Published October 19th, 2016
Family Focus
By Margie Ryerson
Margie Ryerson, MFT, is a marriage and family therapist and author in Orinda and Walnut Creek. Contact her at 925-376-9323 or
Cara's family physician referred her for therapy because she was feeling that no one liked her or cared about her. Cara, age 13, was having difficulty getting along with her family and her peers, and her grades in school were suffering.

I assessed Cara for depression and also found there was a history of alcoholism and depression in her family. When I see evidence of possible depression, I refer an individual to one of several psychiatrists whom I trust to perform a comprehensive evaluation.

Cara was diagnosed with moderate to severe clinical depression. First she participated solely in individual and family psychotherapy because her family was reluctant to put her on medication. But as time went on, it became evident to all of us that Cara would benefit from a low dose of an anti-depressant as well. Happily, Cara is a senior in college this year and is doing well. She continues to see a therapist occasionally and to take medication for depression. Cara understands that at some point she can try to go off her medication - under a doctor's supervision - to see how she does without it, but she is comfortable with her regimen for now.

It is difficult to see children suffer needlessly, as they too often do when their depressive symptoms go untreated. In my psychotherapy practice I have worked with many teens and adults who say they first experienced symptoms of depression as children, but unfortunately they never received help at that time.

It is understandable that parents might want to wait to see if symptoms will subside. After all, children grow and change so much that we often need to take a wait-and-see approach. And depression in children isn't always easy to identify. Often, symptoms of anxiety precede actual depression. By the time some children are in their teen years they may have a combination of anxiety and depression.


Childhood anxiety disorders fall into three categories:

*Separation anxiety. A child may fear something bad will happen to himself or a member of his family. Being apart from his family is very upsetting.

*Social phobia. A child may experience extreme discomfort with social aspects of school or after-school activities. She may refuse to go to school or continuously complain of physical illness to avoid school.

*Generalized anxiety disorder. A child will worry excessively about the future. I once worked with a third-grade boy who was extremely worried about getting into Stanford when he was ready for college. His mother had attended Stanford and had mentioned to her son that she hoped he would be able to go there as well. (A parent who discusses this kind of topic with an eight-year old may well have a great deal of anxiety herself.) The child already had a tendency to worry and began to fixate on this issue at an early age.

If any of these anxieties are strong and persistent, it is important to address them with your physician and a mental health professional. Often, treatment of anxiety at an early stage can help ward off future depression or at least reduce its severity.


According to the National Institute of Mental Health, in 2014 an estimated 11.4 percent of children ages 12 to 17 had at least one major depressive episode in the past year.

Here are some symptoms of childhood depression to watch for from the American Academy of Child and Adolescent Psychiatry:

 Frequent sadness or crying;


 Decreased interest in activities or inability to enjoy previously favorite activities;

 Persistent boredom and low energy;

 Social isolation and poor communication;

 Low self-esteem and guilt;

 Extreme sensitivity to rejection or failure;

 Increased irritability, anger or hostility;

 Difficulty with relationships;

 Frequent complaints of physical illnesses such as headaches or stomachaches;

 Poor performance in school;

 Poor concentration;

 A major change in eating and/or sleeping habits;

 Talk of, or efforts to, run away from home;

 Thoughts or expressions of suicide or self-destructive behavior. Self-destructive behavior includes substance abuse, eating disorders, cutting and other methods of self-harm.

If your child exhibits signs of anxiety or depression over time, it will be important to have him diagnosed. Then you can work together with your physician and a therapist and psychiatrist to determine what the course of treatment should be. It is recommended that a child have not only individual therapy, but also family therapy, since the family has a major influence and impact on the child. Although some parents are reluctant to have their child take pharmacological remedies, the combination of therapy and medication has proven to be the most successful treatment for depression. At the same time, unless the child is suffering with severe depressive symptoms, there is nothing wrong with trying only psychotherapy first to see if that can suffice.

Research has shown that cognitive behavioral therapy, or CBT, is the best type of psychotherapy in treating depression. A therapist who uses CBT helps the child identify and change irrational and self-sabotaging thoughts, behaviors and feelings.

Even if a child with symptoms protests that he or she doesn't want to or need to see a therapist, parents must use their own good judgment and may have to insist. I encourage parents to let their child have a choice of whom to see, not whether or not he or she will see someone. They can visit a therapist and then decide if they want

to work with that person or look for someone else. Even though this really is a forced choice, the child will be slightly empowered in the process.

Remember, even though it may be somewhat of an ordeal at first to have your child diagnosed and treated, you may be saving him years of unnecessary suffering.

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