Bipolar Depression

Depression in youngsters

Tracey was always a bit shy in school, but more recently, she seemed to have become excessively clingy at home. Her mom reported that for the past few months, Tracey had been getting tearful before bed every night, saying that she was worried that her dog might one day get hit by a car and die. Almost every night, her mom had to stay with her until she fell asleep, which could take up to an hour. Tracey also worried that she'd have one of her terrible nightmares. She was especially fearful of the one in which a monster chased her around a castle, then bit off her arms and legs and left her in a pool of blood.

She complained of feeling tired all the time (despite getting more than eleven hours of sleep since the onset of her mood and behavioral changes). She no longer wanted to go on play dates and preferred to stay home with her parents, where she'd lie on the couch with her dog and watch television. She didn't want to eat much except for junk food—cookies, pizza, soda, and chocolate candy—which her parents allowed, if only to get her to eat something. Her teacher commented on how the sparkle had left her eyes, and every morning when her mom dropped her off at school, she'd start to cry. The school nurse began to see Tracey as much as her teachers did. She was having a hard time focusing on her schoolwork, and homework was a horror. She had always seemed a little distracted in the classroom, according to her teacher, but now she "couldn't focus for beans," as her teacher put it.

Tracey also began having social difficulties. She felt as though the other girls at school didn't like her and thought they were saying mean things about her. Her teacher told Tracey's mom that she didn't believe the other girls were rejecting Tracey. Instead, it appeared that Tracey was isolating herself from her peers. What's more, she had always gotten along well with her older sister, Kara, but now often seemed to be provoking her. Tracey would tease her sister about eating too much and being fat. (This wasn't really true, but like most early teenagers, Kara was struggling with changes in her body.)

It had always amazed her mom that Tracey, who could be so loving, had the incredible ability to figure out how to really hurt the person she was upset with. Put another way, she was great at "going for the jugular." By contrast, if her mom was sick with a cold, who but Tracey would be sympathetic and bring her orange juice and toast and say, "Just like you always try so hard to help me feel better when I don't feel good, now it's my turn to take care of you, Mommy."

Until the late 1970s, it was believed that young children such as nine-year-old Tracey were not intellectually developed enough to be able to experience depression in the same way that adults do. Therapists talked about "masked depression," a term that indicated children could not express depression directly but rather communicated their sadness through a variety of other signs and symptoms, among them headaches, hyperactivity, and insomnia. Children were thought to be tabulae rasae, or blank slates, who were shaped by the people who raised them. Today, we realize that each child enters the world with her own biology and her own temperament, which, in turn, is affected by the environment.

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