Technical Assistance Partnership for Child and Family Mental Health

Frequently Asked Questions
MARCH2003

Question: What is Depression?

Depression is a serious form of mental illness that affects all aspects of life. Major depression is one of the mental, emotional, and behavior disorders that can appear during childhood and adolescence. This type of depression affects a young person's thoughts, feelings, behavior, and body. Major depression in children and adolescents is serious; it is more than "the blues." Depression can lead to school failure, alcohol or other drug use, and even suicide. Over 25% of all children referred to the system of care community based programs have a primary diagnosis of Depression/Dysthymia. It is the result of a complex mix of social, psychological, and physical factors, which often trigger sadness, hopelessness, and self-deprecating thinking and behavior. It can come as a reaction to a perceived loss (physical or sexual abuse; auto accident; parents' divorce; best friend's moving; or death of family member, pet, or friend) or can be a lifelong illness that comes and goes in an endless cycle of unhappiness.

Diagnostic Criteria (DSM IV) for Major Depressive Episode At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (I) depressed mood or (2) loss of interest or pleasure.

I. Depressed Mood (or can be irritable mood in children and adolescents) most of the day, nearly every day, as indicated either by subjective account (e.g., feels sad or empty) or observation by others (e.g., appears tearful)

2. Markedly Diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation by others of apathy most of the time)

3. Significant weight loss or weight gain when not dieting (e.g., more than 5% of body weight in a month), or decrease or increase in appetite nearly every day (in children, consider failure to make expected weight gains)

4. Insomnia or Hypersomnia nearly every day

5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

6. Fatigue or loss of energy nearly every day

7. Feelings of worthlessness or excessive or inappropriate guilt (which maybe delusional) nearly every day (not merely self-reproach or guilt about being sick)

8. Diminished ability to think or indecisiveness, nearly every day either by subjective account or as observed by others

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Dysthymic Disorder Dysthymic Disorder is characterized by a chronically depressed mood that occurs for most of the day more days than not for at least 2 years.

Individuals with Dysthymic Disorder describe their mood as sad or "down in the dumps." In children, the mood may be irritable rather than depressed, and the required minimum duration is only 1 year. During periods of depressed mood, at least two of the following additional symptoms are present: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. Individuals may note the prominent presence of low interest and self-criticism, often seeing themselves as uninteresting or incapable. Because these symptoms have become so much a part of the individual's day-to-day experience (e.g., "I've always been this way," "That's just how I am"), they are often not reported unless directly asked about. Children and adolescents with Dysthymic Disorder are usually irritable and cranky as well as depressed. They have low self-esteem and poor social skills and are pessimistic.

What Are Some Common Signs of Depression in Children and Adolescents? Young people with depression may have a hard time coping with everyday activities and responsibilities, have difficulty getting along with others, and suffer from low self-esteem. However, it's important to remember that how they express their depression is usually influenced by their gender, race/ethnicity, age, and culture.

Signs of depression often include

sadness that won't go away,
hopelessness,
loss of interest in usual activities,
changes in eating or sleeping habits,
missed school or poor school performance,
aches and pains that don't get better with treatment, and
thoughts of death /recurrent suicidal ideation.

Younger children often

become clingy/overactive
pretend to be sick/refuse to go to school/worry about their parents death.

Older youth may

sulk/refuse to participate in family and social activities/get into trouble at school,
use alcohol or other drugs/stop paying attention to their appearance,
become negative/grouchy/aggressive/or feel misunderstood.

Adolescents and children with major depression are likely to identify themselves as depressed before their parents suspect a problem.

What Can Parents and Family Members Do?
Meet with a mental health professional as a family.
Read all you can about the illness of depression.
Educate the other adults in your child's world.
Listen carefully and nonjudgmentally. Communicate your observations to your child (e.g., "Are you depressed?" "Can I help?" "I'm worried about you." "Can you tell me what is wrong?" "Can we think about finding someone to help you?").
Develop an activity schedule that will help structure the day and also promote some activity.
Encourage your child to get physical exercise.
Keep normal eating and sleeping routines.
Keep diaries of positive experiences and good things.
Insist that your child participate in normal family child activities (e.g., dinner, church, family events) and positive direction (chores, etc.), even if this only means that he or she is present.
Try not to take your child's negative moods personally. Stay as objective as possible and look at the negative mood as a symptom of illness.
Praise everything you can think of about your child.
Be realistic in determining any family situations that may be contributing to the depression and make necessary changes.
Remember that parents are not responsible for all that is wrong in their children's lives. Do not accept your child's blame for ALL of his or her problems.

Health Education Consultants.P.0. Box 22593. KCMO 64113. (913) 831-1393

What Can Mental Health Professionals Do?
Psychotherapy
Cognitive-Behavioral
Interpersonal, especially for adolescent girls
Systemic Family Therapy

Medication
Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine [Prozac]

U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration. Center for Mental Health Services - 5600 Fishers Lane, Room 13-103. Rockville, MD 20857. Telephone (301) 443-2792.

