The Depressed Child

In one month, 11-year-old Sally changed from being a happy, easy-going child to being irritable, anxious, and unable to eat or sleep. "Her personality suddenly and completely changed," says her mother, Dee Brestin, a best-selling author.

What could have triggered such a change? The Brestins had recently adopted Anne, a 5-year-old Korean girl. Although Sally had been eager for a new sister, the reality of a new sibling caused stress and extreme jealousy. Sally had to adjust to being dethroned as the youngest child and only daughter in a family of boys.

"She had a perfect world before Anne arrived. She had no idea how to share attention," says Dee. I was often upset with Sally during this time. I thought, We've given her everything. We bathed her in love, prayer, and security. Why can't she show a little mercy toward this little orphan so in need of love? Why can't she just snap out of it?

It was Dee's husband, Steve, who realized there was more to Sally's moodiness than adjusting to a new little sister. "Steve would lay next to Sally on her bed, stroking her hair, praying for her for hours, often as she sobbed herself to sleep. But Steve knew." says Dee. "He is a physician who has experienced depression himself. He recognized Sally's symptoms and was aware that depression runs in families. We took Sally to a doctor for testing and she was diagnosed with a chemical imbalance, triggered by stress. Sally was suffering from depression. My heart sank with thoughts that I had done something wrong, but what I have learned is that depression is not a character weakness or a sign of parental failure, and it isn't a bad mood that a child can snap out of."

Depression is defined as an illness when the depressive condition persists. It's real, even for children. "It's occurring in more young children than ever before," says social psychologist Ronald Kessler of Harvard Medical School. "Even the most nurturing environment can't always save a child from depression." And that includes healthy, loving Christian families like the Brestins.

Until recently, it was assumed that kids don't get depressed. But new findings from the National Foundation for Depressive Illness suggest that 5 to 10 percent of all children and adolescents suffer from depression at one time during their growing-up years. The good news is that once detected, depression in children is highly treatable. Doctors and researchers say early detection is key. They believe if children are treated early and taught coping skills, they can prevent lifelong episodes of the illness.

Depression versus the blues

Everybody gets the blues now and then—it's a normal part of our human experience. But depression goes beyond a bout of sadness or a bad day, even beyond the grief felt with a major loss (see sidebar). Clinical depression is an illness and it can take a devastating toll on a child, potentially hindering the development of crucial social, emotional, and cognitive skills. A study from Yale Medical School shows that youngsters who experience depression are three to four times more likely than peers to have drug or alcohol abuse problems by their mid-20s.

Bringing in the professionals

Doctors recommend that when a child has a drastic change in personality and symptoms last more than two weeks, he or she should be evaluated. Start with your family physician to rule out any other causes for the change in personality. Don't assume that depression can't happen to your child. Studies show parents consistently miss signs of depression, chocking it off to teenage angst. It is just as serious an illness as diabetes or asthma.

Why do kids get depressed?

There are no clear answers as to why childhood depression is on the rise, but findings suggest that a complex blend of genetic, biochemical, personal, family, and spiritual factors can interact to trigger depression.

Depression has a genetic link, doubling the risk factor for some kids. If a parent is currently struggling with depression, statistics suggest a child is three times more likely to develop depression.

Children who experience stress through divorce or the death of a loved one, or who have learning or behavior disorders are all at a higher risk for depression. Kessler's Harvard study concluded that depression in today's kids could be anxiety-driven fears about personal safety and the pressure to succeed. His study finds a strong stress-depression link in teens.

Girls have about twice the depression rate of males and adolescent girls tend to dwell on problems such as popularity, appearance, and family issues more than boys, keeping girls depressed longer.

Still, boys are at risk for depression. In the book, Real Boys: Rescuing Our Sons from the Myths of Boyhood (Random House), author William Pollack claims that boys are seriously under-diagnosed for depression, Pollack's studies show that because boys have been taught traditional macho attitudes, some have no healthy way to vent their unhappiness. Consequently, the unhappiness turns to anger and the anger turns to depression.

The counseling question

While in some cases prescription medication is advised for the treatment of depression, the National Mental Health Association insists that no child should be medicated without counseling, stressing that medication alone isn't a cure-all. Robert McGee, founder of Rapha Treatment Centers, says that while medicine can help people deal with the symptoms of depression, counseling is needed to deal with destructive thinking patterns. Early treatment and diagnosis can help a child before such patterns become permanent, creating lifelong difficulties.

Dwight L. Carlson, a doctor and the author of Why Do Christians Shoot Their Wounded (InterVarsity), says, "Good biblical counsel can play a large part in restoring people." He suggests investigating your options with a qualified mental-health-care professional who specializes in treating depression in children and teenagers. Medical doctors, psychologists, counselors, ministers, and youth pastors can all provide helpful information and support for your family. One couple whose son suffers from depression has found therapy to be an invaluable resource, not just for the counseling, but also for the expertise, such as when hospitalization was needed or to discuss schooling options.

