Kids and Depression: How Have We Come to This?

Editor's note: Dr. Kathleen gave a recent interview on this important topic. View that feature here. LMH

By the time kids come to see me in the ER with depression, things are usually pretty bad. Yet, I see it all the time, just about every shift I work. Sometimes it’s after an intentional drug overdose, other times when they are caught holding a gun to their head [link to my gun control article]. Twice in the past year I’ve taken care of runaways. Often kids present with the physical symptoms that can be associated with depression—refusal to eat, fatigue, overeating, poor concentration, etc. After listening to their stories and trying to offer a few encouraging words, I can’t help but ask myself “Why?” What has our society come to? Why are so many of our young people so unhappy? Aren’t they supposed to be the hope and promise of our next generation? Can we turn things around?

About 11% of adolescents are diagnosed with a depressive disorder before they turn 18, according to the National Institute for Mental Health, and about 1 in 33 children (under age 12) are depressed. Approximately 15% of depressed people will commit suicide, according to the Agency for Healthcare Research and Quality, 2003. “National Healthcare Quality Report.” Depression affects female adolescents more frequently than males. Depression affects all socio-economic classes, and every type of kid.

It’s only natural to ask the “why” question, to try to find a cause and fix it. I’ve heard all kinds of theories for the cause of America’s epidemic of child and adolescent depression, most trying to point a finger, find something to blame.

“Parents don’t spend enough time with their children—they feel unloved.”

“Kids need more structure, more rules. Parents need to discipline kids, not try to be their friend.”

“Adolescents don’t know what love is anymore, our society is so sexually perverted.”

“It’s all about food—if you don’t eat right, you’ll get depressed.”

… and the list goes on.

I am a general pediatrician, not a psychiatrist or psychologist, and my role with these patients is limited-- I diagnose their depression and either admit them for inpatient psychiatric treatment or recommend outpatient care. I listen to their crying parents, who also ask the question, “Why?” Was it her boyfriend? Her friends? Too much school stress? The people she met online? Her biological father’s bad genetics? Our recent divorce? What did I do wrong? Did I let her cry too much as a baby? She’s been smoking too much marijuana, or maybe it’s all the caffeine she drinks? Is she gay?

Usually it’s impossible to single out one cause for depression. Often depression is an inherited disorder, the result of an unlucky family history.

It’s time we quit pointing fingers at parents, schools, television or society. Sometimes there is nothing to blame. Other times it is simply unproductive to point fingers. Instead, we need to ask “What can we do for our depressed kids?”

