1. Childhood Depression

2. Characteristics A prolonged unhappy or irritable mood
Change of attitude toward family, friends, life
Marked change in eating and sleeping habits
Develops slowly unless reactive
Lasts from a few weeks to years or permanent
Is associated with suicide.

3. Mood Mood disturbance: cannot ‘snap out of it’ unhappy, tearful
pessimistic, negative
self destructive
hypersensitive, irritable
may look ill, lack ‘bounce’
writes poetry with morbid themes
may claim being ‘bored’

4. Cause unknown in most cases
Physical / Genetic
Change in the concentration of neurotransmitters. Reduced serotonin, Increased 5-hydroxytryptamine 2 (5- HT2), abnormal noradrenergic activity
Linked to a family history, illness occurs earlier when family history, highest where an identical twin commits suicide
Psychological factors:
learning difficulties
excessive sense of responsibility for others
excessive sensitivity, ego vulnerability
low self esteem, poor body image
internal locus of control for -ve outcomes
external locus for +ve outcomes
Environmental factors (reactive)
war and social instability
death of a loved one
rape, injury, chronic illness
family problems (violence, drug abuse, divorce), dysfunctional family
poor school experience (bullying)

5. Diagnosis May be under-diagnosed in UK
Children sometimes unable to express how they feel
Misdiagnosed as conduct disorder
May be masked by co-existing mental illness

6. Signs
Low self esteem
worthless, useless, stupid, ugly, running away, hate themsleves
Doesn’t care what happens to him / her
No interest in doing well
Sleep problems (usually sleeping less)
all night TV watching
difficulty in getting up in the morning
Food problems
anorexia
bulimia

7. School poor concentration dropped performance lost interest truancy
disruptive
suicide threats
Problems with friends
Losing friends
Lonely
Lack of interest in usual activities.

8. Suicide Serious risk in children and adolescents
Management
Naïve methods should be taken seriously
He may do better next time
Serious risk in children and adolescents
2000 annually in US, increasing
Most in adolescence and young adults
Peak incidence 15 years
Boys > Girls [3:1] (but <girls have depression and suicide attempts [9:1])
Commonest methods:
Females: Overdose, Wrist cutting
Males: Gunshot (US), Hanging

9. Risk factors (suicide)
drug and alcohol misuse
availability of guns (US)
homosexuality
child abuse
family history
personal crisis
family conflict
life change
mental illness
serious chronic illness

10. Treatment Selective serotonin re-uptake inhibitors (SSRIs, Prozac)
Psychotherapy
Active listening
Advice and encouragement
Family therapy
Treatment of co-existing conditions

11. Treatment Poorly organised in this country (? better in US)
Stigma of treatment
Effective??
No fast cure
Cause and pathology not understood
Some drugs may be useful (also dangerous)
Range of treatments indicate lack of effectiveness
Society lacks ‘someone to talk to’
Stressors that may not seem important to an adult may be significant to a young person

12. Further reading
Brown, H., N. Pearson, et al. (2013). "Physical Activity Interventions and Depression in Children and Adolescents." Sports Medicine 43(3):
Davis, N. M. (2005). "Depression in children and adolescents." Journal of School Nursing (Allen Press Publishing Services Inc.) 21(6):
Greenberg, B. R. (2009). "How to recognize depressive disorders in children and adolescents." JAAPA: Journal of the American Academy of Physician Assistants (Haymarket Media, Inc.) 22(3):
Murphy, K. (2004). "Recognizing depression in children." Nurse Practitioner 29(9): 18.
PaixÃO, M. J. G. (2013). "Systematic review summary - Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents." Singapore Nursing Journal 40(3):
Pilcher, E. (2008). "Childhood depression in contemporary Australian society." Nuritinga(9): 1-9.
Thomas, S. P. (2012). "Preventing Childhood Depression." Issues in Mental Health Nursing 33(5):
van der Veek, S. M. C., R. A. Nobel, et al. (2012). "The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression." Psychology & Health 27(11):