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While some children diagnosed with depression may be battling acute or chronic illness, many are physically healthy, but suffer from broken homes, neglect, abuse, trauma, or the effects of peer pressure.

The 10-year-old girl sat silently in her hospital bed. During the past eight years, Childrens Hospital Los Angeles had become her second home.

Diagnosed with leukemia at the age of 2, the preteen missed out on many of the simple pleasures of childhood. While her friends were enjoying the last days of summer, the girl was preparing to undergo a bone marrow transplant. During the past week, she had shown little interest in eating or participating in activities.

Darlene Levy, RN, ND, CNS, walked into the girl’s room with a soft smile. While lacking the expertise to cure the cancer, she hoped to make headway with this patient’s depression.

Levy is one of many nurses who work in the area of childhood depression, a condition that affects as many as one in 33 children, and one in eight adolescents, according to the Federal Center for Mental Health Services. While some children diagnosed with depression may be battling acute or chronic illness, many are physically healthy, but suffer from broken homes, neglect, abuse, trauma, or the effects of peer pressure.

“Not all depressed patients suffer from the same symptoms of depression, nor are they treated the same,” Levy says. “For children, psychotherapy with the child and parents comes first, and often this is enough to alleviate the child’s symptoms of depression.”

If the depression persists or is severe, children are prescribed antidepressants. With an increase in the number of children being diagnosed with depression, the medications used to treat the condition recently have come under intense scrutiny.

“There have been reports in the media about possible negative side effects of SSRIs (of which Prozac is one),” Levy says. “However, Prozac is the only antidepressant with FDA approval to treat children. I think it’s a safe and effective medication when appropriately dosed and monitored.”

In September, a comprehensive study conducted the Food and Drug Administration reported that 2% to 3% of children treated with antidepressants had exhibited suicidal thoughts or tendencies. Earlier this year, the FDA released a public health advisory requiring manufacturers of antidepressants, including Prozac, to include in their labeling a warning statement that recommends close observation of adult and pediatric patients being treated with these agents.

The warning asks physicians and parents to watch for worsening depression or suicidal tendencies at the beginning of antidepressant therapy or whenever the dose is changed.

The new FDA report focuses on increases in suicide among youth undergoing short-term treatment, so the solution may lie in providing a more comprehensive approach of both medication and therapy.

In June, a new study sponsored by the National Institute of Mental Health found that Prozac worked far better with depressed children than just talking with a psychologist. The study found that a combination of therapy and Prozac provided the most effective treatment.

The debate about the link between antidepressants and increased suicidal tendencies began last year when British health officials reported that long-suppressed research suggests that certain antidepressants may increase the risk of suicidal behavior in children and teenagers.

Levy suggests that the issue is complicated by the very nature of depression.

“Treatment with antidepressants causes a patient’s energy to improve prior to mood changes,” Levy says. “The patient may feel suicidal, but now has the energy to complete a plan. Close monitoring by a psychiatrist is necessary during the period when antidepressants are started, and for children, this often requires inpatient care.”

Difficult to diagnose

While mental health providers have noted more children suffering from depression throughout the past several decades, it’s unclear whether pediatric depression is on the rise or if providers simply have achieved a greater understanding of the condition. Just 20 years ago, medical and nursing schools taught students that children don’t suffer from depression.