Depression has no respect for age. It can affect children and adolescents as easily as adults.
But, children also may try to compensate for their unhappy feelings by turning to drugs or joining a rebellious group. They may express suicidal thoughts or even attempt suicide."There is one distinct difference between pre-adolescents and adults," said Eliza E. Wochnik, a child psychiatrist at Utah Valley Regional Medical Center.
"Kids don't have a good concept of death until age nine. If you ask them what happens after death, they may say a person goes somewhere and doesn't come back or may be buried in the ground. But they say `I don't know how this person will breathe.'
"Also, children are more impulsive. They may make a suicidal gesture because they want attention. They are saying `Look at me. I'm disappointed, I'm suffering.' They may not mean to commit suicide, but they are impulsive. They may not know how far they are going."
It is often these behaviors that finally alert parents to the fact that a child is experiencing a problem.
At UVRMC, 80-90 percent of the children and adolescents being treated by the Behavioral Medicine Unit suffer from depression, although many were initially brought to the hospital for treatment of another problem, such as a suicide attempt or drug abuse.
"Kids have more stress today," said Wochnik. "There are so many demands on children and families . . . to achieve, to belong . . . competition and peer rivalry. Depression is usually the basis of other problems. But children can't express themselves, and parents may not realize that's what the problem is."
By the time a child is brought to the hospital for treatment, the parents often are angry, said A. James Morgan, medical director of the Behavioral Medicine Unit.
"They've tried all the parental things and it doesn't work," Morgan said. "Parents almost always feel guilty."
The first step in treating children is to try and unravel all the factors that may be causing their symptoms. In some cases, a chemical imbalance may be picked up through blood analysis, but such tests are not very reliable, Wochnik said. A family's medical history may be more indicative of a possible genetic cause for depression.
"We may find outstanding things - the mother's brother is manic depressive, there is a blood relative with a depressive mental illness," Morgan said.
"Most people don't put together that these things are connected. Sometimes we find a relative with an alcohol or drug dependency problem. It is so relieving to a family to find the problem is chemical or inherited and that it is not caused by something they've done wrong."
Depression caused by external factors - moving, a divorce, failing to make a team, etc. - also results in chemical changes in a child's body.
Anti-depression medication is used to treat depression caused by both kinds of factors and is combined with individual and family therapy.
Only in extreme cases, where a child is dangerous to him- or herself or to others, is hospitalization required. In addition to medical and psychological treatment, a child receives three hours of schooling a day during hospitalization, Morgan said.
Medication is usually taken for six months to one year and then gradually tapered off; therapy follows a similar timetable. However, unless depression is situational, it often recurs.
-Disappointment of not being chosen for a sports team.
-Breaking up with a girlfriend or boyfriend.
-Difficulty getting along with family members.
-Inability to concentrate.
-Difficulty functioning at school.
-Loss of appetite or overeating.
-Withdrawal from friends and activities.