatment of choice for anxiety and depressive disorders in children and adolescents.” [1]

-- In a study of 123 depressed adolescents with at least one depressed parent, 9.3 percent of those treated with cognitive behavioral therapy remained depressed, compared to 28.8 percent in the control group. [7]

-- A meta-analysis covering 61,424 children found that girls’ depression scores stay steady from ages 8 to 11 and then increase between ages 12 and 16. Boys’ scores were stable from 8 to 16, with a high score at age 12. Hispanic youth had significantly higher depression scores than black and white children, and there were no socioeconomic effects observed. [2]

-- Once puberty begins, girls are twice as likely as boys to become depressed. This may be due to a combination of genetic background, normal hormonal changes and social factors. Close attention to pubescent girls could prevent depression or facilitate intervention when it is observed. [3]

-- Children and adolescents with depression or bipolar disorder are largely untreated, perhaps because psychiatrists and pediatricians receive little or no training in children’s mental health. As a result, treatments may reflect adult treatment plans that have not been proven to work with youths. Effective treatments have been identified, but they are not yet widely used. [4]

-- Suicidal behavior among 10- to 19-year-olds and other age groups is no more likely with newer, SSRI antidepressants than with older drugs, according to a recent study of 159,810 patients in Britain. [5]

-- Suicidal behavior is associated with antidepressant therapy because the sickest patients are the ones most likely to be prescribed antidepressants. [6]

-- Parental support for adolescent girls decreases the risk of depression, while existing depression is tied to decreases in peer support. [8]

-- Some drugmakers have been accused of hiding clinical trial data indicating that two SSRIs, Paxil and Zoloft, may carry more risks than benefits. [10]

-- Researchers at the National Institute of Mental Health are using functional magnetic resonance imaging to scan brains of people with depression and compare them to mentally healthy volunteers. They’re looking at the networks of interactions between brain structures, at how these specific regions are affected by depression and treatment, and at alternative genetic structures and brain functioning. [9]