What's Inside

• Depression In Kids & Teens

  • What is depression really?

  • Symptoms of true depression

  • Risk factors for depression

  • Protective factors for depression

  • How is depression diagnosed in kids and teens?

  • Depression treatment

  • How big of a problem is depression really?

• Fact Or Fiction: My Kid Has Nothing to Be Depresse …

• What I’m Seeing at Work: Pharyngitis

• Money-Saving Tip: Tricks to Fluoxetine

• WWWD: Pink Eye, Part II

  • Pink eye complication: periorbital cellulitis

• Recalls & Alerts: Witch Hats & PJs

• Funny Things: Stickers

Depression In Kids & Teens

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 loved one, 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 really?

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

In mental health, one book 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 (listed below). 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 true depression

• Depressed mood: A persistently low or depressed mood (often presents as sadness)

• Loss of interest or pleasure: A markedly diminished interest in activities most of the day, nearly every day (e.g., no longer wants to play sports or hang out with friends)

• Guilt feelings or thoughts of worthlessness: Feelings of guilt or worthlessness (can present as hopelessness)

• Energy changes or fatigue: Fatigue or loss of energy nearly every day 

• Concentration or attention impairment: An inability to focus and concentrate (may have failing grades or seem indifferent options/choices)

• Appetite or weight changes: Significant weight loss or gain, or a decrease or increase in appetite nearly every day 

• Psychomotor disturbances: Movements that are unusually slow or agitated (e.g., trouble with speech, fidgeting, or restlessness)

• Suicidal thoughts: Recurrent thoughts of death, suicidal ideation, or suicide attempt (kids will often entertain the idea of how life would be without them)

• Sleep disturbance: Either Insomnia or hypersomnia (sleeping too much)

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).

Risk factors for depression

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

• Parents with depression (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 for depression

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 Youth.gov):

• 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 in kids and teens?

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 depression really?

The American Academy of Pediatrics states that in the United States, up to 3% of children and 20% of adolescents have depression. Lifetime prevalence is around 18-20%.

That’s an astounding number to me when I think that nearly 1 in 5 kids in the local junior high are walking around with or will have 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.

Fact Or Fiction: My Kid Has Nothing to Be Depressed About

FALSE

I once saw an ad that said something along the lines of:

You don’t tell someone with diabetes to snap out of it. It doesn’t work that way. The same goes for depression.

I hear parents say, all the time, “What does my kid have to be depressed about?!”

I explain there’s a VERY clear distinction between a fleeting moment of sadness or depressed feeling and a depression disorder. You don’t “snap out of” a disorder.

What I’m Seeing at Work: Pharyngitis

I’ve seen a number of kids with sore throats this past week. The medical term for it is pharyngitis. The most common bacterial cause is strep throat (tested with a throat swab). Most of what I’ve seen in the office hasn’t been strep. (I’ve tested a dozen kids and they’ve all come back negative for strep). What I’m seeing has been caused by either viruses (thank you spreading at school and daycare) or post nasal drip from allergies.

How do you know what you’re dealing with?

Viral sore throats usually have other associated symptoms: runny nose, cough, fever, etc. Allergic sore throats usually have other allergic type symptoms: itchy/watery eyes, sneezing, etc. (no fever or cough).

I’m hoping this a short lived bug in our community; sore throats are miserable.

Money-Saving Tip: Tricks to Fluoxetine

Fluoxetine (the generic for Prozac) is one of the most commonly prescribed psychiatric medications in pediatrics. While it’s not a hugely expensive medication, there are some significant cost differences depending on the form (liquid, tablet, or capsule) and dosing (it comes liquid, 10 mg, 20 mg. 40 mg and 60 mg). Because it’s a medication for a chronic condition for most people, $7-$83/mo. adds up quickly.

General tips: Liquid is the most expensive. Capsules are cheaper than tablets. The 60 mg dose is disproportionately expensive. It is often cheaper to have a script for 3 caps of the 20 mg or a 20 mg and 40 mg to make the 60 mg dose, rather than pay for the 60 mg dose.

Example (using Good Rx and Walmart as the example) for a 30 day supply

2 bottles of liquid $87.96 (volume needed for a 20 mg dose)

20 mg and 40 mg capsules both $4

20 mg tablets (doesn’t come in a 40 mg tablet) $11.72

60 mg tablets (60 mg doesn’t come in a capsule) $24.87

COST SAVINGS in a year between 20 mg capsules and tablets alone: $92.64

Note: The savings is significantly higher if considering liquid vs. capsules or dosing differences.

WWWD: Pink Eye, Part II

I often joke that if it weren’t for my profession, we’d be at the doctor’s office weekly with one of our four kids. I use my skills at home all the time. Here, I’ll share a recent example from home and how I handled it, including the products I used. This isn’t an advertisement—I don’t have any financial interest in these products. I simply have parents ask me all the time about what to do in certain situations and the products I use.

Pink eye complication: periorbital cellulitis

As you can see, things got worse! Overnight, my husband went from pink eye to a full blown peri-orbital cellulitis. This means the tissue all around the eye got infected. In addition to the prescription eye drop, he needed an oral antibiotic.

This is one reason docs like see the patient before just calling in eye drops. You could have a periorbital cellulitis. Left untreated, a periorbital cellulitis can progress to an orbital cellulitis (meaning the infection crosses into the fat and muscles of the eye). This can permanently damage the eye and cause blindness. It’s one of the most serious infections we take care of in pediatrics.

Fortunately for my husband, things slowly started to improve.

Next week, I’ll show you how things resolved.

Recalls & Alerts: Witch Hats & PJs

Funny Things: Stickers

At the end of a visit in our office, kids are allowed to choose a sticker. One clever little 3 ½ year old asked me if he could get a sticker for Hannah.

MD: Who’s Hannah?

Child: My little sister.

MD: (looking at mom puzzled)

Mom: Nope, I’m not pregnant.

You see, my little patient forgot that I knew he was an only child.

Legal Disclaimer: The information provided in this article is for educational and informational purposes only. It is not intended as a substitute for professional advice or medical treatment. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding a medical condition or the health and welfare of your child. We do not endorse any specific products or brands mentioned in this article. Readers are encouraged to perform their own research and consult with appropriate professionals before making any decisions based on the information provided herein.