8/8/2019 Do Children Get Depression

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Do children and adolescents get depression?

The answer is of course yes they do. For a long time however, the existence of affective disorders,

especially depression was disputed in children.

Physiologically, you can understand why there is.. or why there was at one stage a disagreement. The

monoamine theory of depression which were all familiar with says that depression results from the

deficiencies of specific monoamines, importantly serotonin and noradrenalin.

The noradrenalin system in humans doesnt fully mature for many years, and yet very young children

are being diagnosed with clinical depression. So this depression in young children, is it qualitatively

similar to depression in adults, or a manifestation of something else? Does that make sense? Like, if 

children dont have a fully working noradrenalin system, and we know noradrenalin plays a role in the

aetiology of depression, it is a relevant question how can children have depression?

 

Now the serotonin system develops very rapidly in children, with neurotransmitter concentration,

uptake and binding very similar to adult levels within a few years of birth. So I guess the question here is

- is depression in children a serotonergic phenomenon. Could that possibly explain why only fluoxetine is

clinically effective in treating paediatric depression.

 

Which brings us to another point...most of the pharmacological agents used to treat adult depressionare not efficacious in treating childhood depression, which again, possibly suggests a different

underlying aetiology.

 

But the above arguments are flawed because they reduce depression to a neurochemical anomaly

whereas in reality, depression is simply a feeling of low mood for a specific period of time. It is, at least

in part, an abnormal response to stress - and children, more so than adults experience things around

them that they perceive as stressful, or that they are less able to make sense of. For instance, why are

my parents getting divorced? Is it my fault? Why did my dog die?  As adults, we can rationalise and cope

with such events, but children dont have the emotional intelligence to do so and may respond by

becoming depressed.

 The main difference between adult and paediatric depression then, is that adults are able to

appropriately convey how they feel. Some children may be able to talk about their emotions, but again,

others may not have the emotional literacy to articulate their feelings and can only express how they

feel through the way they behave. So depression in these children may manifest as behavioural

problems, termed masked depression

 

With respect to young children, typical features of depression include reduced performance at school

irritability, fatigue, changes in sleep and appetitive so basically many of the symptoms seen in adult

depression. Adult and paediatric depression share many risk factors, such as environment, significant life

events, genetics. Incidentally, many of the same genes are implicated in susceptibility, in both adult and

childhood depression, the suggestion of course, being that children DO get depression and it IS 

qualitatively similar to depression in adults.

When it comes to depression in teens, things get a bit trickier because of the way it presents. If you go

onto govt websites, they tell parents to watch out for drug taking, social withdrawal, irritability, being

self-critical. This can be part of normal adolescent development and this is where interview techniques

come into play which was covered earlier.

 

So in summary, yes children, like adults get depression. The main differences are that children may not

be able to articulate how they feel, and depression may present atypically.