Each year an estimated 500,000 to 1 million prescriptions for antidepressants are written for children and teens. There is much controversy over giving children antidepressants. A study at the University of Texas determined that the effect of Prozac on children is essentially the same as it is for adults. A New York Long Island Jewish Hospital study found that medication is very effective in treating children for depression and that most children take the non-addictive medication for six months or less with few relapses reported. Little is known about long-term effects of antidepressants on children, but most doctors insist the drugs are a blessing to children in need.

For Sally Brestin, an antidepressant meant the difference between misery and wholeness.Through counseling, loving and supportive relationships with family, and God's mercy, it wasn't long before Sally felt better. In time, she was able to love Annie as deeply as the rest of the family did.

"I encourage parents to be open to medical treatment," advises Dee. "It is too easy to just get medicine, though I think Sally needed that so that she could start sleeping and eating before she was able to deal with the spiritual issues. It is akin to feeding the starving before you deal with their need for Christ."

Christians and depression don't mix

Christians don't like depression. We are ambivalent and reticent to deal with it as an emotional or biological reality. We add layers of spiritual rationalization, calling it sin, weakness, or judgment. "Does it mean I'm not really a Christian if I get depressed?" asks one teen boy.

In his book David (Word), Chuck Swindoll writes: "I weary of the philosophy that the Christian life is just one silver-lined cloud after another—just soaring. It is not! Sometimes the Christian life includes a deep, dark cave."

Dee Brestin bristles over this subject. "There's a much greater stigma about depression in the Christian community than in the secular one. The health and wealth gospel tells us we shouldn't need medical help, but that kind of guilt sinks a struggling Christian. I believe sin can be a reason for depression. But there is pressure from well-meaning but uninformed Christians to go off medication and to 'trust God.' Would they suggest to a diabetic to stop taking insulin?"

Christians may put a stigma on depression, but God certainly doesn't. The Bible is filled with examples of dynamic, effective believers who suffered from depression. King David, a deeply passionate and gifted man, poured out his troubled heart to God in many poignant Psalms (such as Psalm 77). Elijah, one of Israel's greatest prophets, was so depressed that he prayed he would die (1 Kings 19:4). God did not get angry with Elijah but loved him, sending angels to feed him a nourishing meal. God whispered to him gently and led him to a friend, Elisha.

Parents make a difference

A parent can have a huge impact on a child locked in depression. "Supporting your child as he gets help teaches him early in life to exercise a valuable life skill—that it's okay to ask for help when we need it," says Linda Kondracki Sibley of NACR (National Association for Christian Recovery).

Sally Brestin, now grown and married, shares her story at teen and parent groups to educate and help diminish the stigma of depression. She feels her depression was a dramatic, spiritual turning point. Not long after recovering from her depression, she re-committed her life to the Lord. "Looking back, it was the hardest time in our lives," says Dee. "We wanted to do what was right, so we just held on."

Suzanne Woods Fisher is a writer with four children.

Know the signs

Child and adolescent psychiatrists advise parents to be aware of these warning signs of depression in their children. If you see these signs in your child, talk with your family doctor or a mental health professional:

___ Persistent sadness and hopelessness

___ Increased irritability or agitation

___ Withdrawal or isolation from friends and activities once enjoyed

___ Changes in eating and sleeping habits

___ Indecision, lack of concentration, or forgetfulness

___ Poor self-esteem or guilt

___ Frequent physical complaints, such as headaches or stomachaches

___ Lack of enthusiasm, low energy, or motivation

___ Drug and/or alcohol abuse

___ Thoughts of death or suicide

source: National Mental Health Association

Know the Facts

As many as one in every 33 children and one in eight adolescents may be depressed.

? Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next five years.

?Two-thirds of children with mental health problems do not get the help they need.

?A recent study concludes that treatment of major depression is as effective for children as it is for adults.

?Suicide is the third leading cause of death for 15-24 year olds and the sixth leading cause of death for 5 to 15 year olds.

source: National Mental Health Association (http://www.nmha.org/) ?Suzanne Woods Fisher

Finding Help

National Christian Counselors Association: http://ncca.org/

Rapha Christian Counseling: http://www.rapha.info/about/1

Focus on the Family: http://www.focusonthefamily.com/

"Help Me, I'm Sad": Recognizing, Treating, and Preventing Childhood and Adolescent Depression, by David G. Fassler and Lynne S. Dumas (Penguin)

Growing Up Sad: Childhood Depression and Its Treatment, by Leon Cytryn and Donald H. McKnew (W.W. Norton)

Lonely, Sad and Angry: How to Help Your Unhappy Child, by Barbara D. Ingersoll and Sam Goldstein (Specialty Press)

Childhood Depression Sourcebook, by Jeffrey A. Miller (McGraw-Hill)

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