Depression is a syndrome, not a disease. While we in the western world are trained to think of depression as a disease, in fact, it is just a collection of signs and symptoms whose causes vary widely. Just like all pneumonia is not caused by one thing (i.e., pneumonia may be due to HIV, tuberculosis, fungi, or bacteria; all are treated quite differently.) so all depression is not ‘one thing’. Therefore, it is important to look ‘under the hood’ of your child’s depression, so that you can uncover root causes and personalize the treatments accordingly.
Depression is a NOT a ‘Prozac deficiency’. Depression is most often the result of a varying combination of diet, social stresses (e.g., isolation, tensions with family members and/or peers), hormonal problems, immune system problems, drug use, and psychological vulnerabilities interacting with genetic and epigenetic vulnerabilities. While medications have a role in treating depression—particularly in severe cases (e.g., with suicidal ideation, or psychosis, school failure)—it is rare for depression to be only the result of a so-called “chemical imbalance”.
It is NOT normal for children, teens or young adults to be depressed. There is no “normal amount of teenage depression”. When depression is defined as a cluster made up of disturbances in mood, sleep patterns, appetite, motivation, and social activity, which last for several days or more, it becomes clear that the normal teenage ‘angst’ can be present without these symptoms. The developing brain, especially in the teen years, is constantly re-wiring itself, depending on the environmental inputs: who and what your child is exposed to, translates to whom and what identity your child will form. A childhood or adolescence of depression will shape identity, and life choices.
Medications for depression have not been tested for long-term safety in the developing child. The medications used for depression have been tested for safety, but ONLY in short-term trials (weeks, or a small number of months). There are no human studies on the effect of long-term use of medications on the developing brain of a child. This is particularly disturbing because we have absolutely no idea what effect anti-depressants have in the long-term. Do they skew development for the better, for the worse, both, or neither? In my opinion, we have embarked on an ill-conceived experiment: treating America’s next generation with medications without knowing the long-term consequences. In severe situations medication use is reasonable, but medications are relied on in excess.
All therapy is not created equal, when it comes to depression. At last count there were literally hundreds of types of talk therapy. Two types of therapy have been proven to be effective with depression: Cognitive Behavioral Therapy (CBT), and Interpersonal Therapy. Social Rhythm therapy has shown promise as well. Sometimes, when peer problems are part of the etiology of depression, a group therapy of some type (standard group therapy, outward bound, etc.) can be most effective. A good therapist-client fit facilitates healing, regardless of the psychotherapeutic approach used. Your child’s progress over time is your best indicator of the effectiveness of the therapy.