Child Depression Expert: Dr. James Crist

Susie McGee
james crist

Dr. James Crist, author of What to Do When You're Sad & Lonely and a licensed clinical psychologist experienced in working with children, took the time to answer a few questions for our LoveToKnow Kids readers regarding depression in children..

What Are Your Qualifications for Treating Depression in Children?

I have been a licensed clinical psychologist since 1992, though I have experience working with children dating back to 1985. I specialized in working with children during my internship and have given numerous workshops in the community dealing with parenting and mental health issues in children.

What are Some Signs of Depression That Parents Might Notice?

The most common signs include the following:

  • either sadness or increased irritability (or both)
  • anger outbursts
  • sleep disturbances (sleeping too much or not being able to sleep well)
  • appetite disturbances (eating too much or loss of appetite),
  • not enjoying things as much as before
  • a lack of motivation to do much of anything
  • chronic boredom
  • feelings of low self-worth
  • feelings of hopelessness
  • tearfulness
  • trouble concentrating

How Can Depression in Children Be Treated?

  • Psychotherapy: Psychotherapy is usually the first step in treatment.
  • Medication: Medication can also be helpful, particularly when a child's depression does not respond to counseling or when suicidal thoughts are present.
  • Supplements: I will sometimes recommend omega-3 fatty acid supplements (e.g. fish oil), given preliminary evidence that this may help with mood disorders as well as attention difficulties. Coromega is the brand I recommend for children.

How Safe Are the Medications Used to Treat Depression in Children?

When prescribed and monitored carefully, these medicines are considered safe. To gain FDA approval for use in children, both safety and effectiveness need to be demonstrated. Some doctors will prescribe "off label," meaning that they use medicines from the same category that are effective for adults and use them for children, even though they have not yet received FDA approval. So far, only Prozac has received this approval.

What Are the Risks of Children Using Medication to Treat Their Depression?

Any medication used to treat depression in children can potentially make symptoms worse instead of better. There is a slight risk of increased suicidal thoughts or increased agitation when first starting on an antidepressant. This is why it is so important for medication to be prescribed by a psychiatrist who specializes in working with children. Also, children should be seen frequently to monitor for adverse reactions. One thing to consider in making a decision is the risk of not treating a child's depression adequately.

For more information, check out an article by the Mayo Clinic: Antidepressants--Exploring the Pros and Cons.

Is the Risk of Suicide Enhanced By Certain Medications?

This is a cause of alarm to many parents based on warnings issued by the U.S. Food and Drug Administration (FDA)in 2004. In their review of children taking antidepressants, no completed suicides occurred among almost 2,000 children treated with a type of antidepressant known as an SSRI, which is the most common type used in treating depression.

While 2% of children taking a placebo (sugar pill) reported suicidal thinking or behavior, 4% of children taking an SSRI reported such symptoms. This is why the FDA placed a "black box" warning on all these medications to warn people that some antidepressants may increase the risk of suicidal thinking or behavior in children and adolescents being treated. These risks are highest during the early stages of treatment.

Again, though no actual suicides occurred, and many children who are prescribed these medications are already depressed and suicidal thinking is a symptom of depression, it is important to monitor kids closely whenever a new medicine is tried. If any worsening of symptoms occurs, or unusual changes in behavior such as restlessness, agitation, extreme talkativeness, sleep disturbance, self-injury, or aggressiveness, the prescribing doctor should be contacted immediately.

The FDA recommends that your child see his or her health care professional as follows:

  • Once a week during the first month of treatment
  • Every two weeks during the second month of treatment
  • A follow-up visit after 12 weeks of treatment
  • As recommended after those first 12 weeks

What Can Parents Do To Help Their Children?

  • Take threats seriously: First and foremost, always take threats of suicide seriously. While most children will not go on to attempt suicide just because the thought is there, the risk is very real. Children as young as 4 or 5 have committed suicide.
  • Seek psychiatric help: Seeking psychiatric help when a child expresses suicidal thoughts is critical, so that someone with expertise can evaluate the seriousness of the threat.
  • Praise your child: Depressed children also need more understanding and positive feedback. Because of the distorted thinking that often accompanies depression, children will minimize any praise and make a big deal out of any criticism, so parents need to be more forceful with praise and more muted with any criticism.

When Is Hospitalization Necessary?

Hospitalization is needed when a child acknowledges suicidal thoughts and is unable to make a promise to not attempt suicide. Children who have already attempted suicide should also be considered for hospitalization. Finally, when medications are not working well, but it might be risky to discontinue them or switch to a different medication on an outpatient basis, hospitalization can be a safer place to change medications, so that children can be closely monitored.

Are There Any Contributing Environmental Factors?

Absolutely. Depression is often (though not always) the result of a combination of the effects of genetics and environment.

  • Stress, such as that of a child with learning disabilities or ADHD struggling in school and getting a lot of negative feedback, can precipitate depression.
  • Losses, such as the death of a parent or other family member, or though divorce, can be a trigger.
  • Being bullied in school, not having friends, or family stresses such as substance abuse in a parent can all be triggers as well.

Can a Child Outgrow Depression?

Yes, most children will outgrow depression, especially with proper treatment. However, the more episodes of depression that a child has, the more likely that the depression will be a lifelong illness to manage.

What Books Have You Published on This Subject?

My book What to Do When You're Sad & Lonely, published by Free Spirit Publishing in 2005, is written specifically for children ages 7-13 who are suffering from sad thoughts, as well as more serious forms of depression or Bipolar Disorder.

What Other Information Would You Like to Share With Our Readers?

Depression is a serious mental health disorder. While most kids feel sad sometimes, kids with depression feel sad (or angry) most of the time and, left untreated, depression can cause serious problems in functioning. This is why early detection and treatment is so important.

Child Depression Expert: Dr. James Crist