Chronic Depression Strikes Preschoolers As Young As 3 Years Old

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Chronic Depression Strikes Preschoolers
Symptoms Seen In Children As Young As 3
Lindsey Tanner, AP Medical Writer

Posted: Monday, August 3, 2009
Updated: 3:04 pm CDT August 3, 2009

iStockPhoto / Blue_Cutler

Chicago -- Depression in children as young as 3 is real and not just a passing grumpy mood, according to provocative new research.

The study is billed as the first to show major depression can be chronic even in very young children, contrary to the stereotype of the happy-go-lucky preschooler.

Until fairly recently, "people really haven't paid much attention to depressive disorders in children under the age of 6," said lead author Dr. Joan Luby, a psychiatrist at Washington University in St. Louis. "They didn't think it could happen ... because children under 6 were too emotionally immature to experience it."

Previous research suggested that depression affects about 2 percent of U.S. preschoolers, or roughly 160,000 youngsters, at one time or another. But it was unclear whether depression in preschoolers could be chronic, as it can be in older children and adults.

Luby's research team followed more than 200 preschoolers, ages 3 to 6, for up to two years, including 75 diagnosed with major depression. The children had up to four mental health exams during the study.

Among initially depressed children, 64 percent were still depressed or had a recurrent episode of depression six months later, and 40 percent still had problems after two years. Overall, nearly 20 percent had persistent or recurrent depression at all four exams.

Depression was most common in children whose mothers were also depressed or had other mood disorders, and among those who had experienced a traumatic event, such as the death of a parent or physical or sexual abuse.

The new study, funded by the National Institute of Mental Health and released Monday in the August issue of Archives of General Psychiatry, did not examine depression treatment, which is highly controversial among children so young. Some advocates say parents and doctors are too quick to give children powerful psychiatric drugs.

Though sure to raise eyebrows among lay people, the notion that children so young can get depressed is increasingly accepted in psychiatry.

University of Chicago psychiatrist Dr. Sharon Hirsch said the public thinks of preschoolers as carefree. "They get to play. Why would they be depressed?" she said.

But depression involves chemical changes in the brain that can affect even youngsters with an otherwise happy life, said Hirsch, who was not involved in the study.

"When you have that problem, you just don't have that ability to feel good," she said.

And, in fact, Luby said she has separate, unpublished research showing that chemical changes seen in older children also occur in depressed preschoolers.

Dr. Helen Egger, a Duke University psychiatrist who also has studied childhood depression, said it is common among people in her field to first see depressed kids in their teens. Their parents will say symptoms began very early in childhood, but they were told, "Your child will grow out of them," Egger said.

Typical preschoolers can be moody or have temper tantrums, but they quickly bounce back and appear happy when playing or doing everyday activities. Depressed children appear sad even when playing, and their games may have themes of death or other somber topics. Persistent lack of appetite, sleep problems, and frequent temper tantrums that involve biting, kicking or hitting also are signs of possible depression, Egger said.

Luby said another sign is being preoccupied with guilt over common mishaps. For example, a depressed 3-year-old who accidentally breaks a glass might keep saying, "Mommy, I'm sorry I did that," and appear unable to shake off that sense of guilt for days, she said.

University of Massachusetts psychologist Lisa Cosgrove said she is skeptical about the accuracy of labeling preschoolers as depressed, because diagnostic tools for evaluating mental health in children so young aren't as well tested as those used for adults.

And Cosgrove said that while early treatment is important for troubled children, "we just have to make sure that those interventions aren't compromised" by industry pressure to use drugs.

Previous research has suggested that rising numbers of preschoolers are taking psychiatric drugs, including Prozac, which is used to treat depression.

Egger said that there is little research on the effects of psychiatric medicine in very young children, and that psychotherapy should always be tried first.

Dr. David Fassler, a University of Vermont psychiatry professor, stressed that depression in very young children is still pretty rare. However, without treatment, "it can have a devastating and often lasting effect on a child's social and emotional development," he said.

"Hopefully, studies such as this will help parents, teachers, and pediatricians recognize the signs and symptoms of preschool depression so they make sure young children get the help they need and deserve," Fassler said.

Additional Resources:

Archives of General Psychiatry

Copyright 2009 by The Associated Press. All rights reserved.

[Hollow]

i'm surprised this is news. i know it's hard for professionals to diagnose children but i thought it was already pretty much out there that a person can have clinical depression since birth. i was diagnosed with it when i was 12 and most likely inherited it from my mom. the symptoms were prominent my whole life. i like life, but at this point i don't fight the depression at all. it's all i know and the depressive episodes i experience time to time make me feel at home. i don't have any interest in fixing it.

it's scary that preschoolers are taking psychiatric drugs. they have potentially harmful effects on patients under 18, including suicidal thoughts. it may have happened to me during the five years i was on antidepressants, but it's impossible to tell because there were other situations throwing my emotional stability out of whack to begin with. a 3-year-old wouldn't be able to say "mom, i think i should stop taking the lexapro, i was just having thoughts of throwing myself down the stairs." i agree that therapy should be the first approach.

