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What You Should Know About Childhood Depression

No Place for a Child.

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Lisa Lane Filholm’s oldest son was always a sensitive child. “He felt things more deeply, and took things more personally. He was gifted at music and the arts, and he put a lot of pressure on himself,” Filholm, of Denver, remembers. “I was aware of it, because I recognized similar things in myself, but that didn’t make it any easier to know what to do.”

When her son reached adolescence, Filholm saw changes in his behavior. He quit activities that he loved and he began to doubt himself. He cut his arms and used marijuana.

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An experienced high school teacher and author of Beyond Mama Bear: How to Survive the Balancing Act of Parenting Teenagers, Filholm recognized a cry for help beyond typical teen experimentation. She and her husband, with the help of a family therapist, intervened. She began to go through her son’s pockets and journals, and found some disturbing material. She took him to several doctors, and he was diagnosed with depression and anxiety.

“We were actively worried he would commit suicide,” Filholm remembers. “We asked him to sleep on the floor of our room (to protect himself). He didn’t protest.”

Filholm was right to be concerned and take action. According to Dr. Sarah Davidon, research director for Mental Health Colorado, 90 percent of suicides are associated with depression. In addition, depressed teens have trouble concentrating, which can affect their school performance. They are more likely to spend too much time on video games or social media, use drugs and alcohol, shoplift, or engage in risky sex, according to the book, Depression: A Teen’s Guide to Survive and Thrive, by Jacqueline Toner, Ph.D., and Claire Freeland, Ph.D.

Davidon adds that it’s not just teens, younger kids can be at risk, too. The Duke University study Common Emotional and Behavioral Disorders in Preschool Children found that up to three percent of children ages two to five are depressed.

“While this is a smaller percentage, this is something we need to pay attention to,” Davidon says. “People don’t think that very young children can be depressed, but their mental health can profoundly shape their future.” Younger children who are depressed are four times more likely to have anxiety disorders later on, as well as more chronic health problems, says Davidon.

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About 80 percent of children with depression are successfully treatable, says Davidon, and early intervention is key. “When we identify (depression) early, the healthier people will be at all ages,” Davidon says. But what constitutes depression, exactly? And what can families do to help

Who Is at Risk?

The largest risk factor for depression is having a family history of depression, says Dr. Joel Stoddard, child psychiatrist in the Pediatric Mental Health Institute at Children’s Hospital Colorado.

“Some people might have characteristic levels of depressive symptoms—think Eeyore from Winnie-the-Pooh,” Stoddard says. “As a rule, the more severe and persistent the tendency towards depressive symptoms are, the more the child is at risk for developing a depressive disorder.”

What Does Depression Look Like?

Depression is a syndrome characterized by withdrawal and low motivation. In youth, depression may present itself as irritability associated with misbehavior, aggression, and anger.

“By far, the biggest misconception in our culture has been confusing types of depression-related mood with willful, disruptive behavior or bipolar disorder,” says Stoddard. “Interpreting this as willful, rather than related to an emotional disturbance, can set a family or clinician towards overly focusing on behavior.” In addition, Stoddard says it was once thought that severe, chronic irritability was an early form of bipolar disorder. In fact, doctors now know that such irritability has genetic links to depression.

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When being assessed for depression, Stoddard says it’s important for families and clinicians to answer the question, “Is this youth currently in or has he or she ever had a major depressive episode?” A major depressive episode, Stoddard says, “is a distinct period of at least two or more weeks of persistent sadness, markedly reduced enjoyment, or uncharacteristic irritability with some other symptoms.” In Colorado, about 14 percent of youth ages 12 to 17 will suffer from a major depressive episode—higher than the national average, says Davidon.

How Is It Treated?

If a major depressive episode is present, doctors grade ‘the severity and frequency of the depressive episodes to determine treatment,” Stoddard says. This often requires more than one method of treatment, intensive therapy, and medication.

Mild depression (that does not include a major depressive episode) can often be managed with behavioral interventions, such as talk therapy, exercise, and lifestyle changes recommended by a doctor, depending on the cause.

“There are many causes of lower-level or persistent depressive symptoms, such as illness, persistent depressive symptoms, adjustment to a stressor, substance use, and bereavement (that will) have different forms of treatment and follow up,” Stoddard says. (Mild depression that resists behavioral treatment, Stoddard says, might require similar methods used for a major depressive episode.)

What Can Parents and Peers Do?

