While it’s normal for children to feel sad or blue from time to time, if you notice these feelings are stretching into longer periods of time, or your child’s behavior seems to have changed for the worse, do not wait too long, hoping he or she will snap out of it. Aside from the fact that your child may not know what he or she is feeling or know how to communicate these feelings to you, recognize that depression and anxiety can be symptoms of other health-related issues as well. Childhood depression is a risk factor for many potentially negative outcomes such as academic and social problems, as well as issues with drugs and suicide attempts. Two often misunderstood forms of depression seen in children are PDD and PTSD.

PDD (also called Dysthymia)

According to the Mayo Clinic, Persistent Depressive Disorder (PDD) is is a continuous long-term (chronic) form of depression. PDD sufferers may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem paired with an overall feeling of inadequacy. These feelings last for years and may significantly interfere with relationships, school, work and daily activities. The most common symptoms of PDD in children may include depressed mood and irritability.

Other symptoms include:

- Loss of interest in daily activities

- Sadness, emptiness, or feeling down

- Hopelessness

- Tiredness and lack of energy

- Low self-esteem, self-criticism or feeling incapable

- Trouble concentrating and trouble making decisions

- Irritability or excessive anger

- Decreased activity, effectiveness, and productivity

- Avoidance of social activities at school or with friends

- Feelings of guilt and worries over the past

- Poor appetite or overeating

- Sleep problems

PTSD (Post-Traumatic Stress Disorder)

The National Institute of Mental Health defines Post-Traumatic Stress Disorder (PTSD) as a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. Very young children may exhibit bed wetting, act out the traumatic event through play or expression (drawing pictures or telling a scary story), become especially clingy to a parent, and forget or be unable to verbally express themselves.

Older children and teenagers may exhibit more destructive behaviors that lead to feelings of guilt, anger, and confusion concerning the traumatic event.

Symptoms are categorized into re-experiencing, avoidance, reactive, and cognitive:

- Flashbacks: reliving the trauma over and over, including physical symptoms like a racing heart or sweating

- Bad dreams

- Frightening thoughts

- Staying away from places, events, or objects that are reminders of the traumatic experience

- Avoiding thoughts or feelings related to the traumatic event

- Being easily startled

- Feeling tense or “on edge”

- Having difficulty sleeping

- Having angry outbursts

- Trouble remembering key features of the traumatic event

- Negative thoughts about oneself or the world

- Distorted feelings like guilt or blame

- Loss of interest in enjoyable activities

What to do?

Prevention

Although it may not always be within our power as parents, you can help protect your child from depression by being proactive in their lives and by building strong bonds and healthy attachment. Lots of TLC and ensuring your child knows that you’re there for him or her throughout every stage of childhood development may not completely protect from PDD or PTSD, especially if your child experienced a traumatic event; however, having a strong bond is key during treatment and recovery. Parents who do suspect a child is suffering from PDD or PTSD must address risk factors, both general and non-specific, physical and mental, as well as environmental when considering next steps for a child who exhibits signs of depression. Hoping it will go away on its own is not in a child’s best interest.

Diagnosis

While you may be inclined to seek the advice of your child’s primary care physician as someone “safe” to turn to, an accurate diagnosis should come from a trained mental health care provider, such as licensed mental health counselors, pediatricians, psychiatrists, psychologists, psychiatric nurses, nurse practitioners, physician assistants, and social workers who will be able to help to determine whether or not your child is suffering from PDD, PTSD, or another form of clinical depression or mental health issue. Rather than cringe at the thought of a diagnosis, parents should work closely with the health care provider and understand that finding the right treatment may be the first step in recovery.

Treatment and Recovery

If it’s determined that your child does suffer from a form of depression, your mental health care provider will provide next steps concerning appropriate treatment. Treatments will vary based on the cause of the PDD or PTSD. For example, should it be determined that there are underlying medical conditions enhancing the depression or anxiety, you may begin by treating those symptoms to begin.

While different, treatment for PDD and/or PTSD may include psychotherapy (or talk therapy), medication, methods such as cognitive behavioral therapy, or even alternative methods such as supplements and dietary changes. Depressed individuals who have been exposed to trauma (PTSD) are less likely to respond to treatment with antidepressant medication than those who have not experienced trauma, so it’s important to consider the whole person and consider all options.

While it may sound overwhelming and scary, treatment is the first step to health and can have a significantly positive effect on your child’s functioning in social situations with family and friends. Without treatment, symptoms may last much longer, may not improve, and could worsen.

While depression and anxiety in any form can be chronic, getting treatment for your child greatly improves the chances of improvement and recovery. Know that your child will need your support and understanding. Make sure to allow time for a period of adjustment. Work to keep life as normal/planned as is possible. This will help the family as a whole while you take this step toward recovery together. Encourage conversation and reassure your child throughout treatment.

Recovery can be draining on your child and put a strain on your entire family; make sure to keep the big picture in mind and take care of yourself as you’re taking care of your child while, together, you move toward a place of healing.