Until recently, neither health professionals nor the general public believed that children could feel depressed. Now we know that this serious illness can strike people of all ages.
But children may express their condition quite differently, so it's especially important for parents and other caring adults to be sensitive to the signs of childhood depression.
Everyone feels sad once in a while, whether it's over something fairly small like a disappointing test score, or a major upheaval like a family move to a new city.
Depression occurs when sadness turns into despair, lasts for weeks or months and prevents children from functioning happily and successfully at home, among friends or at school. About 5 percent of children and adolescents suffer from depression.
Kids who are chronically or extremely stressed (think abuse), who experience loss (such as a death or divorce in the family) or who have mental, behavioral or certain physical disorders are at higher risk for depression.
Having a parent who is depressed is the single biggest risk factor for a child becoming depressed. There is some genetic influence, though the impact is compounded by the depressed parent's diminished ability to respond to the child's emotional needs.
Rates of depression are about equal among boys and girls until around 11 years of age. During adolescence, girls become twice as likely as boys to experience bouts of depression. Perhaps girls are just more conditioned to be reflective about themselves. For instance, more teenage girls than boys worry about matters such as appearance, popularity, safety, friendships, romance, family problems and self-worth.
Young children likely won't recognize when they feel depressed, but parents can look for telltale signs. A depressed child may lack energy, show little emotion, withdraw from people, appear hopeless and have trouble sleeping. School-aged children may complain of physical symptoms like headaches or stomachaches and have changes in appetite. They may lose interest in their friends and the activities that used to be fun for them.
Teens may sleep a lot more than they normally would, they may move or speak more slowly than usual, hallucinate or have delusions. (All of which can also be signs of substance abuse.)
Although it's rare, some children can be so depressed that they want to die. Even mild depression can have a significant long-term impact on a child's development.
So it's important to seek professional help through your pediatrician, school psychologist or community mental health professional when you observe one or more of the behavior changes listed above, especially if they occur suddenly and persist.
A physician should always rule out the possibility that depression may be caused by a serious medical condition. Diagnosing and treating the physical illness could relieve the psychological symptoms.
Once depression is identified as the problem, individual and family therapy may be useful. Treatment may include the well-supervised use of antidepressant medication.
All of us should heighten our attention, sensitivity and response to the ways our children communicate their inner feelings. You might be the one who helps a child out of a tunnel of darkness into the light.
Peter A. Gorski, M.D., M.P.A., is a child development expert at the Children's Board of Hillsborough County, a pediatrician and a professor of pediatrics, public health and psychiatry at the University of South Florida.