Two children are in the middle of their parents' divorce. The parents are both worried about the children becoming depressed. One of the children talks, asks questions, and cries regularly. The other child does not speak of the situation and goes on as normally as possible but is beginning to struggle with some school subjects. Which child should they worry about most?

The answer is both. Both children are exhibiting symptoms of depression and should be evaluated and monitored.

Who is at risk?

There are a few factors that can cause a child to become depressed. Depression appears to run in families and a child with relatives who have depression is more likely to become depressed himself. Children who have difficulty with acting in, and reacting to, their social environment are more likely to become depressed. Major life events such as divorce, moving, the death of a loved one and abuse can cause children to face depression.

Recognizing depression

Depression is an illness that involves a depressive mood that lasts for a long time and interferes with a child or adolescent's ability to function. About 1 in 33 children has depression. Symptoms of depression may include:

• Emotional outbursts such as shouting or complaining

• Anxiousness

• Being rejected by other children

• A decrease in appetite

• A change in sleep patterns

• Worries that a parent will die

• Clinging to parents

• Getting into trouble at school

• Grouchiness

• Often feeling sad

• Crying frequently

• Feeling misunderstood

• Low energy

• Social isolation

• Poor communication

• Feelings of guilt

• Low self-esteem

• Extreme sensitivity to rejection or failure

• Increased irritability

• Complaints of physical ailments such as headaches and stomachaches

• Poor performance in school

• Frequent absence from school

• Behavior problems

• Poor concentration

• Feelings of worthlessness

• Talk of self-harm or suicide

• Planning or efforts to run away from home

Because of the variety of stages of development that children go through, it can be difficult to recognize the symptoms of depression in children. If your child has symptoms of depression and physical reasons have been ruled out, it might be good to have the child evaluated by a mental health professional.

Treating depression

The earlier depression symptoms are recognized and treatment begins, the more effective it will be. The American Academy of Child and Adolescent Psychiatry recommends a comprehensive treatment that includes family and individual therapy. This treatment may also include an antidepressant. Below are some common forms of therapy and their focus:

• Cognitive: alters negative thinking.

• Behavioral: helps to increase pleasurable activities.

• Social skills: teaches children how to react in situations and increases a child's social skills.

• Self-control: provides strategies for self-monitoring and self-control.

• Interpersonal: focuses on relationships and social roles.

Medication

Antidepressant drugs are also a form of treatment. It can take 4-6 weeks before the full effect of medication is apparent. The biggest reason that people stop taking medication is because of the side effects, however, medication should only be stopped under a doctor's supervision. Let the doctor know of your concerns and discuss alternative treatments.

Diet, sleep and activity

Help your child keep a regular diet because his body needs the energy to help him cope with the depression. Also, look at sleep and physical activity. A child with poor sleep patterns may increase the effects of the depression or may lengthen the duration of the illness. Physical activity can help fight the effects of, or relieve, the symptoms of depression. Parents should also listen carefully to their children. Try to understand what they are going through and help them find pleasurable and meaningful activities.

While it can be difficult to approach your child with questions about depression, it can be life altering and become very important to your child's overall well-being.