Depression in Children May Not Look Like Adult Depression

When most people think about depression, they usually picture a gloomy, dispirited Sad Sack walking through life like the cartoon character who carries his own dark cloud wherever he goes. But depression may look very different in children than it does in adults. Instead of sitting quietly in his room and crying, a child may yell, scream, use foul language, be defiant, and throw temper tantrums.

Children tend to exhibit depression by displaying anger and irritability, especially with family members. When they’re at home, depressed children might argue with parents, pick fights with siblings, or become annoyed at requests to help around the house. Children who are depressed try to avoid doing things that make them feel more irritable, such as chores or homework. Moreover, it’s unlikely that a child will be able to tell anyone that she’s feeling depressed.

Depression Is Not a Choice That a Child Makes

Depression is something that happens to a child – it is not a choice. Childhood depression appears to be associated with a biochemical imbalance in the brain that leads to negative changes in a child’s mood, attitude, energy level, sleep, concentration, appetite, self-esteem, social relationships, family life and school performance.

Children who are depressed may behave in ways that test the patience of parents, teachers, siblings and friends, but they aren’t simply being willful and difficult. Depression is an unwanted illness that in no way reflects upon the moral character of a child. Depression is a serious illness that affects a child’s ability to meet the demands of his or her life situation.

Being angry and irritable is not a natural state for a child. I’ve heard depression described as anger turned inward, but there’s a limit to how much anger a person can keep inside before he lets it out on other people. When parents ask me why their child is so angry, they seem to be thinking that if they knew who or what provoked such strong feelings in their child, they could fix everything. What they don’t yet understand is that too many problems can’t be solved by a simple conversation because the problems are really manifestations of depression.

No child would voluntarily choose to be so unhappy and cut off from the satisfactions of ordinary life for long periods of time. And no parent who struggles to make sense of a child’s difficult and even provocative behavior in the midst of the responsibilities of jobs, school and family wants that child to be miserable when something can be done to help. The first step in getting the right help for a child is to understand depression, where it comes from, what it looks like, and what treatments and strategies exist to help alleviate its symptoms.

Know the Signs of Sadness

The million-dollar question is: Are you depressed or just sad? Everyone experiences sadness, bad days, and blue moods from time to time. Feeling sad is not the same thing as being depressed. So the first order of business is to define what normal sadness is and how it is distinct from depression.

What exactly is sadness? Sadness can be defined as mental anguish or suffering in the absence of any physical pain, such as experiencing the death of a loved one or empathizing with a loved one who is ill. A mother watching her child suffer, for example, is not in any physical pain, but she still suffers and experiences sadness. When we are sad, our emotions are expressed through crying, talking, or thinking continuously about our sorrow. We may find it difficult to sleep, concentrate and eat. Sadness is characterized by sad feelings – the opposite of the numbness that is the main feature of depression.

The problem for many people in affluent cultures is that often sadness is not triggered by anything obvious. For example, our sadness can develop when we realize our lives or situations are not improving or even declining. Stagnating (being in a rut) or finding your life is getting worse rather than better are conditions that lead to sadness and suffering. As human beings, once our basic needs (safety, food, shelter, love) are looked after, we are driven toward self-actualization. But when our life circumstances stymie self-actualization or spiritual growth, we suffer and feel sad. The longing for material possessions, money, or an intimate relationship is often just an expression of the desire for self-realization. Later in life, many of us also begin to question our attachments to material possessions and power; as we get older, we begin to see the difference between real needs (such as love, friendship and respect) and artificial needs (such as money, power and prestige).

For those of us who like the status quo and our quality of life, sadness and suffering can develop when a life event of some kind threatens that status quo, our sense of our own identity, or our quality of life. The threat can come from an infinite variety of sources, of course, ranging from physical illness to financial hardship.

Understand Types of Depression in Teenagers

There are a couple of different types of depression that a person can experience. Several of these start during the teenage years. The most frequently diagnosed types of depression in teens include:

1. Major Depression

A person suffering from major depression experiences persistent low moods or sadness, or loss of interest or pleasure in most activities over at least two weeks. Not everyone with major depression experiences the same symptoms, but the more severe the depression, the more symptoms are experienced. Major depression has a severe impact on daily life, interfering with work, school or social activities.

People with major depression may feel despair and hopelessness, their energy levels may be extremely low and they might find it hard to motivate themselves to do even the simplest of daily tasks. People with major depression also commonly experience low self-esteem and thoughts of death and suicide. It is important to get immediate help to stay safe when having thoughts about suicide.

Major depression is identified by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy activities that were once pleasurable (see symptoms of depression). Such a disabling episode of depression may occur only once, but more commonly occurs several times in a lifetime. Major depression can occur for the first time during the teenage years.

In teenagers, an episode of depression lasts on average from seven to nine months and has many signs of depression similar to those in adults. Teenagers with depression can be:

• Sad
• Irritable (which may lead to aggressive behavior)
• Indecisive (which may be accompanied by having problems concentrating)
• Pessimistic, or even hopeless, about the future.

They may also:

• Lose interest in activities that used to please them
• Criticize themselves and feel that others criticize them
• Feel unloved
• Think that life is not worth living (thoughts of suicide may be present)
• Lack energy or motivation
• Neglect their appearance and hygiene.

Major depression is also known as:

• Clinical depression.
• Unipolar depression.
• Major depressive disorder.

2. Dysthymia

Dysthymia is a less severe type of depression that can be long-lasting. It can keep a person from functioning well, feeling good, or experiencing joy. Dysthymia often starts during childhood or adolescence. Someone with dysthymia may experience fatigue, sleeping and eating problems, and be plagued by low self-esteem, guilt and negative thinking. Cognitive difficulties include concentration and memory problems.

