It has been called the dark night of the soul, a time when the human spirit is strangled from within. Most people see it as a disease that can only affect those who have lived long and arduous lives. But, in fact, depression affects more than five per cent of all children and 10 per cent of all teenagers.
"It's much more common than we realise," says registered psychologist Dr Rosemary Troy. "So many people see it as an adult problem because it's horrific to think that there are children who are less than 12 who are depressed and who have attempted suicide."
Depression is a psychiatric illness that combines feelings of hopelessness, pessimism and general loss of interest. This often leads depressed people to stop socialising, to withdraw and make no attempt to accomplish even the simplest of tasks. It can even lead to suicide. In children, it can also interfere with their social and emotional growth and it can prevent them from succeeding in school.
"These days, we are seeing children as young as eight and nine who have attempted suicide or who have considered it," says Dr Myra Barry, a senior clinical psychologist at the Castleknock Child Guidance Centre in Dublin. "The vast majority of them are suffering from depression. Yet this is often not known to those around them because it can be difficult to diagnose in young people."
The problems with diagnosis arise from two different sources. First, the normal signs of depression - loss of appetite, difficulty sleeping, loss of interest and enjoyment in social activities, feelings of tiredness and loss of concentration - are often absent in young children.
"It can present as a conduct disorder in children," Dr Barry explains. "The child will be moody and irritable, acting out frustrations and anger, and the adults will immediately assume that it is a behavioural problem - often they won't look at what's behind it. It may also manifest itself as an eating disorder like anorexia or over-eating."
Even when the classic symptoms are exhibited by children and adolescents, they are often written off as part of a phase. "It's inadequate to just assume that it will pass," explains Dr Patrick McKeon, director of Aware. "Sometimes it won't. Often, all these kids need is a little more understanding and attention. But if they don't get it, it could turn into a much bigger problem."
Just as difficult as diagnosing depression in children, is identifying its causes. "Sometimes, the cause is not so clear," says clinical psychologist Dr Ella Lovett. "Sometimes it's a reaction to a life event - like problems at school or the death of a loved one. But other times, it seems to come from a lot of different things going wrong."
Among those things that can go wrong are problems with school work, bullying and friends. But young people will also become depressed when they live in abusive situations. And they can also learn it from their parents.
"I have had kids in my office who say that there was a dark cloud hanging over their houses," Dr Troy says. "The children came from homes where their parents were depressed, where their parents weren't able to attend to their needs. But usually, the parents would not even recognise the effect their behaviour would have on their children."
On the other hand, in teenagers, many experts believe the cause of depression is chemical. "You can draw a line between those who get depressed before adolescence and those who get it afterwards," says Dr McKeon. "When they are younger it is usually a reaction to something. But when they are older it is usually the result of having a genetic predisposition to depression. In fact, the strongest predictor for depression is having a parent who has been depressed."
And beyond the problems with diagnosis and cause are the problems of treatment. Therapists do not have the fall-back of medication for children that they would for adults. And though psychotropic medications are widely used in the United States to treat young depressives, here in Ireland that practice is frowned upon. Thus, other treatments are used on depressed children.
"A lot of that is building up a relationship with the child, first alone and then with their parents," Dr Lovett explains. "A lot of these children have never had someone to confide in, and their parents have felt uncomfortable talking to them. So we work with both the child and the family to improve communication and their relationships."
Other therapeutic techniques used with children include play therapy - in which they act out the thoughts and feelings they otherwise have trouble expressing - and cognitive therapy, in which specific thoughts and behaviours are targeted for modification.
To assist with the therapeutic process, some experts encourage their patients to keep behavioural diaries, in which they record their moods and experiences. By keeping the journal, many youngsters soon realise that their moods are not always black and that there are some positive aspects to their lives. Further, by tracking their feelings, patterns of behaviour and reaction can be identified and worked on.
But with nearly five per cent of all children and 10 per cent of all teenagers suffering from depression, parents should keep their eyes open for signs. For those who do think their children are having problems, the best thing to do is talk to them.
"Make the time for positive, individual attention," recommends Dr McKeon. "Get involved without being intrusive. Get interested in their interests - pop stars, sports. Give yourself permission to discuss feelings, and show them your own.
"And something else that most parents with troubled children have to realise is that some of their behaviours, like being argumentative or taciturn, are simply part of their personalities," Dr McKeon adds. "And you have to adjust and adapt to who they are."
For information on depression, call the Aware hotline at 01- 6766166