​This is the second time this blog has covered depression, so if you are looking for information about depression in adults, feel free to check out the post titled: Accessible Steps in Fighting Depression. Today, I’ll focus on exploring how depression can present in children and adolescents, which sometimes appears differently than in adults. The DSM 5 TR by the American Psychiatric Association notes two diagnostic differences in children with depression. First, rather than having a down or depressed mood nearly every day, depressed children may instead present with frequent irritability (APA, 2022). An important caveat is that the irritable mood must be distinct from the child's observed pattern of becoming irritable when frustrated (APA, 2022).  Second, rather than noticeable weight loss or gain, children who are depressed may instead fall short of expected growth metrics as predicted by their doctor (APA, 2022).
 
Since children’s lives often revolve around play, school attendance, and social activity, early signs of depression to watch out for include a sudden drop in grades or a decreased interest in taking part in previously enjoyed activities (sports, spending time with friends, etc.). Other signs could be decreased energy and/or difficulty with thinking and concentration (APA, 2022). Childhood depression may also manifest as social withdrawal (APA, 2022).
 
Parents may feel overwhelmed upon learning that their child may be depressed and may be unsure of how to navigate this development. One helpful tip is to have patience in interactions with the child and model positive and healthy life practices. Good sleep, exercise, and eating can all help alleviate depression, and modeling an optimistic attitude can help children avoid slipping into despair. Encourage your child to spend more time with family and to avoid withdrawing from friends and social activities, as isolation can worsen depression.
 
If you have experience with depression yourself, don’t be afraid to share your own experiences and empathize with your child. Make sure to emphasize that depression is often temporary and that there is no stigma in feeling that way. If you are concerned that your child may be having suicidal thoughts, or if they confide in having suicidal thoughts, do not shame or stigmatize these thoughts. Suicidal thoughts are common in depression, do not indicate that a child will take their own life, and may be scary for a child to be vulnerable about these thoughts. In fact, it is much better for your child to feel comfortable sharing when they are having unsafe thoughts than it is for them to be scared and keep them secret. If your child does verbalize suicidal thoughts, it is recommended to seek out therapy or crisis services and take simple steps to maintain safety, such as locking up guns, removing unsupervised access to sharp objects, and making sure that pills and other potentially poisonous substances are accounted for. Crisis services are generally available at local community mental health centers or at local hospitals.

​By Gabriel Macfee, LCP, LMLP

Gabriel believes firmly that therapy should promote growth in both the client and practitioner, so he is always focused on learning and working. 
 
Works Cited
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association.
 

Depression is one of the most common mental health disorders in the United States — this is not a controversial statement. The DSM 5-TR by the American Psychiatric Association notes that the “twelve-month prevalence of Major depressive disorder in the United States is approximately 7%” (APA, 2022, p. 187).* This means that over one year, approximately 7% of the entire U.S. population will experience at least one episode of major depressive disorder. This number does not include individuals experiencing other forms of depression, such as persistent depressive disorder or premenstrual dysphoric disorder. Cognitive theorists (a school of psychological thinking) believe that depression is primarily fueled by two main issues: first, depressed individuals are overly negative in their beliefs about themselves, the future, and the world (Sokol & Fox, 2019). Put simply, individuals who are depressed speak or think poorly of themselves, believe that the future will not be bright, and believe that the world either is ruined or will be ruined. The second issue is that depressed people behaviorally withdraw from life, which often leads them to reinforce their unhealthy negative beliefs (Sokol & Fox, 2019). For example, it is difficult to determine if you are skilled at running if you never go out to run. Another example, it is difficult to notice that the weather outside is great if you don’t smell the roses.

While depression is a complex interaction of social, psychological, and biological factors, here are some suggestions to potentially assist you in managing depressive symptoms. To address negative thinking, the simplest step is to notice and/or document when, how often, and what you are thinking about when you are feeling down. Many people are surprised when they discover just how much of the day is spent brooding when feeling depressed. Once you are aware of your unhealthy negative thinking patterns, consider alternative perspectives. Next, compare and contrast your mood when you adopt the alternative thought process versus your typical ruminative thought process. For example, rather than ruminating on “today is bound to be awful,” the alternative could be, “today could be hard, but maybe something enjoyable could happen as well.”

To address the behavioral withdrawal, the most accessible step to take is to become behaviorally activated. Go for a walk, start a new hobby, call a friend on the phone, bake a cake. Get up and move your body, or spend time with someone with whom you can take in new data to compare with your negative beliefs. Avoid doomscrolling and staying in bed all day. Depression often contributes to a sense of inertia that makes you believe you must be “in the mood” to do something when, in reality, this is false. The research shows that “action in the face of depression is what leads to energy, motivation, and a positive mood” (Sokol & Fox, 2019, p. 75). If depression persists, it is, of course, always a good idea to seek out additional support and treatment.

*American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association.
Sokol, L. & Fox, M. (2019). The comprehensive clinician’s guide to cognitive behavioral therapy. PESI Publishing.

By Gabriel Macfee, LCP, LMLP

Gabriel believes firmly that therapy should promote growth in both the client and practitioner, so he is always focused on learning and working.