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Column originally published Nov 29, 2000
Column last revised/updated on Oct 23, 2018

Depression In Children Is Serious And Require Treatment, Including Medication

Question: We are really concerned about our 12-year-old son. Few days ago he told us that he was thinking about killing himself. This was a complete shock to us. We have noticed him crying without reason in the last few weeks. He has lost interest in sports that he loved dearly, and one night I found him still awake at midnight. I think he is depressed. I should tell you that when he was younger, he was terrified of germs that would make him sick. At that time we got counselling from a psychologist. There is a long history of depression and nervous breakdown on my husband’s side of family. Is it possible that this can be related to our son’s condition? Please advise us where to get help.


It is very possible that your son is depressed, as you suspected. The signs of depression can be rather subtle in children and easily overlooked.

The most common complaint in depressed individuals is a feeling of sadness. Many children are not able to express this feeling to their parents, teachers, or caretakers. They can present with irritability, loss of energy, and loss of interest. Sleep disturbance is very common. Many children have difficulty falling asleep, or wake up in the middle of the night, while others want to stay in bed all the time.

It is not uncommon for these children to have no appetite. Weight loss, or not gaining weight appropriately, are common findings in depressed children. Sometimes they can overeat and develop excessive weight gain.

A sense of worthlessness and excessive or inappropriate guilt also happens to these children. They may blame themselves for others’ mistakes. With a sense of hopelessness, some children may even consider killing themselves.

In recent months, there are a number of reports of children committing suicide. Almost all of them have depression, although their immediate families or teachers might not have recognized it.

Some children can get depressed when they have lost a love one, even a pet. The sadness caused by grief and bereavement usually starts shortly after the loss, and can last a few months. If the sense of sadness continues, or if it is severe, it is important to consider true depression.

Stress can also induce depression in some children. Some of the stresses that they face in school are teasing and bullying. It is important to make sure that this is not happening by talking to your son as well as his teachers in school. Bullying has caused untold psychological trauma to many children, and the effect can last years and decades.

Alcoholism and drug addiction can sometimes present as depression. Although these are uncommon in younger children, it is certainly something that needs to be considered in your present situation. Certain medications can also induce depression. Check with your doctor to ensure that none of his medicine may have this side effect.

Depression in adults has been recognized throughout human history. However, children with depression have received medical attention only in the last few decades. The cause of depression is believed to be a combination of genetics and environment.

It has been observed that the majority of depressed individuals have close relatives suffering from depression also. Recent research suggests that dysfunction of neurotransmitters, especially serotonin, is likely the underlying problem in the brain. Some people will describe this as chemical imbalance of the brain.

Other research suggests abnormal hormonal levels may contribute to depression. These include cortisol and thyroid hormones. A simple blood test can be done to make sure these are normal in the body.

Interesting enough, some individuals with depression also exhibit other psychiatric problems, including obsessive-compulsive disorder, anxiety disorder, etc. Your son’s excessive worry about germs can be a sign of obsessive-compulsive disorder, although further observation is necessary to ensure that this is actually the case.

It is always shocking to parents to hear that their child wants to die. All parents have to take this remark seriously. The first thing to do is to sit down with your son and ask him for the reason. Don’t forget to ask whether there are school bullies bothering him. The next important thing to find out is whether he has made any plan of killing himself. Listen to him and remain calm. Try to be as supportive as possible, even though you are terrified inside.

You are going to need professional help. Counselling by psychologist can help your son to recognize what is actually bothering him, and learn strategies to deal with the problem. However, counselling alone may not be sufficient.

You should consult with your family doctor and explain to him or her about your son’s condition. If your doctor is not familiar with managing children with depression, ask for a referral to a child psychiatrist. Most adult psychiatrists are not comfortable dealing with young children.

If you live in an area where there is no child psychiatrist, a referral to a paediatrician can be helpful. Nowadays many paediatricians have some experience with managing children with psychiatric problems, including depression.

Medications have been used for many decades with reasonable success in adults with depression. Some of them have side effects. The most recent class of medicine, called SSRI (selective serotonin reuptake inhibitor), has been used extensively in adults with good success and very little serious side effects.

Although the experience is more limited in children, published reports have shown that these medications are both useful and safe for children. Don’t be too scared if the doctor recommends medicine for your son. It can start to help within one to two weeks, although it may take a few more weeks to show significant benefit.

How long medicine is necessary depends on the individual. Those who have additional psychiatric conditions may require medicine for a longer time. Fortunately this class of SSRI is not addictive, and overdose does not result in life-threatening complications.

I hope this overview is useful for you to deal with this very stressful situation. Remember this: many children with depression require long-term support from the family as well as professionals. Some, unfortunately, can develop recurrent episodes of depression that requires repeated treatment.

[Note to Readers: Since the publication of this column, Health Canada has placed a “Black Box Warning” on all SSRI anti-depressants. Some teenagers have expressed thoughts of self-harm on this class of medicine. However, this did not lead to suicide. When doctors heeded the warning of Health Canada and didn’t prescribe medicine for those with depression, there was a significant rise of teenagers who completed suicide. As a result, Canadian Paediatric Society (CPS) published a statement to support paediatricians that they can prescribe anti-depressants carefully in those who need them.]