Depression in kids: How to spot it, and where to look for help

For Kristi Gunderson*, a Bremerton mom of two, the signs of depression in her children weren’t immediately obvious. Yes, both of her sons seemed a little down and escaped the world with hours of video games, but she had no idea that their mental health was in peril.

“It can be difficult [for parents] to sort out what’s normal and what’s not … there is a normal moodiness that happens,” says Dr. Carolyn McCarty, a research professor at Seattle Children's Center for Child Health, Behavior and Development.

When Kristi’s 12-year-old son confessed that he no longer found pleasure in any of the activities that he used to enjoy, she took the kids to the doctor, where one son was diagnosed with depression and the other with bipolar disorder.

Gunderson regrets not intervening sooner: “As a mom, [I asked myself] what could I have done differently? Why didn’t I understand? I didn’t recognize what depression looks like in kids, because it’s so different for adults.”

[ More on the subject: A pediatrician addresses depression in teens ]

An estimated 3.1 million people between ages 12 and 17 have had at least one major depressive episode, defined as “a period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities, and had a majority of specified symptoms, such as problems with sleep, eating, energy, concentration, or self-worth,” according to the National Institute of Mental Health.

Despite national efforts to reduce stigma, many young people still fear judgment and are reluctant to seek help. Because depression is also a risk factor for suicide, the consequences of bottling it all up inside can be fatal. Suicide attempts and ideation for youth under 18 years of age more than doubled between 2007 and 2015 nationwide, according to a recent study by JAMA Pediatrics.

Even some very young children seem to be at risk of depression. For these children, it is likely a combination of genetic factors, temperament and difficulty getting involved and enjoying activities, according to Seattle Children’s Hospital.

Marissa Fields* is worried about her 5-year-old daughter, Olivia*, who she believes is depressed. The Kent mom says Olivia has been withdrawn and often angry, but won’t talk about what is bothering her.

“She doesn’t want to eat, wants to be alone all the time. She doesn’t want to hang out with the other kids or play like other kids … it’s hard to see,” says Fields. She suspects that Olivia may be having a hard time adjusting to shared custody between her parents, but isn’t sure if that is the cause for her daughter’s change in behavior.

“Talking to your children — and making sure that they can always talk to you — increases the chances of learning that your child is depressed. Think about prevention, or things you can do early, rather than waiting for it to get worse,” writes Dr. Liliana Lengua, psychology professor at the University of Washington and Director of the UW Center for Child and Family Well-Being. She also adds: “A parent’s mental health can impact a child’s mental health. When we take care of ourselves, we’re better able to take care of our kids.”

Marissa admits that she isn’t sure how to get her daughter to open up about what’s going on. In addition, Fields works long hours in a low-wage job, and her own stress, fatigue and economic burden take a toll — not to mention the fact that therapy can be quite expensive. Depression, then, is not simply an issue of mental health; here, it also becomes an issue of class. And with the Seattle metro area’s high cost of living, kids like Olivia can bear the brunt of this.

“The key gap here is access to services and getting kids into treatment who need it … there’s still a lot of teens and young people who meet criteria for depression who don't ever get treatment,” says Dr. McCarty.

To address this disparity, she says, professionals are taking a more integral approach by increasing school-based mental health services and training primary-care doctors to screen for depression during well-child visits.

Youth in the Emerald City could be more prone to feelings of sadness than children in other regions. Gloomy weather, like our overcast skies and downpours of rain, can correlate with feelings of melancholy. Seattle’s ongoing opioid and homelessness crises have hit our city hard — leaving plenty of kids devastated in their wake. Seattle is a melting pot of cultures, but despite it being home to the most diverse ZIP code in America, some families who have immigrated to the city may feel isolated or Othered, especially if they have experienced upheaval or displacement. And despite the city’s reputation as a progressive powerhouse, LGBTQ youth are still more vulnerable to depression than their cisgender and heterosexual peers. Marginalization can be a risk factor.

“If the responses of adults is read by the youth's nervous system as ‘I am not accepted, I do not belong, and I am not what you want me to be,’ depression and anxiety symptoms are going to happen,” says Elliot Sweet, a child and family therapist at QTherapy, a Seattle-based clinic specializing in LGBTQ youth. “Approach youth with the assumption that the way you treat them will shape the way they treat themselves.”

* not their real names