While there are many types of mood disorders, the three most common types of depression in children according to the Surgeon General's Health Report are major depressive disorder (MDD), dysthymic disorder (DD), and bipolar disorder (BD).
Major depressive disorder is a severe condition in which a child experiences episodes of depression. The episodes typically last 7 to 9 months. According to the DSM-IV, symptoms of childhood depression can include:
- Academic decline
- Withdrawal from friends and family
- Thoughts or actions of self-harm
- Loss of interest in things of past enjoyment
- Problems with sleep
- Appetite and/or weight changes
- Feelings of guilt or being misunderstood
- Clinging to a parent
- Unexplained crying
Approximately 2 to 3% of children under age 10 meet the criteria for MDD, but between the ages of 10 and 14, the rate increases to 5 to 8% for children overall. Approximately twice as many girls will experience depression as boys by age 15. Prior to puberty, boys have a higher rate of depression than girls.
Recovery rates for MDD are high for children who receive treatment. However, so are recurrent episodes of depression. The National Institute of Mental Health (NIMH) suggests early identification and treatment of depression in children, given the short- and long-term consequences, such as poor self-esteem, substance abuse, risk-taking, poor academic performance, poor social development, and risk of suicide.
Dysthymic disorder is a persistent but milder mood disorder than MDD, lasting at least two years. Children with DD are more functional than children with MDD. Despite their symptoms, children with DD can usually attend school and participate in activities that some children with MDD may not be able to. Children with DD may have suffered with DD for so long that they believe their depressed state is "normal". Parents or others close to the child may just think that she has a shy or introverted personality rather than a depressive disorder.
Symptoms of DD in children are similar to symptoms in MDD, but less severe. The rate of DD in children is 3%. According to Dr. Daniel Klein and colleagues, who published a study in The Journal of Psychiatric Research in 2008, 75% of those children go on to experience MDD. The combination of MDD and DD it is considered double depression.
Recovery rates for dysthymic disorder are high in children, especially with appropriate treatment. Again, so are relapses. Dr. Klein and colleagues found that relapse rates for DD were approximately 70% over 10 years in children. Additionally, it was reported that the longer a child lives with DD, the more likely she is to experience MDD or DD.
Depression can occur as part of bipolar disorder. This is a condition in which the child experiences manic as well as depressive episodes.
There is some controversy over the diagnosis of bipolar disorder in children. However, Dr. Elizabeth Weller, a psychiatrist whose review of childhood BD was reported in Psychiatric News in 2002, reports that while BD is rare in children, it exists and is often misdiagnosed.
The onset for BD is typically late adolescence or early adulthood, but can occur in young children. Symptoms of BD in young children are different than in adults: Children before age 9 may show irritability and psychomotor agitation, increased or repetitive movements, paranoia, and psychotic symptoms.
After the age of 9, BD symptoms are similar to adults with BD: Elation or overly excited state; risk-taking; ability to function on little or no sleep; racing thoughts; fast or loud talking; disorganization; and exaggerated sense of abilities or accomplishments.
A 2007 press release from the NIMH indicated that rates of childhood bipolar disorder were approximately 1%, which is a forty-fold increase over 10 years.
Treatment is always needed for children with BD given its serious consequences, like poor academic performance, disturbed personal relationships, substance abuse, and suicide. Medication can be helpful in stabilizing a child's mood, but BD is often a lifetime disorder.
What Parents Can Do
If you notice symptoms of a depressive disorder in your child, consult with her pediatrician immediately. A physician can rule out an underlying medical cause and recommend treatment when appropriate.
While it can be terrifying to hear that your child has a depressive disorder, it is not a "life sentence." With treatment and support, your child can recover and enjoy her childhood.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.
Depression and Suicide in Children and Adolescents. A Report of the Surgeon General. Access: 08/09/2010. http://mentalhealth.about.com/library/sg/chapter3/blsec5.htm
Jim Rosack. "Bipolar Disorder Often Misdiagnosed In Children, Expert Says." Psychiatric News , July 5, 2002 37(13): 26.
NCHS Data Brief: Depression in the United States Household Population, 2005-2006. Centers For Disease Control. Accessed: 08/09/2010. http://www.cdc.gov/nchs/data/databriefs/db07.htm
Press Release: Rates of Bipolar Diagnosis in Youth Rapidly Climbing, Treatment Patterns Similar to Adult. September 03, 2007. National Institute of Mental Health. Accessed: 08/10/2010. http://www.nimh.nih.gov/science-news/2007/rates-of-bipolar-diagnosis-in-youth-rapidly-climbing-treatment-patterns-similar-to-adults.shtml
What are the Signs and Symptoms of Depression? National Institute on Mental Health. Accessed: May 30, 2010. http://www.nimh.nih.gov/health/publications/depression/what-are-the-signs-and-symptoms-of-depression.shtml