With dysthymia, the child or adolescent is depressed for most of the day, on most days, and symptoms continue for several years. The average duration of a dysthymia period in teenagers is about four years.

Sometimes children with dysthymia are depressed for so long that they do not recognize their mood as being out of the ordinary. As a result, they may not complain of feeling depressed. Seventy percent (70%) of children and adolescents with dysthymia eventually experience an episode of major depression. When a combination of major depression and dysthymia occurs, the condition is referred to as double depression.

3. Bipolar Disorder

Bipolar disorder is the least common type of depression (also called manic-depressive illness or manic-depression). Bipolar disorder can occur anytime from childhood to old age. A person with bipolar disorder can have moods that swing between extreme highs, where they feel invincible, to paralyzing lows where they feel complete despair.

During the depressed cycle, an individual can have any or all of the symptoms of depression. During the manic cycle, the individual may have a great deal of energy and be overactive and over talkative. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated and full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

This psychiatric illness can be mild, moderate or severe. During the manic phase, the person is optimistic and buoyed by exaggerated feelings of wellbeing. Their mind is overactive and they need very little sleep but, while they have plenty of energy, they lack concentration. Work and study may suffer.

During the depressive phase, the person feels despairing and may contemplate suicide.

4. Reactive Depression

Reactive depression, also known as adjustment disorder with depressed mood, is the most common form of mood problem in children and adolescents. In children suffering from reactive depression, depressed feelings are short-lived and usually occur in response to some adverse experience, such as a rejection, a slight, a letdown, or a loss.

With reactive depression, a child may feel sad or lethargic and appear preoccupied for periods as short as a few hours or as long as two weeks. However, the child's mood improves with a change in activity or an interesting or pleasant event. These short-lived mood swings in reaction to minor events are not regarded as a form of mental disorder.

5. Seasonal affective disorder (SAD)

Depression is more common in the winter months and in the Northern Hemisphere, which suggests to some researchers that brain chemistry is affected by sunlight exposure. This is often called seasonal affective disorder (SAD). Some studies have shown that light hitting the back of the eye (retina) stimulates the brain to make chemicals that lift a person’s mood.

Apart from depression, other characteristics of SAD include eating more and gaining weight, excessive sleeping and withdrawing from others. Usually, a person with SAD comes out of their ‘hibernation’ in the spring.

How Depression Affects School Performance

When a teen is failing or doing poorly in school, parents may react with understandable frustration and try all sorts of strategies, from bribery to punishment, to get their teen to turn things around. When all things fail, tension rises and everyone becomes exasperated and at a loss to figure out the cause – and a cure – of the problems at school.

Depression, and not willfulness or laziness. Approximately 4% to 12% of school-aged children (depending upon their age) meet the criteria for being depressed, and since depression isn’t just experienced at home, it’s likely to affect a teen’s performance at school, too. Teenagers experiencing symptoms of depression usually have difficulty completing schoolwork and are at risk for academic underachievement and failure. Without early diagnosis and treatment, a teen is likely to have a negative cycle of depression > school failure > increased depression because of the failure.

School failure has a negative impact on a teen’s self esteem. A depressed teen is apt to have difficulty working to his academic and intellectual capability. He seldom completes his homework, and his test grades are likely to go down because he is tired and has trouble concentrating. To complicate matters, his teachers nay not recognize the symptoms of depression.

School may also be s source of stress for your teen. For a depressed teen, school may be the primary situation in which substantial demands are placed on her. Significant social stress might result if your teen has difficulty fitting in with his peer group.

Depression is likely to affect your teen in the following areas in school:

1) Ability to focus and pay attention.

The depressed teen is often preoccupied with negative thoughts and feelings and finds it hard to put his full attention on schoolwork. Problems with concentration at school are one of the major complaints for teens experiencing depression. A depressed teen can improve his ability to sustain attention if he gets a good night’s sleep and feels rested.

2) Completing class work.

When a teen is depressed, he has little energy to apply to activities that he perceives as being stressful or of low interest. A depressed teen may withdraw from typical activities and become resistant to teacher requests to participate in classroom activities. In this situation, it is good that the teachers can provide daily feedback to parents regarding a teen’s completion of assignments. It works better if this is used in a positive instead of a negative way, so that it doesn’t add undue pressure to the teen’s stress level. if he has a bad day, you can ignore it and try to focus on the next day being a better one.

3) Completing homework.

Teenagers who are depressed often have great difficulty finishing their homework because they lack focus, energy and motivation. Most teenagers, of course, prefer to have no homework, but they do it because they know they have to. They’re also aware that if they don’t get it done, they may pay a price in the future. The depressed teen is stuck in an unpleasant here and now. He’s not thinking about the future, and when he does, it’s without much hope or interest. You might create a behavior plan to set up rewards for good homework completion. If homework continues to be a problem, you can try to enroll your teen in an after school homework program or suggest finding a peer study buddy.

4) Getting to school.

Many depressed teens have difficulty getting up in the morning and going to school. Because they are tired and have a hard time dealing with stressful events, they may try to avoid school. You can help by encouraging your teen to develop good routines for going to bed and waking up. The less your teen has to think about what he has to do in the morning or at night, the better. The process should become automatic, so that it goes smoothly.

5) Peer Relations.

Depressed teens often have difficulties that lead to social isolation. It’s another depression cycle. A teen may withdraw and isolate him from friends and classmates, leading to loneliness, which may perpetuate the depression. Having friends and social support system can be of great help to a teen dealing with depression. You should encourage your teen to attend after-school activities that teach a mix of social and academic skills, through activities such as non-competitive sports, special interest clubs or skills enhancement programs.