By Dr Raoul Goldberg
BSc (Med), MB ChB (Wits), CEDH (Hom)

The cries of depressed children who have no advocates to speak for them are sounding all around us. It is estimated that 2% of primary school children and 5% of adolescents are affected by major clinical depression. These children show signs of full-blown depression. They constantly feel sad or irritable, have no interest or pleasure in life, may be agitated or apathetic, feel worthless or guilty, cannot concentrate, their school performance decreases and they have recurrent thoughts of death and suicide. This invariably leads to social, behavioural and academic difficulties, and frequently illicit substance abuse. There are usually associated physical symptoms such as fatigue, loss of energy, insomnia, appetite loss, weight loss or weight gain. Often we do not realise how desperate they are. Some of these children will end up committing suicide. The incidence of suicide in children has dramatically increased in recent years. It has become the sixth leading cause of death in 5 to 14 year old children and the third leading cause in 10 to 21 year olds.[sup]1,2[/sup]

There are many other children who suffer from an inborn tendency to a depressed mood, the so-called [i]dysthymic disorder.[/i] They may not be so desperate, but are chronically depressed. Their depression or irritability usually lasts most of the day for long periods of time, spanning a duration of at least 1 year with feelings of hopelessness, loss of self worth, pessimism, guilt, turbulent moods, brooding, interest loss, poor concentration and memory, social withdrawal, chronic fatigue and decreased productivity.
Countless others have a depressive character and tend to look on the dark side of things: their glass of water is always half empty rather than half full. These are sad, gloomy, introverted children who either say little or are always complaining. They are sometimes referred to as [i]melancholic[/i] children. They appear heavily weighed down in body and soul, their bodies droop and move slowly, their metabolism is sluggish, and they always appear self-involved.
There is also the natural ebb and flow of childhood feeling where the darker colours of soul feeling (sadness, sorrow, disappointment, and despair) for short periods cast a shadow or bring a dark night into the lightness of being. This is a natural and necessary part of the soul development of every child that they learn to know the depths and the heights of their inner human experience.
What we see here is a spectrum of soul experiences ranging from transient mild sadness and apathy, to longer and more constant experiences of despondency and sorrow, to deep depression and despair. Common to them all, however shallow or deep it goes, is the feeling of heaviness in the body, being trapped inside and cut off from the outside world. Younger children may not yet be conscious of these feelings that manifest organically with physical symptoms such as tummy aches or headaches and non-specific anxiety, clinginess and irritability. In the adolescent, these feelings may be expressed reactively with disruptive or impulsive behaviour (defiance, aggression, destructiveness, and stealing), eating disorders, sexual promiscuity and substance abuse. It is well documented that depressive disorders in children and adolescents have far-reaching effects on their functioning and adjustment, and confer increased risk of substance abuse, suicidal behaviour and interpersonal and psychosocial difficulties in later life. They therefore need to be detected as early as possible.[sup]3[/sup]

Experiencing depression
Probably most of us have had some experience of depression in our lives that can make it easier for us to comprehend the depressed child. We can call up within ourselves the feeling/memory of depression and sense how it affects our bodily nature. The depression may be reactive to some known cause, or it may arise without obvious cause. We notice in both cases that there is always a sense of shrinking, withdrawal, retraction and immobilisation of one’s inner life. If we observe this retracted self or imagine how this person in us feels, we may notice that the experience is often accompanied by one or a combination of three major soul feelings: feeling frightened or anxious, feeling inadequate and not good enough, or with feeling unworthy and disliking oneself. If we go further in our inner exploration, we notice that something must be happening to make this person experience these feelings. Something provokes the fear inside.
Sometimes it is possible to trace the inner provocation to an original external cause such as a violent father imprinting the power of fear into the soul life, or a nagging, critical mother reinforcing the sense of inadequacy, or a hateful stepmother over years instilling a feeling of unworthiness and hatred of self. The depressive regards this inner presence as a great misfortune about which he can do nothing. However, the very fact that this presence is present now means that one can deal with it now by helping the child to find a new relationship to it. He learns to see it as something separate from him, and learns to call up other resources of nurturing and protection to overcome the attack coming from inside.

