main logo
Posted by Dr. Monica Wonnacott | May 15, 2017

Depression: The Warning Signs

May is mental health awareness month. It seemed only appropriate to address depression. As a parent, it can be hard to acknowledge that your kid may have depression. After all, they are a kid; they don’t have anything to be stressed about, right? The thing is, all depression isn’t situational (parental divorce, death of a siblings, etc.). Many kids who apparently ‘have it all’ are still depressed. Increasing your awareness could potentially save your child’s life one day.

What is depression?

The Mayo clinic has one of the most concise definitions of depression that I’ve seen. Their definition states:

“Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems.”

In mental health, there is one book that essentially outlines all mental conditions in medicine and it is considered the gold standard. It is the Diagnostic and Statistical Manual of Mental Disorders (DSM), the most current volume is volume 5 (published in 2013). To make a diagnosis of depression, a person is supposed to have 5 of 9 listed conditions for more than 2 weeks. It also notes that to have a diagnosis of depression, symptoms must cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning.” And “depression” should not be diagnosed if the symptoms are the result of effects from a substance or other medical condition.

Symptoms of depression

To meet a clinical diagnosis of depression, one doesn’t have to all of the symptoms. It’s also important to remember that kids can present in a variety of ways. While your mind may have pictured a depressed person as sad, mopey, crying all the time, and can’t get out of bed, that may not be how a kid actually presents. A kid may be irritable, tired, complaining of headaches, and having trouble sleeping (which can be a difficult presentation to decipher between other medical problems). Here’s the general list of symptoms:

  • Sadness
  • Irritability
  • Loss of interest in activities (that were previously considered pleasurable, e.g. sports or hanging out with friends)
  • Feeling hopeless or helpless
  • Feeling tired/fatigued
  • Sleep changes (either too much or too little)
  • Change in appetite (either overeating or not eating) which may result in changes in weight
  • Feeling guilty
  • Thoughts of suicide (or entertaining the idea of how life would be without you)
  • Vague physical complaints (e.g., headache, stomachache, overall feeling poorly)
  • Trouble concentrating (including failing grades)
  • Inability to make a decision (seemingly indifferent to options/choices)

Risk factors for depression

While risk factors don’t predict depression, they are just that: risk factors:

  • Parents that are depressed (there seems to be a genetic component to depression)
  • Having anxiety (depression and anxiety often co-exist)
  • Personal temperament (some people are inherently more happy or sad)
  • Negative thoughts
  • Chronic or intense stress
  • Family conflict
  • Poor health

Protective factors

Every parent wants to know how to help raise more emotionally resilient children. Sometimes, no amount of “perfect parenting” can prevent childhood depression. However, there are certainly factors that seem to be protective. They include (taken from

  • Positive physical development
  • Academic achievement/intellectual development
  • Good coping skills and problem solving skills
  • Involvement in 2 or more of the following: school, athletics, employment, religion, or culture
  • Family that provides: structure, limits, rules, monitoring, values, and supportive relationships
  • Presence of mentors and support systems

How is depression diagnosed?

Depression is usually diagnosed by a physician. Diagnosis includes a thorough history (including the history of symptoms, questions about suicide/death, and a family history of mental health illnesses). Physicians will often use standardized depression tools/questionnaires (the PHQ 9, Beck Depression Inventory, Hamilton Rating Scale for Depression, etc.). Do not be surprised if the physician asks to speak to your child privately. Those conversations (tailored to age appropriateness) will often inquire into sex, drugs, relationship problems (with parents or significant others), home environment, etc.

Depression treatment

There are a couple of different approaches to treatment of depression. The first includes psychotherapy, essentially talking with your “therapist” or psychologist. For some people, this approach is enough. However, many people who suffer from depression need the aid of a depression medication (sometimes in combination with therapy). Usually a class of medications called Selective Serotonin Reuptake Inhibitors (SSRIs) are used first line (this includes medications like Fluoxetine, a.k.a. Prozac and Sertraline, a.k.a., Zoloft). These medications are designed to increase a chemical in the brain called serotonin. Treatment duration is classically 6+ months. Your pediatrician will help you determine if your child will need to stay on the medication long term.

How big of a problem is this really?

The American Academy of Pediatrics states that in the United States, up to 3% of children and 8% of adolescents suffer from depression. Lifetime prevalence is around 18-20%. That’s an astounding number to me when I think that nearly 1 in 12 kids in the local junior high and 1 of 5 adults walking around have or will suffer from depression at some point.

Eight of the top 10 highest suicide rates in teens across the nation are in the states in the west. In Utah, where I live, suicide is the #1 killer of kids aged 10-18 years old. In most states, suicide ranks in the top 5 causes of death in adolescents. That’s a huge problem.

Hopefully by talking more and more about it, we can raise general awareness of depression and help our kids who are suffering needlessly.