Parents” and friends” efforts certainly won’t “fix” a very serious and complicated human condition like depression. But there are a few ways they can help kids cope, and help prevent depression from manifesting itself in the worst ways.

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Normalize negative emotions. Davidon says that people often try to talk one another out of feeling something negative, or say, “it could be worse.” “Students should know it’s OK to express negative emotions,” she says. She encourages parents to help their kids complete emotional sentences, such as “I feel mad because” or “I feel mad and I don’t know why.” Avoid phrases like “don’t cry” or “calm down.” “If a child is crying, there has never been a time that saying those things has worked,” Davidon says.

Destigmatize mental health issues and therapy. Davidon says that one Colorado study found that one quarter of teens report they would be embarrassed to seek help for emotional problems. If kids can tell their friends it’s OK to have depressed feelings, and offer to talk to them about it, Davidon believes this would go a long way. “If all teens would support their classmates, that would be key to helping them feel more comfortable with their emotions and asking for help,” Davidon says.

Build community. A lack of social support is one factor that can contribute to depression, Davidon says. Help prevent social isolation by checking in on friends you haven’t heard from in a while. Pick up the phone, send a personal text, or arrange to meet a friend that tends to isolate herself. Encourage your children to reach out to new students and ask them about their lives, or learn something about a classmate who might seem different from themselves.

Don’t “power through” academics. When Filholm was teaching high school, she often got requests from parents of high-achieving children, asking if the child could have more time on assignments or have other special considerations, because the child had depression. While she was concerned for her students, she believes this is the wrong message for parents to send when their child is clinically depressed. “The parents” number one goal should be that their kid get healthy,” Filholm says. “Sometimes you just don’t forge ahead as planned. This might mean your child shouldn’t be taking advanced classes or maybe they need to take a C in a class.” For Filholm’s own son, it meant taking a gap year between high school and college.

Build resilience. Davidon says that teaching your kids how to bounce back when things get tough is helpful when depression creeps in. “We can’t resolve all of it, but that doesn’t mean we can’t create more resilient environments and help kids get through things.” She encourages parents to think about how they react to negative circumstances, because their kids will pick up on this. Check out zilliance.com for clinically proven, custom-built resiliency skills.

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Talk. After her son began taking medication for depression, Filholm found out that several men in her extended family were taking the same medication, but no one had ever talked about it. She urges families to start talking about what is going on, for the safety of their children. “We are not out of the woods,” Filholm says, “but we talk about it. We talk about his brain and protecting it. And he is willing to have those conversations.”

Lydia Rueger is an Arvada-based freelance writer and mom of two.

[Continued on the next page – Community Resources]

When You Don’t Know Who To Tell

Morgan Fritzler, a middle school student from Arvada, was texting with a friend when the friend admitted she had considered suicide. Morgan followed up by sending encouraging texts to her friend, and then told her mom. Morgan’s mom, Shawna Fritzler, responded by contacting Safe2Tell Colorado (safe2tell.org), a way to make an anonymous report about anything concerning or threatening. After a report, law enforcement immediately follows up to assess the situation. “When a teenager is considering suicide, you don’t have a lot of time to act,” Fritzler says. “School hadn’t started, so she didn’t have a counselor to go to.” The girl is now OK, and has talked about it with her mom.

Fritzler encourages every parent and teen to download the Safe2Tell app on their phones. Morgan likes having an anonymous way to report concerns quickly if something like this ever happens again. “Not everyone likes to go to a counselor and it can be awkward,” Morgan says. “Texting is a lot less pressure.”

Community Mental Health Resources

Mental Health Colorado mentalhealthcolorado.org/dashboard

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An advocate organization for Coloradans with mental health or substance use disorders. Its new Data Dashboard details important indicators and statistics of mental health based on a variety of factors. Currently developing mental health toolkit for all community members, available in 2018.

Colorado Crisis Services coloradocrisisservices.org

Live chat, text, call, and walk-in locations for people struggling with depression, suicidal thoughts, or other concerns.

Community Behavioral Health Services Program colorado.gov/pacific/hcpf/behavioral-health-organizations

Mental health and substance abuse services for recipients of Health First Colorado (Colorado’s Medicaid program).

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Jefferson Center for Mental Health jcmh.org

Group, individual, and family services to foster recovery and resilience.

Emerson St. for Teens and Young Adults mhcd.org/emerson-st-for-teens-young-adults

A supportive community place offering activities and services to promote good mental health for youth.

Colorado Health Institute coloradohealthinstitute.org

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A research organization dedicated to innovations in health and current data for Colorado families.

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