[sandybk]

My son has been exhibiting signs of depression noticed by myself and his teachers at school (lack of interest, irritable, appetite loss, sad). He also recognizes it in himself. It started about 2 months ago. Both sides of our family have a history of depression. Would it be in his best interest to make an appointment with a child psychiatrist or a child psychologist?

[J_9]

Start with your pediatrician then get a referral if necessary.

[DrBill100]

I have the greatest respect for the opinions of J_9 and while I don't disagree with her choice I am going to present an alternative recommendation. Psychologist. My reasoning is as follows:

Medical practitioners (MDs regardless of specialty) seldom make outside mental health referrals or even seek specialty consultation in relation to diagnosing or treating depression.

Depression is usually treated by MDs via pharmacotherapy (antidepressants of some type) and they seldom employ adjunctive therapies such as CBT or other types of counseling.

Psychologists generally test for depression using one of many available psychometric measures (Ex: Epidemiologic Studies Depression Scale for children and adolescents). Medical practitioners, on the other hand, seldom avail themselves of any type of Depression Inventory even though they are recommended in all Practice Guidelines and are widely available.

Psychologists seldom resort to pharmacotherapy as a first step while medical practitioners usually do. It is my opinion that pharmacotherapy should be a last resort and employed only when other simpler methods have proven ineffective.

Finally, the rate of misdiagnosis of all types of depression is extremely high. If for no other reason than testing I believe a psychologist is a good first step. It should serve to confirm or rule out your suspicions.

In the interest of full disclosure, my background is in physiological psychology, although the practices cited are derived from practice assessments in the medical literature. Nonetheless you may infer a professional bias on my part.

[Wondergirl]

I have the greatest respect for the opinions of J_9 and while I don't disagree with her choice I am going to present an alternative recommendation. Psychologist.

I'm going to agree with J_9 on this one. All the health insurance plans I've been under have required that the patient begin with a GP/family practice physician as the primary doctor who will refer the patient to one or more specialists. (My primary doctor is especially good at rounding up a medical care team, as I found out when I ended up in the hospital with anemia and then discovered breast cancer the next day.)

Now, that primary guy can question the patient and, in this case, a parent, and send the patient to a counselor or social worker or psychologist or even to a psychiatrist, any of which would then be covered by the insurance plan. (Of course, check the plan's guidelines or call the company to make sure of this.)

If there is no health insurance, then I'd start with a family systems therapist who would counsel on a sliding scale and, if he felt out of his league and/or the patient seemed to require medication, would consult with a area psychiatrist and possibly refer the patient for that, meanwhile continuing with the family and individual counseling while in close communication with the psychiatrist so the patient gets the best possible (holistic) treatment.

[DrBill100]

I'm going to agree with J_9 on this one. All the health insurance plans I've been under have required that the patient begin with a GP/family practice physician as the primary doctor who will refer the patient to one or more specialists.....

This may be the deciding factor. Health insurance plans may require, as Wondergirl notes, that you first present to a Primary Care Physician. I hadn't thought of that. There's the benefit of group input.

[J_9]

Insurance was the reason I suggested starting with the pediatrician. Also, these days many psychs don't take children without a referral because other illnesses have to be ruled out first.

[KBC]

In any case,the OP has a few options to pursue.

At the age of 12,it is tough to get an adult diagnosis for depression, when I was that young(albeit this was a number of years ago),they simply attempted to do the therapy only, it really didn't help much,my needs weren't met.

Today's therapy might be more child friendly,and parent friendly as well.. I really don't know.

If you already understand depression and have an open mind towards treatments,go with whichever your insurance allows.

Good luck, hope to hear how things go.

KBC

[EmoPrincess]

When I was around this age, everyone around me just put it off as a phase, and it got worse, do not do what my parents did to me to your child.

First, go to your pediatrition. See what he says, if needed, get a referral.

[Jake2008]

I really applaud you for taking that step in getting help for your son. It may make all the difference in his development.

If you have to start with your local MD, ask that it be a referral for assessment by a qualified practitioner of CBT as Dr. Bill suggested (cognitive behavioural therapy- much information on line), or a Psychologist who has skill in this area, and with the particular expertise of dealing with depression in teenagers.

There are so many options once you get the ball rolling. Therapy may or may not include anti-depressants, but most likely it would include one on one, goal orientated assistance, with learning the tools to manage the problems your son faces every day.

If you are in a larger centre, or are near one, group therapy is a good option as well, with others who are experiencing the same thing.

Please let us know how this works out for you.

[sandybk]

I had a thought last night about my son' depression. My husband and I went through a period in the last year where we were arguing quite a bit (after the kids went to bed... although found out much, much later they heard us). I've looked up the effects of parental fighting on kids and it was very eye-opening. I'm seriously considering looking into family counselling to deal with any damage this bickering may have done to them. (I have 3 boys ages 12 x 2 (twins) and age 14). I'll never forgive myself if our stupid fights (now resolved and we are getting along great) traumatized them to the point it will follow them into adulthood. I know I still remember huddling under the covers when my parents would scream at each other (it was pretty rare, but it happened).

[Wondergirl]

I still remember huddling under the covers when my parents would scream at each other (it was pretty rare, but it happened).

And the kids tend to blame themselves on top of it. Since depression is anger turned inward, you may have hit on the reason, or one of the reasons, why your son is depressed. Your children may have a few things to say to you and your husband, once they are given permission to do so.

[Jake2008]

In answer to your question, yes, there are specialists whose focus is the teen years. It has been my experience that there are many outpatient services available that are also specifically geared to teens, and younger.

