This is Part Two in our Winter 2013 blog series Understanding Depression in Kids and Teens…A Primer for Pastors, Church Staff and Christian Parents. Today, we’ll help readers develop a mental picture of what they might notice in a child or teen experiencing an episode of Major Depression.

Yesterday, I made a point of emphasizing the difference between sadness and depression. Sadness is an emotion, depression is a mood state. A good analogy to think about is that sadness is like the weather outside at any given time, while mood is more descriptive of the climate. Last Sunday, it was 62 degrees outside when my wife and I left the house for church. That’s a highly unusual situation on the second Sunday in January living in the teeth of Northeast Ohio’s “snow belt.” That’s very similar to what we see with kids with depression. While they may experience fleeting moments of joy or happiness, one of the cardinal features of depression is that kids or teens with the condition are sad or unhappy most of the time, most every day, with a minimum duration of symptoms of at least two weeks.

When kids experience depressed mood as a direct result of an identifiable stressor in the past three months without meeting full criteria for a major depressive episode (typically, they lack the physical signs and symptoms associated with depression), we classify their symptoms as an Adjustment Disorder with Depressed Mood as opposed to Major Depression. Some common examples would include a child’s response to a parent’s illness, a family move related to job relocation or for teens, a breakup with a boyfriend or girlfriend. These reactions tend to be time-limited (by definition, no longer than six months), represent a level of distress in excess of what is typical for the stressor and result in significant social or academic impairment.

The other cardinal feature of depression is anhedonia…a markedly diminished interest in, or ability to obtain pleasure from previously enjoyable activities. Things that are normally fun for kids aren’t fun anymore. Some red flags for a youth pastor would include a kid who regularly attend church missing more than two consecutive Sundays, disappearing from small group, or turning down the opportunity to go on a retreat after having enjoyed them before absent a clear scheduling conflict. A parent might notice their child isolating themselves, becoming more withdrawn, not wanting to do things with friends, not exhibiting their usual excitement for vacation or a trip to a water or amusement park. An adult with depression might experience anhedonia as a markedly diminished sex drive. In order to meet the criteria for Major Depression, kids have to have at least two weeks of depressed mood and/or anhedonia.

Other symptoms parents or church staff might notice…

• Significant changes in eating habits or weight (+/- 5% of baseline body weight). Kids experiencing depression often lose significant amounts of weight without attempting to diet. Kids with seasonal depression may gain weight…think of a bear in hibernation. Note: Weight loss is a common side effect of stimulant medications used to treat ADHD, while weight gain is a very common side effect of antipsychotic and antidepressant medication given to kids. Kids and teens may be very sensitive to questions about weight as body image concerns are a common target for bullies.

• Significant changes in sleep patterns…either insomnia or hypersomnia. Kids with ADHD and anxiety typically have difficulty falling asleep. Kids with depression typically have difficulties staying asleep. It’s not unusual for kids with depression to present to our practice with middle insomnia (being awake for extended periods in the middle of the night) or terminal insomnia (waking up too early in the morning on a regular basis without getting back to sleep). I’m more inclined to recommend medication or medication plus therapy when kids experience middle or terminal insomnia along with depressed mood.

• Significant changes in motor activity, readily observable by others. Kids who were never before fidgety, restless or hyperactive may become so when depressed…they may also experience these symptoms as a side effect of antidepressant medication. Kids who were very physically active before becoming depressed may become markedly less active during an episode of depression.

• A marked decrease in energy or daily/near daily complaints of fatigue.

• Excessive feelings of worthlessness or inappropriate guilt nearly every day…these symptoms are also common among kids with specific anxiety disorders.

• Significantly diminished ability to think or concentrate. Kids with “comorbid” ADHD often have longstanding difficulties with focus or concentration that predate their depressive episodes, but may experience a change from their already diminished ability to concentrate when they develop symptoms of depression. The teen who has always been highly organized who abruptly experiences problems with work completion or organization or experiences a precipitous drop in grades should be screened for depression.

• Recurrent thoughts of death or suicidal thinking/behavior. Note…cutting or self-injury is not necessarily indicative of suicidal behavior, and has (unfortunately) become a common strategy for school-age children and teens attempting to self-manage anxiety.

When compared to adults, children with depression may be more likely to experience temper tantrums, irritability, low frustration tolerance, physical complaints and/or social withdrawal. They are less likely to experience delusional thoughts or attempt suicide compared to teens and adults with depression.

Here’s a summary slide comparing differences in how depression may present in children versus teenagers…

Photos courtesy of  freedigitalphotos.net

Today’s recommended resource…As part of their Depression Resource Center, the American Academy of Child and Adolescent Psychiatry has a webpage addressing frequently asked questions about depression.

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