Do children and adolescents get depression?

The answer is of course yes they do. For a long time however, the existence of affective disorders,
especially depression was disputed in children.
Physiologically, you can understand why there is.. or why there was at one stage a disagreement. The
monoamine theory of depression which we’re all familiar with says that depression results from the
deficiencies of specific monoamines, importantly serotonin and noradrenalin.
The noradrenalin system in humans doesn’t fully mature for many years, and yet very young children
are being diagnosed with “clinical depression.” So this depression in young children, is it qualitatively
similar to depression in adults, or a manifestation of something else? Does that make sense? Like, if
children don’t have a fully working noradrenalin system, and we know noradrenalin plays a role in the
aetiology of depression, it is a relevant question – how can children have depression?

Now the serotonin system develops very rapidly in children, with neurotransmitter concentration,
uptake and binding very similar to adult levels within a few years of birth. So I guess the question here is
- is depression in children a serotonergic phenomenon. Could that possibly explain why only fluoxetine is
clinically effective in treating paediatric depression.

Which brings us to another point...most of the pharmacological agents used to treat adult depression
are not efficacious in treating childhood depression, which again, possibly suggests a different
underlying aetiology.

But the above arguments are flawed because they reduce depression to a neurochemical anomaly
whereas in reality, depression is simply a feeling of low mood for a specific period of time. It is, at least
in part, an abnormal response to stress - and children, more so than adults experience things around
them that they perceive as stressful, or that they are less able to make sense of. For instance, why are
my parents getting divorced? Is it my fault? Why did my dog die? As adults, we can rationalise and cope
with such events, but children don’t have the emotional intelligence to do so and may respond by
becoming depressed.

The main difference between adult and paediatric depression then, is that adults are able to
appropriately convey how they feel. Some children may be able to talk about their emotions, but again,
others may not have the emotional literacy to articulate their feelings and can only express how they
feel through the way they behave. So depression in these children may manifest as behavioural
problems, termed “masked depression”

With respect to young children, typical features of depression include reduced performance at school
irritability, fatigue, changes in sleep and appetitive – so basically many of the symptoms seen in adult
depression. Adult and paediatric depression share many risk factors, such as environment, significant life
events, genetics. Incidentally, many of the same genes are implicated in susceptibility, in both adult and
childhood depression, the suggestion of course, being that children DO get depression and it IS
qualitatively similar to depression in adults.
When it comes to depression in teens, things get a bit trickier because of the way it presents. If you go
onto govt websites, they tell parents to watch out for drug taking, social withdrawal, irritability, being
self-critical. This can be part of normal adolescent development and this is where interview techniques
come into play which was covered earlier.

So in summary, yes children, like adults get depression. The main differences are that children may not
be able to articulate how they feel, and depression may present atypically.