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Children's Mental Health Advocate
 
Mental Health Advocate

Questions and Answers

Q: I am a middle school teacher. I have been noticing that the number of children coming into my classroom diagnosed with depression is really increasing. And sometimes I am confused by what I am seeing. The child is laughing with friends one minute and is irritable the next, but doesn't seem to be sad at all. Yet I am told they have been diagnosed with depression. How can they be laughing if they are depressed?

A: The child may show no outward signs of a depressed MOOD, yet still have depression. Depression in children and adolescents often takes the form of irritability. Here is the criteria for a diagnosis of Major Depression:

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood, or (2) loss of interest or pleasure

  1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
  2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
  3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains
  4. Insomnia or Hypersomnia nearly every day
  5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
  6. fatigue or loss of energy nearly every day
  7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
  8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
  9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

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