Highly sensitive children
Depressed children are by and large all highly sensitive children. In the previous three issues of the [i]Journal[/i] a description of these children is given.[sup]4-6[/sup] Highly sensitive children may react in different ways depending on their temperament and personality. For example, the more sanguine child usually expresses his hypersensitivity with a heightened will activity as in attention deficit and hyperactivity disorder (ADHD), and the more melancholic child reacts with a diminished will activity as in depressed children.

Factors involved in depression

Hypersensitive soul disposition or melancholic temperament may predispose the child to any level of depression.

Mood disorders undoubtedly run in families. There is an increased incidence of depression in children who have depressed parents or relatives. Having one depressed parent doubles the risk for children, and having two depressed parents probably increases the risk of a child having a mood disorder before age 18 fourfold. In these articles I have repeatedly emphasised that genes provide a blueprint code for physical-biological factors, however, they have never been proven to code for psychological attributes. Therefore endogenous depression due to a dysfunctional life body may well be genetically determined. However it is difficult to distinguish environmental factors from genetic ones.

Biological factors
• Hepatobiliary system: this system appears to play a central role in depression.
• Neurological factors: studies have shown a decrease in the size of the brain’s frontal lobe in depressed children and adults.
• Hormonal factors: some evidence suggests that hormonal impairment along the hypothalamic-pituitary-thyroid-adrenal axis may contribute to depression in young people. The hypothalamus, as a specialised area at the base of the brain, connects with the pituitary gland, the master gland that regulates the other hormonal glands such as the thyroid, adrenal and reproductive glands to produce their respective hormones: together they form a control unit that regulates diverse metabolic activities including thyroid and adrenal function. The hypothalamus also appears to be a critical relay station for psycho-emotional experiences. A wide range of stimuli, e.g. pain, emotions, and depressing or exciting thoughts, activate the hypothalamus to release neurotransmitter hormones that influence the hormonal axis. Abnormalities in growth hormone, thyroid hormone and cortisol levels have been found in depressed children.
• Neurotransmitters: currently the most prevalent theory for depression is that it is a disturbance in the brain of two families of neurotransmitters, namely serotonin and noradrenalin. These are chemical substances secreted by specialised nerve cells and transmitted through the nervous tissue to exercise physiological, and it is claimed, psychological functions. Therefore serotonin reduces pain but also influences mood, and adrenalin and nor-adrenalin derived from dopamine influence the sympathetic nervous system but also influence wakefulness and motivation. Drugs that block these neurotransmitters cause depression. Conversely drugs that stimulate their secretion reduce depression. The Prozac-type drug is the newest class of drug that enhances the action of serotonin alone.
• Nutritional factors: blood sugar imbalances, often associated with excessive sugar intake or stimulants have been linked to depression. Likewise deficiencies in vitamins B3, B6, B12, C, folic acid, zinc, magnesium, and essential fatty acids have been connected to depression.[sup]7,8,9[/sup]
• Allergies and sensitivities are frequently associated with depression.

Psycho-social factors
Although there is not much evidence suggesting that domestic factors such as parental dysfunction, separation, divorce, socio-economic status, etc. are primary causes of depression in children, there can be no doubt that psycho-social dysfunction may trigger and aggravate a child who is genetically or constitutionally predisposed to depression. Stress is known to decrease serotonin levels.

Anatomy of depression
Depression is a state of relative immobility of the will resulting in depressed physiological or psychological responses. It may be caused by dysfunctions in the soul imprinting downwards into the life body and thence into the physical, or from the dysfunctioning life body up into the soul body. This means that psycho-social factors impacting on the growing and developing soul life of the child, and in particular in a sensitively constituted child, will be the primary trigger factors. This will always affect the life processes and hence the physical bodily symptoms by virtue of the dynamic interconnection of soul and body. On the other hand, genetic and biological factors create dys-resonance in the life processes leading to disturbances of the will activities of the soul body. Nutritional deficiencies and disturbances in neurotransmission chemistry of all kinds results in dysfunction of the life processes.