Seek professional help—depression is often a fatal illness. As I mentioned above, 15% of depressed people commit suicide. Start by seeing your primary care physician, or going to the ER. Your doctor can make sure depression is not related to medications your child is already taking, and run blood tests to be sure that thyroid or hormonal disorders aren’t contributing to the problem. Your doctor will be familiar with psychiatrists and psychologists/counselors in your area and can make a good referral. Many primary care physicians will start depressed children and adolescents on anti-depressants so that they don’t have to wait until they can get a psychiatrist appointment.
Encourage exercise. Exercise has been shown to be as effective as antidepressants in some studies. Help your child find some form of exercise they really can do on a regular basis. Go for a daily walk with him/her. Encourage dance. Join an aerobics class together. Dust off your bikes. Take a tennis class.
Figure out your child’s love language, and recognize that it might not be yours. I have a child that needs hugs and snuggles several times every day, even when I need my personal space. I have to make time to snuggle with him everyday. Children need love with words, actions, and physical touch. Everyone needs all three, but most people respond better to certain expressions of love. Does your child need to hear praise and “I love you” more? Is this hard for you to say? Or do they need more physical touch, a hand on the shoulder or a hug? It can be especially hard for some dads to show physical love to boys, but perhaps this is what your child needs. Perhaps your child needs more time with you, one-on-one activities, favorite dinners prepared, or other acts of service even when you don’t think they “deserve” it.
Get the alcohol and guns out of your house. The risk of suicide is 5 times more likely if a gun is kept in the home. I know guns have significant financial value and families are very hesitant to get rid of them, even when they have a depressed child. Parents often tell me they’ve hid ammunition or otherwise secured their firearms. But I’ve also seen kids who found the amo… and usually these kids don’t make it to the ER. Alcohol use also increases risk of suicide—1 in 4 suicide victims is legally drunk. If you have a depressed child, leaving alcohol in your home is like handing them gun. Just get rid of it. If you want to have a drink, go out.
Go outside. A 2007 study by researchers at the University of Essex in England found that a daily outdoor walk could be as effective as taking antidepressant drugs for treating mild to moderate depression. And it wasn’t just the exercise: patients who walked in a shopping mall did not get the same antidepressant effect as those who walked through green spaces.
Plant a Garden. A 2009 study from Norway showed what gardeners have known for a long time—that gardening is good for the body, mind an spirit, especially if you are depressed.
Expect that your depressed teen can be very irritable and moody. Remember, their body has been assaulted by changing hormones. If you’re experiencing menopause or andropause, as many parents of teens are, you might be able to empathize with this point. Weathering the storm of such moodiness can be hard. Take care of yourself. Know when you need to take a break from your teen rather than blow up at them.
Hold your tongue when you want to criticize. Depressed teens and kids and be overly sensitive to criticism. Try not to criticize when you are angry. Choose your words carefully and try to find the most effective way to deliver constructive.
Don’t let them withdraw from you. Depressed teens often withdraw from parents, and they can push you away by being very unpleasant to be around. Your job as a parent is not to abandon them.
Help them contribute to your family. Give them manual labor jobs. Paint the house. Pull weeds. Play games with younger children or ask them to hold a baby (with your supervision).
Help them help other people. Do service projects. Serve food at a soup kitchen, volunteer for Habitat for Humanity, raise money for a charity. Try to find ways to help your child think less about themselves and more about others.
Limit time on Facebook and social media. In 2011 the American Academy of Pediatrics coined the term “Facebook Depression” and warned that too much time on social media could lead to adolescent depression. This claim has been disputed, but I think it is still important to realize that social media can’t replace an in-person or even telephone relationships. One study of girls in stressful situations found that those who spoke with their moms on the phone had lower levels of stress hormones after the call than those who conversed with their moms via text messaging. Teens often “market” themselves on Facebook, painting an idealized version of themselves that leaves out reality. Teach your child to market themselves when they need a job, not when they need a friend.
Encourage healthy eating. Yes, diet matters. There is no dietary cure for depression but what you eat can effect your mood. I had one depressed teen tell me all she had eaten that day was smiley face fries and Twizzlers. Limit caffeine and junk food. Don’t skip breakfast and watch school snacks and lunches. Eat a balanced diet and use common sense. There is growing evidence that omega-3 fatty acids and vitamin D may be effective in improving depressive symptoms.
Avoid sleep deprivation by encouraging regular bedtimes and wakeup times. Sleep deprivation in kids and adults is associated with depression. If you have a depressed child, make sure you get enough sleep, too. Sleep deprived parenting doesn’t make you a martyr—only a less attuned parent.
Address addiction. Drugs, alcohol, food, the internet, pornography, sex, and reckless behavior can all be addictive. I’ve even seen kids addicted to eating non-food products such as paper or their hair. Watch for addictive behaviors and address them early.
Take care of yourself. Taking care of kids with depression is exhausting, even depressing. Many parents feel helpless, or have a desire to give up. Violent behavior and disrespect for household rules leads many parents to kick depressed teens out of the house, or let them run away. You can’t take care of a depressed kid unless you take care of yourself first. This was true when your child was a newborn, and it’s still true now. Like they say on the airplane, put your oxygen mask on first, then assist your child.

Someday your child’s depression may turn out to be a gift to them—a life experience that will make them stronger, more compassionate, and better prepared to live a healthy adult life outside of the home. Perhaps it is a good thing that so many of our children struggle with mental illness while they still live under our roofs. This is our chance to help them learn to live with depression and cope with the stresses of life. How could they ever face these challenges alone?

What’s your advice for parents of kids with depression? Have people blamed you for your children’s depression? Have you blamed yourself? What has worked to help your child? How have you helped yourself?