[catlover79]

It's very sad news, but somehow it doesn't surprise me.

[MickeyMac]

Originally Posted by catlover79

It's very sad news, but somehow it doesn't surprise me.

Yeah I was thinking the same thing. With everything that is going on in the world I think sadly we will see a lot more of this.

[catlover79]

Originally Posted by MickeyMac

Yeah I was thinking the same thing. With everything that is going on in the world I think sadly we will see a lot more of this.

I know - I wouldn't be surprised if I've had it that long. It is very often genetic anyway.

[Chocoholic]

Instead of drugging these children, why not try to get to the cause of the problem and use behavior therapy and stuff like that? It's scary, the number of children who are diagnosed with all these mental/emotional/behavioral disorders and are put on these types of medications. Maybe if we stop putting so much pressure on children and go back to letting kids be kids, that could help. A little fresh air, exercise, and healthy food works wonders too, as well as structure and discipline in the child's life.

[Sharop]

Originally Posted by safety pin

i'm surprised this is news. i know it's hard for professionals to diagnose children but i thought it was already pretty much out there that a person can have clinical depression since birth.

I actually didn't know that children this young could get it. I did know children could have depression but I wasn't aware that depression could manifest at this age - I would have expected it to be after the age of about five or so.

I am in favour of trying both drugs and therapy as both will work for different people. I know that for some people, anti-depressants just don't work. But I also know some people who take anti-depressants and they're fine, as long as they take them.

[browneyes106]

Originally Posted by Chocoholic

Instead of drugging these children, why not try to get to the cause of the problem and use behavior therapy and stuff like that? It's scary, the number of children who are diagnosed with all these mental/emotional/behavioral disorders and are put on these types of medications. Maybe if we stop putting so much pressure on children and go back to letting kids be kids, that could help. A little fresh air, exercise, and healthy food works wonders too, as well as structure and discipline in the child's life.

They are numerous therapies available but medications tend to get pushed more. I agree with you sometimes some people put a lot of pressure on their their kids and that sometimes leads to depression. I have seen parents blow up at their kids for getting C's in school or doing dumb little things. Depression is a complex disease though there are some people who are very physically active, have well structured lives and they still deal with depression. My dad coached youth baseball and football for many years and he saw a few cases of depression. I do think alternative therapies should be pushed more.

[*Pleasant Tomorrow*]

I don't think this is news, either. It's very sad though and I hate that little kids who don't even really understand what's going on with their emotions are feeling this way. It just hits close to home because I've had depressive tendencies from a young age, too, although I wasn't diagnosed until later on.

I agree that therapy is very important, especially at that age because I'd think it's easier for a child to overcome certain depressive tendencies than an adult. Medication for depression isn't a cure all. It all comes down to the self, and at such a young age children need the guidance. I wish I'd had it.

[catlover79]

Originally Posted by *Pleasant Tomorrow*

I don't think this is news, either. It's very sad though and I hate that little kids who don't even really understand what's going on with their emotions are feeling this way. It just hits close to home because I've had depressive tendencies from a young age, too, although I wasn't diagnosed until later on.

I agree that therapy is very important, especially at that age because I'd think it's easier for a child to overcome certain depressive tendencies than an adult. Medication for depression isn't a cure all. It all comes down to the self, and at such a young age children need the guidance. I wish I'd had it.

Exactly. It's true that antidepressants and anti-anxiety meds can stabilize your symptoms, but medication alone is not the be all end all. You need to dig down deep into your psyche, try to root out the fears and deal with them. Easier said than done, I know. I'm still trying to figure it all out.

[sunshinefizzy]

I feel for these kids. I just hope that some of these children have at least one supportive person they can trust and talk to. I believe having a supportive backgrouns is key to any child's development. Sadly, more often than not, the children really don't have that.

I also agree that pills aren't the total answer. I think they should be a last resort if one-on-one or group therapy isn't enough.

[Wreckless]

Very Sad news. Not surprising, since everybody seems to have it these days, including myself, but very sad.

[TheGreatPretender]

In my generation kids are not allowed to be kids. Kids are constantly overprotected and given TV and electronics as their playtime. People are afraid of love and bonding, then they wonder why children would rather play videogames than spend time with family. The PRESSURES are amazing as well, I remember being a child and almost having a panic attack afraid of what my dad would say because I got a 75 on a history test. We are taught to be afraid of the world instead of exploring it. Just think about it, the 60s and 70s was about discovering....in the 2000s all we did was watch it on YouTube.

I'm going on a rant because of my own painful demons, but y'all get the point its no ****ing wonder why our depressives are getting younger and younger. And the fact that people just want to drug us up instead of listening to us makes it a worse situation.