Caring for depressed children
• Hear their cry! It is well documented that depressive disorders in children and adolescents have far-reaching effects on their current lives, and confer increased risk of substance abuse, suicidal behaviour, and interpersonal and psychosocial difficulties in later life. They therefore need to be detected as early as possible. We need to develop a more sensitive awareness for the depressed child. We cannot rely on them telling us how they feel. We need to awaken to the very definite signs that tell us when a child is depressed and warn us when they are in danger: irritability or agitation, disinterest, withdrawal, loss of motivation, behaviour disorders, anxiety, loss of appetite, sleep disorders, weight gain or loss, or other physical symptoms. We also need to have respect and understanding for the mildly depressed and melancholic child. So often these children are neglected, misunderstood and handled insensitively, reinforcing their feeling of isolation and insecurity. The child needs to know that someone is trying to understand him. Treat him kindly and with sensitivity, lead him to feel the pain of others, which will help him to deal with his own.
• Optimum nutrition: regular, balanced wholesome food with individual modifications supports depressed children with depressed metabolisms. [sup]7,10[/sup]
• Regulate blood sugar levels by avoiding excess refined sugar or sugar products, provide secondary in-between meals and natural, unprocessed foods, including protein and fibre.
• Tryptophan-rich foods such as fish, turkey, chicken, cheese, beans, tofu, oats and eggs increase serotonin production.
• Avoid synthetic food additives.
• Supplements, used with discretion, may be very helpful: vitamins B-complex, C and folic acid, minerals such as zinc, magnesium and chromium, essential fatty acids (omega-3), and amino acids such as tryptophan, 5HTP, phenylalanine, tyrosine and tri-methyl-glycine (TMG) can be individually prescribed.
• Increase light exposure: some children are prone to winter blues, a disorder known as seasonal affective disorder. Light stimulates the brain to produce serotonin.
• Natural medication: individually prescribed natural and dynamic medication including anthroposophical, homeopathic and herbal preparations.
• Learn to communicate effectively with children.[sup]11,12[/sup]
• Counselling children can be very effective.[sup]11,12[/sup]
• Referral to specialist care with the option of antidepressants in severe depression and suicidal tendencies is mandatory.
The silent cry of depressed children can awaken us to the enormous burden the world is placing on innocent children. Their sensitive souls are overwhelmed by the world they are growing into, calling up in them the shadow experiences of fear, self-doubt and self-hatred, those sub-human forces that would prevent them from reaching their true humanity. Depression in innocent children can challenge us to easing their burden and to recognising those forces of the human soul that would block our path towards wholeness and true health.

1. Sadock BJ, Sadock VA. Kaplan and Sadock’s Synopsis of Psychiatry 8th ed. Baltimore, Maryland USA: Lippencott Williams and Wilkins, 1998.
2. Gordon,MS, Tonge, BJ. Diagnosing and treating depression in childhood and adolescence. Modern Medicine 2001; Aug: 32-40.
3. National Institute of Mental Health Sept 2000
4. Goldberg R. Highly sensitive children part 1: understanding the highly sensitive child. South African Journal of Natural Medicine 2005; 19: 65-68.
5. Goldberg R. Highly sensitive children part 2: care of the sensitive child. South African Journal of Natural Medicine 2005; 20: 40-44.
6. Goldberg R. Highly sensitive children part 3: the autistic spectrum disorder. South African Journal of Natural Medicine 2005; 21: 54-69.
7. Holford P. Optimum Nutrition for the Mind. London: Judy Piatkus Publishers, 2003.
8. Bottiglieri T, Hyland K, Laundy M, et al. Enhancement of recovery from psychiatric illness by methylfolate. Lancet 1990; 336: 392-395.
9. Nemets B, et al. Addition of omega 3 fatty acids to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry 2002; 159: 477-479.
10. Goldberg R. Creative nutrition for children part 2. South African Journal of Natural Medicine Issue 2004; 13: 33-39.
11. Goldberg R. Challenge of stress in childhood. South African Journal of Natural Medicine 2005; 16: 63-68.
12. Goldberg R. Essentials in communicating with stressed children. South African Journal of Natural Medicine 2005; 18: 62-67.