You said that the symptoms he displays are mostly recent, in the past two months, and they are at a level noticed by his teachers. Not to say that he wasn't depressed before, but perhaps the depression has gone on longer, and just not to this extent. Also another sign that help is needed.

I doubt that you and your husband arguing is a cause of how he is feeling. At the time, he may have been sensitive enough that it bothered him more than the others, but as a cause of depression to where he is now, I really doubt it. If you and your husband were at eachothers throats daily for the past 10 years, that is another story.

Sometimes, as parents, and even health care professionals, look for obvious answers, and it is all too easy to find causal relationships with one or both parents, a sibling; some sort of neglect psychologically, etc. Please try to stay out of that boat, when you start finding fault or reasons with yourself, for the resulting behaviour of your son.

Look at it as an opportunity to help him. If he had problems with hearing, you'd make sure he got hearing aids, and wouldn't blame yourself for screaming at your husband as the cause of his hearing loss right? (Mine should both be deaf if that's the case!).

It is a problem that needs to be addressed, just like any other problem. If he is diagnosed with depression, he is in good company because depression is not exactly unheard of with children of any age. Untreated or ignored can have huge consequences to his development.

Don't give up, I can tell you that you may have to really dig and become assertive to get the help your son needs, but don't let anybody tell you anything that you are not comfortable with. Follow your instinct.

When you talk to your son, does he happen to say or indicate anything about the school environment? I'm thinking bullying here.

[sandybk]

I have the greatest respect for the opinions of J_9 and while I don't disagree with her choice I am going to present an alternative recommendation. Psychologist. My reasoning is as follows:

Medical practitioners (MDs regardless of specialty) seldom make outside mental health referrals or even seek specialty consultation in relation to diagnosing or treating depression.

Depression is usually treated by MDs via pharmacotherapy (antidepressants of some type) and they seldom employ adjunctive therapies such as CBT or other types of counseling.

Psychologists generally test for depression using one of many available psychometric measures (Ex: Epidemiologic Studies Depression Scale for children and adolescents). Medical practitioners, on the other hand, seldom avail themselves of any type of Depression Inventory even though they are recommended in all Practice Guidelines and are widely available.

Psychologists seldom resort to pharmacotherapy as a first step while medical practitioners usually do. It is my opinion that pharmacotherapy should be a last resort and employed only when other simpler methods have proven ineffective.

Finally, the rate of misdiagnosis of all types of depression is extremely high. If for no other reason than testing I believe a psychologist is a good first step. It should serve to confirm or rule out your suspicions.

In the interest of full disclosure, my background is in physiological psychology, although the practices cited are derived from practice assessments in the medical literature. Nonetheless you may infer a professional bias on my part.

Thank you so much for your insight. He has an appointment with a Ph.D. psychotherapist tomorrow. I agree with pills as a last resort, especially in such a young child.

[DrBill100]

Thank you so much for your insight. He has an appointment with a Ph.D. psychotherapist tomorrow. I agree with pills as a last resort, especially in such a young child.

Listen closely to your sons opinion after meeting with the therapist. The foremost predictor of success in psychotherapy is the relationship between patient and therapist.

[sandybk]

And the kids tend to blame themselves on top of it. Since depression is anger turned inward, you may have hit on the reason, or one of the reasons, why your son is depressed. Your children may have a few things to say to you and your husband, once they are given permission to do so.

We have sat them down and explained what our arguments were about. That it had nothing at all to do with them. We also admitted we set a bad example in the manner of which we had our disagreements (yelling). We have told them we are working together to disagree and discuss without things turning into an all and out fight, since that never really seems to solve anything.

[sandybk]

In answer to your question, yes, there are specialists whose focus is the teen years. It has been my experience that there are many outpatient services available that are also specifically geared to teens, and younger.

You said that the symptoms he displays are mostly recent, in the past two months, and they are at a level noticed by his teachers. Not to say that he wasn't depressed before, but perhaps the depression has gone on longer, and just not to this extent. Also another sign that help is needed.

I doubt that you and your husband arguing is a cause of how he is feeling. At the time, he may have been sensitive enough that it bothered him more than the others, but as a cause of depression to where he is now, I really doubt it. If you and your husband were at eachothers throats daily for the past 10 years, that is another story.

Sometimes, as parents, and even health care professionals, look for obvious answers, and it is all too easy to find causal relationships with one or both parents, a sibling; some sort of neglect psychologically, etc. Please try to stay out of that boat, when you start finding fault or reasons with yourself, for the resulting behaviour of your son.

Look at it as an opportunity to help him. If he had problems with hearing, you'd make sure he got hearing aids, and wouldn't blame yourself for screaming at your husband as the cause of his hearing loss right? (Mine should both be deaf if that's the case!).

It is a problem that needs to be addressed, just like any other problem. If he is diagnosed with depression, he is in good company because depression is not exactly unheard of with children of any age. Untreated or ignored can have huge consequences to his development.

Don't give up, I can tell you that you may have to really dig and become assertive to get the help your son needs, but dont' let anybody tell you anything that you are not comfortable with. Follow your instinct.

When you talk to your son, does he happen to say or indicate anything about the school environment? I'm thinking bullying here.

Yes, I am wondering if it has gone on longer than 2 months, but we did not notice. He has always been a quiet child. I have talked to him about school and the environment has been fine. Now, he does have a brother who is 2 years older and can be a bully at times, but for the most part they get along very well.

[sandybk]

Listen closely to your sons opinion after meeting with the therapist. The foremost predictor of success in psychotherapy is the relationship between patient and therapist.

Thank you -- very good advice!