Depression Casts Cloud Over Wonder Years

The 10-year-old boy huddled in a closet, put a toy gun to his head and screamed through his tears: “If it was real, I’d use it.”

His terrified mother sought to comfort him. “Please help me, please help me,” he sobbed.

It was 11:30 p.m. on Aug. 2, 1994--the worst moment of Susan Dubuque’s life. “I was totally guilt-ridden and feeling like a horrible mother,” she said.

That moment, an epiphany in the young life of Nicholas Dubuque, helped confirm what his mother had feared and what medical professionals had failed to see for years: The boy was suffering from acute depression.

It is difficult to associate such an insidious, dark illness with the joyful years of childhood.

And the bias against believing that depression could besiege the spirit of an innocent child is what makes it so hard for parents to accept and for many doctors to recognize, said child psychiatrist Dr. Lawrence L. Kerns, author of “Helping Your Depressed Child.”

The American Academy of Child and Adolescent Psychiatry estimates that significant depression exists in about 5% of children and adolescents--about 3 million kids. Other studies have placed the number at twice that.

From 1980 to 1992, the suicide rate for 10- to 14-year-olds increased 120%, from 0.8 per 100,000 to 1.7 per 100,000. The rate for 15- to 19-year-olds rose 28.3%, from 8.5 per 100,000 to 10.9 per 100,000, according to the federal Centers for Disease Control and Prevention.

Kerns, who practices in the Chicago suburb of Barrington, Ill., said most children’s depression remain undiagnosed and untreated.

“There are times when a professional will indicate to parents that a child is depressed but parents refuse to see it and don’t want to risk the stigma associated with mental health treatment,” he said.

Dubuque said depression must be a great deal more horrifying for a child than for adults. “As an adult you can counterbalance with previous feelings of joy. For Nicholas, this is all he had experienced.”

“I felt really scared about telling people how I felt,” said Nicholas, a bright child with a crew cut and disarming smile. “I was sad and upset and angry the whole time.”

Nicholas, now 11, said he holed up in the closet because “I felt upset, scared,” though he didn’t know why. “I used the gun to make a point that I needed help.”

With the help of medication and therapy, his thoughts of self-destruction have virtually disappeared. “Sometimes I think of it, but I would never do it,” he said.

Dubuque and her son have collaborated on a book about childhood depression to be published in March by the Center for Applied Psychology in King of Prussia, Pa.

In it, they use “turtle” and “dragon” analogies to illustrate the two faces of childhood depression.

A turtle is withdrawn, quiet and compliant and may be described by her parents as sensitive and shy. Dragons appear to be aggressive and angry and have problems making friends.

Nicholas said he’s a dragon “because sometimes I can really be angry. Last year I kicked a hole in the wall and did some stuff that was not very nice.”

His depression was compounded by attention deficit disorder with hyperactivity, a condition diagnosed when he was 7.

A psychiatrist prescribed the drug Ritalin. Dubuque’s initial reaction was: “Oh, my God, we’re going to be drugging this child. He’s going to be a zombie.”

But she said the medication “had a miraculous impact on Nicholas’ behavior and ability to focus at school.”

Emotionally, however, he remained a joyless, angry and sullen child. Clinical psychologist Livia S. Jansen said that Nicholas had poor self-esteem when she started seeing him in May 1993 and that full-blown depression developed gradually. A battery of psychological tests confirmed the condition on Aug. 3, 1994--the day after the closet episode.

“He was preoccupied with death and dying and with very morbid thoughts,” Dubuque said.

Aggressive therapy was recommended; the psychiatrist treating him now prescribed the antidepressant Prozac. Dubuque was skeptical about her son using the drug, but she soon relented. “At that point, we were desperate,” she said.

She said the process of diagnosing Nicholas’ attention problems and depression was long, tortuous and frustrating.

She knew something was wrong when Nicholas, at age 2 1/2, was enrolled in a private school.

“We immediately began getting phone calls and teacher conferences. One teacher said he was like a frightened little animal. He recoiled to the teacher’s touch and appeared to be terrified.”

Physical exams showed Nicholas in good health. The first conference with a psychologist came when he was 5. “Nicholas had the trash can on his head and literally was on the Venetian blinds while I’m trying to explain he has some attention disorder,” Dubuque said.

She said the psychologist told her Nicholas was too young for his condition to be accurately diagnosed. Dubuque was angered later when another psychologist said Nicholas “had no problems except a lack of discipline in the home.”

In 1991, the attention disorder was confirmed, but Dubuque’s worries that her son might be suffering from depression persisted.

The diagnosis of depression three years later “painted a picture of a child deeply distressed,” said the boy’s father, Steve Dubuque.

Susan Dubuque said she thinks her son developed the condition partly because members of her family have suffered from it for at least three generations, including herself. She said Nicholas was also emotionally bombarded over the last three years by his parents’ separation and the death of two grandparents and one great-grandparent.

“Every possible cause for depression, this child experienced,” she said. “He didn’t have a choice.”

She said the keys to helping Nicholas were persistence in trying to determine the nature of his problem and a commitment to getting him the care he needed.

“Just look at this kid,” she said. “His sense of humor has returned. Before, he was serious. Now he’s a kid who giggles and laughs and has that joy of being a kid.”

Nicholas’ room is typical for a boy. Toy ships, planes and cars are scattered about. There are soccer and archery trophies and a video-game player.

He is friendly and upbeat, but he still battles one of the most painful of illnesses, one that requires more than medication and therapy.

“It takes courage,” he says with certainty.

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Warning Signals

Signs of depression in young children and adolescents:

* Persistent sadness.

* Inability to enjoy previously favorite activities.

* Increased irritability.

* Frequent complaints of physical illnesses such as headaches and stomachaches.

* Frequent absences from school or poor performance in school.

* Persistent boredom, low energy, poor concentration.

* A major change in eating or sleeping patterns.

* Spends most of time alone.

* Speaks of wanting to be dead or talks about suicide.

* May abuse alcohol or other drugs.

Source: American Academy of Child & Adolescent Psychiatry / Associated Press