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Depression and the Young

"At the height of Nirvana’s popularity, when they managed to both
top the charts and smash their instruments on Saturday Night Live,
I remember thinking that American youth must be really
pissed off to have turned something like this into a hit."

Elizabeth Wurtzel, Prozac Nation

It wasn’t too long ago that psychologists and psychiatrists believed that children did not get depressed. With increased awareness about depression, better diagnosis and the advent of a new class of antidepressants, that view has dramatically changed. The American Academy of Child and Adolescent Psychiatry now estimates that at least 3.4 million children younger than 18 suffer from depression. Depression is a significant risk factor for suicide. A youth at risk behavior survey, conducted by the National Centers for Disease Control and Prevention, found that more than one in five students reported they had seriously considered suicide in the previous year, while 7.7 percent admitted that they had tried one or more times. Suicide is the third leading cause of death for adolescents and young adults.

Part of the reason that depression in young people has come to light is due to the increased stress of growing up in modern society. In Breaking the Patterns of Depression, psychologist Michael Yapko writes:

When I was eight years old, my biggest concern is whether I’d be the starting pitcher on my Little League baseball team. I didn’t have to choose between Mom or Dad for my primary residence. I didn’t have to set up a complex visitation schedule following their divorce, because they never divorced. No one instilled in me a fear of people who wanted to do “bad touches” to me. No one tried to scare me away from drugs, because drugs weren’t a kid’s issue. No one lectured me in fourth grade about safe sex and AIDS. No one brought guns to school and opened fire. It is a different and tougher world for today’s youth, who do face these sorts of things every day.

With weighty concerns such as these to deal with, many children and teens are at risk for depression. According to a recent report by the American Medical Association, today’s youngsters “are having trouble coping with stresses in their lives and have more serious psychological problems” than the previous generation. In one school system, one of every four children exhibited behavioral or emotional problems within the space of the school year.

Children who suffer depression exhibit a wide variety of symptoms, sometimes making it hard to diagnose. Some kids with depression look like unhappy adults; they’re sad, despondent, tearful, and have a loss of appetite. Others, however (especially boys), react in an opposite manner; they become aggressive, hyperactive, break rules, get in fights, and use drugs and alcohol. Moreover, depression in children often coexists with other problems such as learning disabilities, eating disorders, anxiety disorders and substance abuse. In addition, 20 percent of children who have ADHD (attention-deficit hyperactivity disorder) also have depression, and it is believed that these disorders may be both genetically and neurologically related.

The problems of children in our culture can be further analyzed as the problems of boys. At the turn of the millennium, boys in America drop out of school, are considered emotionally disturbed, and commit suicide four times as often as girls. They get in twice as many fights, commit 10 times more murders, and are the victims of violent crime 15 times more often. They are less likely than girls to go to college (because they haven’t done as well in high school), are labeled “slow learners” and assigned to special-ed classes twice as often, and are far more likely to be labeled as having attention-deficit disorders and placed on powerful prescription drugs.

One reason that boys are so much more at risk lies in the way they are socialized. According to therapist Pia Mellody, “Boys in our culture are taught that real men are stoic. The ability to not complain, endure pain, and strive in the face of adversity is admired and celebrated in story and in song. The price paid for this isolation is depression.” For a comprehensive analysis of how boys are socialized to become depressed and act out through violence, please refer to Terrance Real’s seminal book, I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression.

Depression and Teenagers

A Newsweek cover story in 2002 focused national attention on the troubled world of a particular subset of children—teenagers. The article pointed out that millions of teenagers suffer from serious untreated mood disorders—especially depression.

Here is a list of some of the classic symptoms of depression in adolescents:

  • being ill-tempered, “touchy,” overreactive, or difficult to get along with
  • aggressive, disruptive, or delinquent behavior
  • falling grades
  • loss of interest in clubs, athletics, spending time with friends, or other activities they were formally interested in
  • compulsive partying, boy or girl chasing, or thrill seeking; or they may be just the opposite—withdrawn, inhibited, and overly serious
  • compulsive studying (never taking a break and relaxing) or compulsive exercising
  • low self-worth and low self-esteem
  • having unrealistic concerns that they are unattractive or are disliked by others

The increase in depression among teens is partially caused by the steady decline in the amount of time parents spend with their children. Two-thirds of school-age children have working parents who are often unavailable during the hours directly after school, leaving an alarming thirty-five percent of 12-year-olds to fend for themselves. (Researchers call this the “3-6 p.m. teen alone zone.”) A University of Illinois study found that children who are unsupervised after school are more likely to use drugs and alcohol. The FBI reports that during the “teen alone zone,” youths are most likely to commit crime or be crime victims. It is also when they are most likely to commit suicide.

Hope for the Future

Despite the susceptibility to depression among young people, the good news is that once diagnosed, depression in children and teens is highly treatable. Most children and teens respond quite well to a combination of individual therapy, family therapy, and medication. In more serious cases, day treatment programs, home-based therapy, therapeutic foster care and/or residential treatment are recommended. In addition, many of the coping strategies and healing modalities discussed in my book Healing From Depression can be directly applied to help kids with mood disorders.

But while treating individual children for depression is important, it is not sufficient to reverse the rising trend in childhood depression. We must address the social and economic conditions that have turned the lives of too many young people into a struggle for physical and emotional survival. Here are some suggestions that, if implemented, would radically change our children’s quality of life:

  • Create economic and social support for children and their families through prenatal and maternity care, parenting leave, and more affordable childcare.
  • Encourage couples to take parenting classes before they have children. Just as driving a car is considered to be a privilege and not a right, parenting should likewise be seen as a privilege that requires knowledge and training.
  • Reduce the hours parents spend working so that they can spend more time with their children.
  • Encourage children—especially boys—to express a full range of emotions without the fear of ridicule or disapproval.
  • Increase access to mental health counseling through granting parity between mental and physical health benefits.
  • Develop greater awareness of and early treatment for depression and other mood disorders.
  • Increase the number of school counselors and reduce classroom size.
  • Teach young people principles of good communication, active listening and conflict resolution.
  • As part of the school curriculum, teach children about values and ethics.
  • Model good conflict resolution for children through respectfully working out adult disagreements.
  • Reduce violence in the media and children’s exposure to sexually exploitative media.
  • Set limits with children and let them experience the natural consequences of their actions.
  • Return to more traditional forms of moral development—through exposing children to ethical values and religious traditions.
  • Rebuild local communities so that “the whole village” is once again available to raise a child.
  • Establish a more balanced and respectful relationship with the earth and its inhabitants.

Childhood should be a time of innocence, discovery and joy. We owe it to our children and their children to create a safe, structured and nurturing environment in which young people can grow and flourish. Let us dedicate our ourselves, our communities and our country to transforming “Prozac nation” into a humane, just and loving society, where children’s health is the norm rather than the exception.

Please take a look at my book, Helping Your Depressed Child, if you are concerned that a young person you know is depressed.