Depression is the most common mental health problem in the United States, affecting about 17 million people.
When you think of depression, you probably don't think about children, especially preschool children. Researchers, however, are discovering new insights about this disorder in the very young.
For most preschoolers, life is about laughing, playing and having fun, but even the smallest tykes feel down sometimes.
Child psychiatrist Joan Luby has been studying depression in preschool children for more than 20 years.
"Children as young as age 3 can get clinical depression," said Dr. Joan L. Luby, professor of psychiatry (child), director of the early emotional development program, Washington University School of Medicine.
In a recent imaging study, Luby's group found depressed preschoolers had elevated activity in an area of the brain called the amygdala.
"We can see changes in the structure and volume of several key brain regions that are known to be involved in emotion processing," Luby said.
The study was the first to show these changes in children so young.
"We believe that the earlier you can identify the disorder, the more effective treatment will be," Luby said.
Researchers believe as many as one in every 33 children may have depression. Children with depression are often withdrawn, highly sensitive, have a difficult time dealing with negative emotions, and are preoccupied with feelings of guilt. The symptoms often go unnoticed.
"Most people don't pick up on depression in their young children. Mostly parents pick up on what we call disruptive symptoms in children," Luby said.
If you do spot the symptoms, however, getting help could make all the difference.
In very young children, Luby said a strategy called "parent child interaction therapy — emotion development" is helpful. It works on strengthening the parent-child relationship and helps the parent serve as an "emotional coach" for their depressed child.
There are several treatments for older children with depression. Anti-depressants are considered generally safe for children older than seven, but the FDA has placed a "black box" warning on these drugs because of the increased risk of suicidal thinking.