Serious Depression That Children Can Suffer Gains Wider Recognition
Sixteen-year-old Carrie White can’t identify an exact moment when it happened--when she turned from sunny to depressed, when she went from happily riding and showing horses to wondering what would happen if she drank bleach.
“It started gradually. It’s like you’re standing in the shallow end of a pool, and you start walking to the deep end,” says Carrie, a 10th-grade student at a private school here. “It started around seventh grade, and by the fall of eighth grade, the light started to go. I got bogged down. The winter of eighth grade, I was in the deep end of the pool.”
Grim words at any age, especially from someone so young. But, as experts increasingly are finding, such words and the depression behind them indeed can come from the mouths of babes.
“Even at age 7 or 8 they can talk about wanting to die, holding their breath or jumping in front of a car,” says Dr. Robinson Munoz, chief of the University of Maryland Hospital’s child psychiatric unit, where more than half of the patients have been admitted for depression.
About 2% to 3% of children and teen-agers are believed to be seriously depressed, studies have found, with some particular groups, such as teen-age girls, showing even higher rates. The most common of mental illnesses, depression afflicts an estimated 5% of the population at large. An additional 1% suffers from manic depression, a condition characterized by wild mood swings.
Researchers at the University of Missouri found 2.5% of the children they studied were depressed. And yet another study, by a researcher in New York, found that as many as 7% of 13- and 14-year-old girls are depressed.
It has only been in recent years that the idea that children could even be depressed has gained wider acceptance.
“I think people are becoming more aware it can exist in children,” says Dr. Paramjit Joshi, who heads the outpatient clinic for depressed children that opened in July at Johns Hopkins Hospital in Baltimore. “If you look for it, you find it.”
Spotting potentially depressed youngsters and teen-agers can be difficult. Many of the symptoms of depression, such as changes in sleeping and eating behavior and mood swings, for example, mimic basic garden-variety growing pains. What teen-ager, for example, has ever gotten through adolescence without some sort of behavioral changes and mood swings?
“It’s much easier to make the distinction if the child behaved before,” Joshi says. “If the child has always been a pain, it’s harder to tell.”
“A lot of people will just think they’re being obnoxious,” agrees registered nurse Sally Mink, who works with the Baltimore-based support group DRADA (for Depression and Related Affective Disorders Assn.). “But there are ways of distinguishing between obnoxious teen-age behavior and depression.
“Change is probably the main thing to look for. The teen-ager suddenly can’t get enough sleep, or just can’t sleep at all. With these kids, you’d see a big change in their grades, maybe, or they can’t concentrate. They don’t derive pleasure anymore, they don’t like to hang around their friends anymore.”
To help teachers and other adults who work with children spot possible signs of depression before they get to a life-threatening point, Mink is distributing a video featuring Carrie White and her doctors speaking about her depression.
Some adults wonder, however, what children could be depressed about. But such thoughts hit at the root of a basic misunderstanding about depression in general and childhood depression in particular.
Clinical depression--not the occasional blues that everyone lapses into on occasion--need not be related to an incident, like the loss of a loved one, for instance.
“It’s not in relation to something around you,” Joshi says. “It’s like developing diabetes.”
While many people outside the medical field think depression is an “all-in-your-mind” kind of problem, experts say there are physical, biochemical and genetic explanations in many cases. Depressed persons have been shown to have lower levels of some brain chemicals, for example.
Other researchers have identified a “genetic marker,” or genetic defect, on one of the 23 pairs of chromosomes that is related to developing manic depression. From 60% to 80% of persons with this marker ultimately develop the disorder, according to the study, which involved researchers at the University of Miami, Yale and the Massachusetts Institute of Technology.
“We have indirect evidence that this is a brain disease,” says Dr. Raymond DePaulo, director of the affective disorders clinic at Johns Hopkins Hospital. “We’re closing in on understanding depression from a mechanical point of view.”
Such physical reasons for depression would explain why some children and adolescents would suffer from the disease even if they have had non-traumatic childhoods.
Still, events such as death, divorce and abuse do contribute to depression among youngsters, triggering episodes of depression that can be debilitating if not treated.
“One of the major causes has to do with losses, through death or through separation or divorce,” says Dr. Alicia J. Guttman, medical director of the child and adolescent psychiatric clinic at the University of Maryland Hospital. “There can be a lack of parental availability, because of alcohol or drugs.”
The effect of stress and loss on children is not entirely clear. The question is “where does bereavement end and major affective disorder start,” Joshi says.
“Not all children who lose a parent will develop depression,” says Dr. Alan Breier, a psychiatrist at the Maryland Psychiatric Research Center in Catonsville, Md.
Breier studied 90 adults who had lost a parent when they were from 2 to 17 years old and found that the ones who ultimately became depressed were those who had a troubled relationship with the surviving parent.
Scientists know that children who have lost a parent do have higher levels of hormones related to stress, he says, and those elevated levels may stay with them throughout their lives, leaving them vulnerable to developing depression.
Although children and young adults may not face the same stress factors that plague adults, such as jobs and family responsibilities, they do have stresses of their own, experts say.
A study last year of more than 300,000 college freshmen found feelings of depression and stress are on the rise. The finding was part of a broad, nationwide survey of college freshmen that the UCLA Higher Education Research Institute has conducted for 23 years.
Freshmen who said they frequently had felt depressed during the past year numbered 10.5%, up from the 8.3% who felt that way in 1987.
The researchers believe that those feelings are part of an overall decline in the emotional health of college freshmen. They cite other trends that, together, form a picture of young people under increasing stress. More freshmen, for example, reported feeling “overwhelmed” by all they have to do; 21.5% felt that way, compared to 16.4% the year before.
Rising costs of college, the increased competition to get admitted to selective institutions and the current economic uncertainty have combined to increase the stress level for young people, the researchers believe.
“The preoccupation with what looks to be greed is actually concern about economic security,” says Kenneth Green, associate director of the UCLA institute. While today’s “baby boomers” grew up in an atmosphere of optimism for the future, today’s freshmen have, instead, grown up with inflation, recession and economic uncertainty, he says.
If left untreated, depression can be life-threatening. The vast majority of suicides--and estimated 60% to 80% of them--result from depressive illness.
Among the young, suicide has been increasing. The suicide rate among people 15 to 24 years old has risen 150% in the past 20 years, and suicide is second only to accidents as the most common cause of death among adolescent boys.
But depression can be treated. Treating depressed children, in fact, is much like treating depressed adults--therapy, especially family therapy and, in more severe cases, anti-depressant drugs.
