Last week, I met a three-year-old princess who was very, very sad. Unlike fairytale princesses who get their smile back with a wave of the fairy godmother's magic wand, this little princess needed a whole lot of pills and counselling before she learnt how to laugh again.
Her mother, an executive in the advertising industry, is still struggling to understand what triggered the little girl's sadness. Her older brother is like any 8-year-old, with scabby knees and a Barca jersey that he lives in. The quiet little girl has no interests, except clinging to her bewildered mother who is doing her best to get her enjoy her Princess Barbie films and Clifford picture books.
Preschoolers are now being prescribed drugs for depression, with some as young as three ending up on the counselling couch. The big hurdle in diagnosing childhood depression is that the symptoms vary widely, with "prolonged sadness" - the qualifier of depression in adults - not being present in most children at all.
The more common symptoms are listlessness and anhedonia, the medical world used to describe an inability to enjoy experiences that give others pleasure. In still younger children, the signs of depression are crying, clinging to parents, irritability or aggression.
An occasional scuffle is clearly not a sign of clinical depression. Some behavioural problems are normal, especially in adolescents or children about to start a new school. But if, over a few weeks, a child's behaviour changes so much that parents need to ask, "what happened to her?' they should consider depression being a trigger.
More than stress, it's usually a combination of hereditary, personality and the company you keep - bullying or peer pressure - which are to blame. Depression in children usually occurs with other psychiatric disorders such as anxiety and disruptive behaviour, or illnesses such as diabetes, reports the American Journal of Psychiatry.
In India, it may accompany anxiety disorders, ADHD (attention deficit hyperactivity disorder) or OCD (obsessive compulsive disorder) and social dysfunction.
While there is no data on preschoolers - we are a nation still in denial that children have a brain big enough to get depressed -- Indian Council Of Medical Research reports show that 12.8% adolescents have psychiatric problems. Of these, about 3-4% have clinical depression. During adolescence, girls are twice more likely to develop depression as they undergo more hormonal changes at the age.
Counselling along with antidepressant drugs such as selective serotonin reuptake inhibitors is very effective in treating severe and persistent depression in young people. Available studies, however, do not support the efficacy of tricyclic antidepressants for treatment.
Since noticing behaviour changes and offering support early on can stop the slide, spending time with your child makes a huge difference. The Journal of the American Academy of Child and Adolescent Psychiatry reports that a child's behaviour in the preteen years is a fairly good indicator of psychological problems in adulthood.
The results of a decade-long study of 10 and 11-year-olds with behaviour problems are four times more likely than their better-behaved peers to get depressed or turn violent by the age of 21.
Persistent complaints of headache, tiredness, social isolation, irritability, anger or hostility are some of the early signs of depression. If you catch them early enough, talking her through it may be enough to help her grow up without demons from the past.