Parents bring children plagued by headaches to Joel Herskowitz, a pediatric neurologist, fearing the diagnosis will be a brain tumor.
Among those hundreds of kids, "for every one who had a brain tumor, 30 were depressed," he says.
It is now recognized that children do have major depressive episodes, not just the transitory blues.
Although mental health professionals may be knowledgeable about the condition, many children are suffering because their parents and family physicians are not adequately informed, says Herskowitz, who practices in Boston and Framingham, Mass.
It is often apparent that something is not right with a child, but neither parents nor pediatricians may be able to recognize the symptoms of depression, he says. So he wrote "Is Your Child Depressed?" (Pharos Books).
Depression can manifest itself quite differently in children than in adults, he says.
The 'Right Questions'
"A child doesn't have to be sad to be depressed. You have to look and see what is the child's prevailing mood," he says. It could be anger or irritability. "There don't have to be tears. When children are depressed, you just have to ask the right questions."
Often, pediatricians--who typically do not get much exposure to psychiatry in their training--are too busy or uninformed to be of help, he says, and some may actually be reluctant to find the true diagnosis.
"A lot of pediatricians are not comfortable" diagnosing depression," he adds. "They don't consider it a real disease."
"Childhood," Herskowitz writes, "is supposed to be a time of exuberance and joy. What I was seeing was children whose lives were drained of energy and enthusiasm."
And the situation is often more tragic; depression often figures in suicide.
In many depressed children, there is a genetic predisposition toward the condition, which is brought on by stressful circumstances. Medication is often the answer, in conjunction with psychotherapy. While it may seem daunting to parents unfamiliar with psychiatry, treatment is effective.
Here is Herskowitz's checklist for symptoms indicating depression in childhood: marked loss of interest or pleasure in most activities; significant changes in appetite, weight or activity level; sleep disturbances; increased or decreased fatigue or frequent loss of energy; excessive or inappropriate guilt; low self-esteem; problems in concentrating or thinking in general; suicidal thoughts or actions; and physical complaints, such as headaches or stomach aches.
These behaviors may indicate depression specifically in preschoolers: Looking bored, angry or sad; crying for no apparent reason; needing to rest or seeming tired or listless; being rejected by or rejecting others; seeming cranky or irritable; being moody, changeable, constantly on the move or fidgety; fighting with others; talking often.
A combination of behavior changes and mood disturbance strongly suggests a depressive disorder, he writes.
Parents should be aware that certain situations are "set-ups for depression," Herskowitz says. Whether it is separation or divorce in the family, the death of a loved one (person or pet), a move, academic failure or physical illness, the common denominator is loss.