The national attention focused on suicide amongst our youth has raised the awareness of depression in our pediatric population. It is likely that undiagnosed, untreated depression was behind at least some of these completed suicides, and is certainly behind the suicidal thinking that some children and teens struggle with. Childhood and adolescent depression is a form of suffering that is intensely personal. External manifestations include behavioral changes such as isolation, neglect of friends, families, school work, and responsibilities; having an uncaring attitude, negativity, pessimism, anger, hostility, irritability and poor frustration tolerance. Suicidal thinking is common in this population, and may progress to outright suicidal behavior. But there is hope for youth depression. Medications and psychotherapy can be most helpful; but the condition must first be recognized for what it is. Signs and symptoms suggestive of youth depression include: 1. Poor scholastic performance. 2. Difficulty having fun or finding pleasure in life. 3. Social withdrawal and isolation. 4. Sleep that is disturbed – too much or too little. 5. Changes in appetite or weight – loss or gain. 6. Fatigue. 7. Unexplained physical complaints such as headaches, stomachaches, an
d various other aches and pains. 8. Irritability. 9. Guilt. 10. Poor self-esteem. 11. Depressed mood. 12. Thoughts of death or suicidal thinking. 13. Weeping or inability to cry when it is otherwise appropriate. 14. Family history of mood disorders and substance use disorders. The presence of any number of these signs and symptoms, evident to a significant extent in intensity or duration, should prompt professional evaluation and treatment. Few medications have been approved by the FDA to treat youth depression, among these being fluoxetine (Prozac) and escitalopram (Lexapro). Other medications, shown to be safe and effective in adults, are now being investigated for youth depression. However, the clinical trials to get these drugs approved are critically dependent upon volunteers willing to enter these trials. Untreated youth depression is associated with substantial loss of function, failure to attain developmental milestones, increased likelihood to use substances, and even suicide. Depressed children are frequently targeted by bullies, especially on social media, contributing to the risk of suicide. When depressed youth attempt suicide, they usually choose lethal means and are frequently successful. Depressed youth may also have other psychiatric diagnoses – substance use, as noted previously; anxiety disorders and posttraumatic stress disorder are often seen. In fact, exposure to verbal, physical, sexual, or emotional trauma, personally experienced or witnessed, confers severe psychiatric consequences such as youth depression, substance use disorders, posttraumatic stress disorder, and completed suicide. Fortunately, many of the consequences of youth depression are much mitigated with treatment, often inclusive of psychotherapy and medication. But the first step is recognizing youth depression as present. Then, seek out help through school counselors, community mental health centers, or referral to a psychiatrist made by a primary care office. Pursuing any of these avenues of help and assistance will result in a much lower burden of illness for both the youth and their families.