More Than the Winter Blues
Depression can strike any age or gender, and the symptoms can vary widely. Parents need to know what to look for and what treatments are effective to keep kids—and themselves—in good spirits.
By Dwain Hebda
Depression is one of, if not the most common mental health diagnosis. It affects all ages, both genders and according to the Centers for Disease Control, the estimated 2.1 percent of young people ages 3 to 17 diagnosed with clinical depression grossly underreports the actual scope of the issue.
Yes, you read that age range correctly. Children as young as elementary school can and do suffer from depression, although assessing an accurate number is difficult. The American Academy of Child & Adolescent Psychiatry estimates that about five percent of American children and adolescents suffer from the disease, but chances are good you wouldn't know depression in your child because the symptoms don't match stereotypes.
"Adults’ symptomology usually is going to be your very clinical depression that we think of—withdrawing, isolating, crying, tearfulness, poor sleep," said Katie Walker registered play therapist with Chenal Family Therapy's North Little Rock practice. "For kids, it’s almost the opposite of how adults process depression. They look very different."
Children suffering from depression will often display anger, Walker said, because they lack the coping skills to express sadness in the same way an adult does. Nightmares and other sleeping difficulties, acting out and problems concentrating in school are also common symptoms not usually thought of as depressive by the general population. What's more, this biological inability to process emotions can last through middle school and into high school.
"When teenagers go through their hormones, around ages 12 to 15, they actually function the same as a toddler," Walker said. "I would say up until 15, you’ll still see very much elementary age emotion. Then starting at 16 or 17, towards the end of adolescence, is when they’re really going to start understanding sadness and processing it more as an adult does."
Middle and high schoolers were the subject of a 2015 study by the National Institute of Mental Health on major depressive episodes. The study looked at individuals ages 12 to 17 who experienced depressed mood of at least two weeks and displayed at least four depressive symptoms. The study found such occurrences were most frequent among 15- to 17-year-olds and among mixed race children than among other age and ethnic categories. Girls were more than three times more likely than boys to suffer a major depressive episode.
Given the prevalence of the condition, treatment options have multiplied. Among newer therapies is eye movement desensitization and reprocessing (EMDR), a trauma therapy often used to address an underlying event that may be at the root of depression. There's also a growing demand for essential treatments that don’t include pharmaceuticals.
Walker's specialty, play therapy, is another relatively new treatment. Play therapy helps harness a child's ability to express themselves using toys, paints, puppets or other play materials in ways their limited comprehension and vocabulary can't.
"A few years ago, there weren't many registered play therapists. A lot of kids just went to treatment and it was regular talk therapy," Walker said. "But that kind of treatment doesn’t work for children. Children don’t have the brain capacity or capacity at all to say, 'I am sad because...' That requires very high prefrontal cortex thinking. Play therapy is a great way to reach the brain and let them process through it."
One highly-effective treatment for adult depression many people don't know still exists is electroconvulsive therapy (ECT), where highly controlled mini-doses of electricity that last from under a second to about two seconds are administered to the brain. Generally reserved for problematic cases or where other treatment options have failed, it's considered a highly-effective option.
"If you take a severely depressed person they have about a 60 percent chance of getting effective improvement with medicines," said Dr. Richard Owings, partner with Psychiatric Associates in Little Rock. "About 90 percent will get improvement with ECT."
Owings, who conducts the therapy at The Bridgeway in Little Rock, has been performing the procedure since 1993 and said a common analogy for how ECT works is like rebooting a computer. Patients' neuro processes can get caught in a feedback loop they can't get out of.
"When you do ECT, it essentially disorganizes the brain," he said. "We do EEG monitoring and right after the stimulus you just see erratic random waves. But after about 30 or 40 seconds you’ll start seeing coherent coordinated waves." The primary side effect of ECT is about half the patients experience some form of memory loss, ranging from temporary to severe. About 10 percent of patients simply don't do well with ECT or medication at all.