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	Frequently Asked Questions MARCH2003 Question: What is Depression? Depression is a serious form of mental illness that affects all aspects of life. Major depression is one of the mental, emotional, and behavior disorders that can appear during childhood and adolescence. This type of depression affects a young person's thoughts, feelings, behavior, and body. Major depression in children and adolescents is serious; it is more than "the blues." Depression can lead to school failure, alcohol or other drug use, and even suicide. Over 25% of all children referred to the system of care community based programs have a primary diagnosis of Depression/Dysthymia. It is the result of a complex mix of social, psychological, and physical factors, which often trigger sadness, hopelessness, and self-deprecating thinking and behavior. It can come as a reaction to a perceived loss (physical or sexual abuse; auto accident; parents' divorce; best friend's moving; or death of family member, pet, or friend) or can be a lifelong illness that comes and goes in an endless cycle of unhappiness. Diagnostic Criteria (DSM IV) for Major Depressive Episode At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (I) depressed mood or (2) loss of interest or pleasure. I. Depressed Mood (or can be irritable mood in children and adolescents) most of the day, nearly every day, as indicated either by subjective account (e.g., feels sad or empty) or observation by others (e.g., appears tearful) 2. Markedly Diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation by others of apathy most of the time) 3. Significant weight loss or weight gain when not dieting (e.g., more than 5% of body weight in a month), or decrease or increase in appetite nearly every day (in children, consider failure to make expected weight gains) 4. Insomnia or Hypersomnia nearly every day 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 6. Fatigue or loss of energy nearly every day 7. Feelings of worthlessness or excessive or inappropriate guilt (which maybe delusional) nearly every day (not merely self-reproach or guilt about being sick) 8. Diminished ability to think or indecisiveness, nearly every day either by subjective account or as observed by others 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide Dysthymic Disorder Dysthymic Disorder is characterized by a chronically depressed mood that occurs for most of the day more days than not for at least 2 years. Individuals with Dysthymic Disorder describe their mood as sad or "down in the dumps." In children, the mood may be irritable rather than depressed, and the required minimum duration is only 1 year. During periods of depressed mood, at least two of the following additional symptoms are present: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. Individuals may note the prominent presence of low interest and self-criticism, often seeing themselves as uninteresting or incapable. Because these symptoms have become so much a part of the individual's day-to-day experience (e.g., "I've always been this way," "That's just how I am"), they are often not reported unless directly asked about. Children and adolescents with Dysthymic Disorder are usually irritable and cranky as well as depressed. They have low self-esteem and poor social skills and are pessimistic. What Are Some Common Signs of Depression in Children and Adolescents? Young people with depression may have a hard time coping with everyday activities and responsibilities, have difficulty getting along with others, and suffer from low self-esteem. However, it's important to remember that how they express their depression is usually influenced by their gender, race/ethnicity, age, and culture. Signs of depression often include sadness that won't go away, hopelessness, loss of interest in usual activities, changes in eating or sleeping habits, missed school or poor school performance, aches and pains that don't get better with treatment, and thoughts of death /recurrent suicidal ideation. Younger children often become clingy/overactive pretend to be sick/refuse to go to school/worry about their parents death. Older youth may sulk/refuse to participate in family and social activities/get into trouble at school, use alcohol or other drugs/stop paying attention to their appearance, become negative/grouchy/aggressive/or feel misunderstood. Adolescents and children with major depression are likely to identify themselves as depressed before their parents suspect a problem. What Can Parents and Family Members Do? Meet with a mental health professional as a family. Read all you can about the illness of depression. Educate the other adults in your child's world. Listen carefully and nonjudgmentally. Communicate your observations to your child (e.g., "Are you depressed?" "Can I help?" "I'm worried about you." "Can you tell me what is wrong?" "Can we think about finding someone to help you?"). Develop an activity schedule that will help structure the day and also promote some activity. Encourage your child to get physical exercise. Keep normal eating and sleeping routines. Keep diaries of positive experiences and good things. Insist that your child participate in normal family child activities (e.g., dinner, church, family events) and positive direction (chores, etc.), even if this only means that he or she is present. Try not to take your child's negative moods personally. Stay as objective as possible and look at the negative mood as a symptom of illness. Praise everything you can think of about your child. Be realistic in determining any family situations that may be contributing to the depression and make necessary changes. Remember that parents are not responsible for all that is wrong in their children's lives. Do not accept your child's blame for ALL of his or her problems. Health Education Consultants.P.0. Box 22593. KCMO 64113. (913) 831-1393 What Can Mental Health Professionals Do? Psychotherapy Cognitive-Behavioral Interpersonal, especially for adolescent girls Systemic Family Therapy Medication Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine [Prozac] U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration. Center for Mental Health Services - 5600 Fishers Lane, Room 13-103. Rockville, MD 20857. Telephone (301) 443-2792.

Mental Health and Systems of Care Frequently Asked Questions