How to Treat Depression in Children

Depression is, by most accounts, on the rise among America’s children. A recent study published in the journal Translational Psychiatry provided the most disturbing news yet. It looked at data on adolescents ages 12 to 17, from the 2009 to 2014 editions of the National Survey of Drug Use and Health, an annual cross-sectional survey conducted in a representative sample of the U.S. population. Researchers concluded that a whopping 36.1 percent of girls had experienced a first bout of depression. Boys were recorded at 13.6 percent – much lower, but still alarmingly high.

Those children also exhibited more behavioral and academic problems than children with no history of depression, prompting the study’s authors to write: “High levels of impairment, suicide attempts, conduct problems and poor academic functioning argue against a ‘wait and see’ approach to clinical treatment of recent first-onset depression.” In other words, getting depressed kids into proper treatment is paramount.

But how do you treat a child with depression? Children, as most health practitioners are quick to say, are not “small adults.” They have their own biochemistry, their own cognitive capabilities and their own tolerances for medications, psychotherapy and other common treatments for depression. They also have more erratic and potentially dangerous reactions to those treatments, particularly medications. That’s why parents should employ the skills of a trained child and adolescent psychiatrist or psychologist for any child with mental illness.

Psychotherapy

“Most psychiatric symptoms were first described for adults, then later extrapolated to kids,” says Dr. Steven C. Schlozman, assistant professor of psychiatry at Harvard Medical School and associate director of the Clay Center for Young Healthy Minds. “That makes it a bit like fitting a square peg into a round hole.” That fit is made smoother by adding knowledge about childhood development into the geometry, he says. For instance, depression in children may manifest as irritability, rather than sadness or melancholy. “It is important for the physician to recognize this, because you might not think of someone who is irritable as being depressed,” he says.

Likewise, treatments must be adjusted to meet the developmental stage of the child. The treatments are, in broad strokes, the same as those used for adults. The American Academy of Child and Adolescent Psychiatry, or AACAP, says that treatment for childhood depression should include both psychotherapy and medication. “In milder forms of depression, it is reasonable to start with a psychotherapy, but treatment with a medication and psychotherapy should be considered for moderate to severe forms of major depression,” it recommends.

The AACAP says the following therapy styles can be used to help depressed children:

  • Individual therapy. Well-studies therapies include cognitive behavior therapy, or CBT, and interpersonal therapy, or IPT. CBT teaches how to recognize and change unhealthy patterns of thinking that cause feelings and moods that can affect behavior. IPT helps depressed children identify interpersonal events and how these events affect their relationships, their moods and their lives.
  • Family therapy. Here, a therapist helps the entire family – the child or adolescent, parents, siblings and even grandparents – improve communication and support skills to work together in more positive and constructive ways.
  • Group therapy. Multiple patients are led by one or more therapists who teach the group how to better understand and recover from depression.