It began in second grade. Suddenly, I didn’t have any friends, or didn’t think I did. I cried all the time. I would worry over things, really worry, obsess over homework or a stray remark — behavior you would normally associate with adults, not children.
Something, I knew, was deeply wrong with me. I thought it would be better if I died. No one loved me. Everything was a gray slog except when it was all terrifying. In retrospect, I know what neither my parents nor the school realized. At age 7, I was caught deep in the grips of depression.
I’m not alone. According to the AAP, 1% of preschoolers, 2% of school-aged children, and 5% to 8% of teens suffer from major depressive disorder. Dysthymia, a milder form of depression, with less severe presentation, shows up in 0.6% to 1.7% of prepubescent kids, and 1.6% to 8% of teens. That’s a heck of a lot of kids — at least two or three of them in every grade in every elementary school in America. The AAP calls depression and dysthymia in children “common but frequently unrecognized.” I wasn’t alone in my misery, nor in the way it went unnoticed by the adults who were supposed to protect me.
Symptoms of major depressive disorder in children can be hard to spot. A child must manifest at least five of the nine symptoms the AAP lists. But the symptoms are maddening in their difficulty to see or quantify. First, a child must be depressed and/or irritable. What kid doesn’t seem irritable from time to time? But if irritability lingers, day in and day out, and your kid is constantly “sensitive,” it may be worth a second thought. I was continually derided as “sensitive” as a child; my mother often snapped at me when I was crying: “You’re being too sensitive.” Instead of revealing a character defect, this sensitivity masked the deep fear and sadness that I felt. Every small cut, even inadvertent, felt like a deep wound.
Your child may also have recurrent thoughts of death and/or suicide. It’s hard to know if that’s the case because you’re not living inside your kid’s head. But a preoccupation with death, asking persistent questions about death, or making comments like, “It would be better if I weren’t here,” warrant concern and a follow-up with their pediatrician.
Diminished interest or pleasure is another major sign. If your kid suddenly doesn’t like the toys and games he once enjoyed, or if he doesn’t show the same interest in the activities he once loved, you need to evaluate him for other signs and symptoms of depression. Imagine a little girl who loved horses suddenly doesn’t care about her riding lessons, or a boy who once loved baseball doesn’t want to play on the team anymore. Yes, kids change their mind all the time, but this is on a different level than the typical “I’m ready to try something new” impulse in young children.
Your child may also seem fatigued. This might mean they sleep all the time, or they may spend all their time on the couch in front of the TV although they once were active and happy.
Children who are in the throes of a major depressive episode also exhibit feelings of worthlessness. I thought no one cared whether I lived or died, and that the world would be better without me. I didn’t think anyone loved me. I once prayed, crying, for God and the Blessed Mother to be my parents, because my parents clearly didn’t love me at all. I wasn’t worth loving. I also thought I didn’t have any friends, when, looking back, I clearly did — or at least had children whom I played with.
A diminished ability to think or concentrate is another hallmark of childhood depression. This can, and often does, manifest itself in sliding grades and test scores. I found, as my depression went on, that I had trouble with basic math, and later, was unable to learn my multiplication tables despite careful practice. These sliding grades only enhanced my feelings of worthlessness which intensified my other symptoms of depression.
Kids will often exhibit either hypersomnia (too much sleeping) or insomnia. I lay awake for hours, convinced drug dealers were going to break into our house and kill us all. You also may see weight loss or gain, along with psychomotor agitation or slowness. Either your kid starts with the nervous tics (mine is picking my cuticles, which started then and always manifests when I’m feeling anxious), or seems slow and sluggish.
You may also see low self-esteem and guilt. These won’t likely manifest in your child speaking about them; instead, you’ll see psychosomatic issues like stomachaches and headaches; anxiety like school or social phobia; and irritability, possibly including behavior problems. Depression is often seen in the company of other mental conditions, especially dysthymia, which often lasts for more than two years; anxiety disorders; and ADHD or ADD. I’m diagnosed with the triple threat of depression, anxiety, and ADD. I suffered from them then, and I suffer from them now.
I received no treatment for my childhood depression. Psychotherapy and sometimes medication are typically recommended. The psychotherapy can include many kinds of therapy, from the familiar cognitive-behavioral therapy to play therapy to even group therapy and parental training. Treatment with medication usually involves SSRIs, and this is decided under the care of medical professionals on a case-by-case basis.
I wish I had received treatment for my depression, beyond the obvious reasons. Very Well details the consequences of untreated childhood depression: relationship problems, recurrent depression or the appearance of other mental illness, reckless behavior, drug or alcohol abuse, academic decline, and suicidal behaviors and possibly even suicide. I suffered from many of these problems and continue to suffer intermittently from depression and severe anxiety to this day. I firmly believe that, had my problems been treated when I was young, my problems wouldn’t be so severe as an adult. I resent that.
It’s scary to think that kids can be depressed. Parents often feel like they’re somehow to blame for it, and that can cause denial — a denial that can hamper their child’s ability to get treatment. If you are concerned your child may be suffering from depression, don’t wait. If they are showing some of the signs listed above, get to your pediatrician and have a talk. They can refer you to someone qualified to assess your child’s mental health and give them the care they desperately need. Depression is one of the most painful things a child can suffer. But you can help.