According to statistics provided by the U.S. Department of Health and Human Services, approximately one out of every 33 children in the U.S. may suffer from depression. And while the cause for the disease can range from environment to chemical makeup, the signals and signs often mimic that of adult depression.

What is Childhood Depression?

"Depression is a mood disorder, it affects the mood of the human being," Ada pediatrician Dr. Tawfik Ramadan said. "It affects the mood of children and it is more prevalent than people thought. People thought that depression is mainly a disease of adults, but it's not. It can start as early as six years of age. It's not just a change to feeling unhappy or sad, it is a complex of symptoms, which affects the child's body and brain. It involves the whole human being."

According to Ramadan, several factors can induce depression in minors, including inherited traits, with symptoms of irritability or anger, sadness and social withdrawal.

"The neurobiology of depression is the chemical imbalance of the brain," he said. "It's what you inherit, but there are environmental factors, developmental factors, and then the psychosocial factors, how much coping they have, all this together brings depression," he said. "When we talk about social risk factors, we start first with the home. If the home environment is friendly, even if the child has the genetic risk, depression can be at least modified, but if you have unfriendly or hostile parents, those who only care about themselves, then that will accelerate the progression of depression in adolescents."

While symptoms vary from child to child, depression can take on new forms, according to Licensed Professional Counselor Dana Hargis with Biofeedback Counseling Inc.

"Lots of people think of childhood depression in the same way they think of adult depression," she said. "A lot of the time it looks different in children. They can be more irritable, they can still have the tears, but that irritability and anger and those kinds of things can serve as signs that they are depressed as well."

How to diagnose Childhood Depression

Dismissing a child's attitude as something superficial or not important may cause symptoms to increase when dealing with a child who is depressed. "People look at it as 'Oh they're acting out,' or they're this or that, and a lot of times it's that genetic predisposition," Hargis said. "There can be that internal imbalance."

Symptoms of childhood depression can include feeling fearful, tense or anxious, inability to sit still, fidgeting and pacing and repeated emotional outbursts, shouting or complaining.

"These symptoms could be passed as normal problems, but put together they're not," Ramadan said. " If we don't know the signs or symptoms, or pay attention to it, the results could be disastrous."

In addition to recognizing possible chronic symptoms that have persisted, Ramadan noted evaluations should be given to the child in question.

"The child should go through a complete medical and physical evaluation, neurological evaluation and psychological evaluation," Ramadan said. "You have to have all these people, a team, make the proper diagnosis. It's not just a family brings a child and says 'Oh my child is depressed' and the doctor just prescribes Prozac and sends him home. I think this is wrong. It should not be like that. I think the child should go through the proper evaluations and the proper diagnosis should be arrived at."

Part 2 “Misconceptions and treatment” will be published Friday.

Misconceptions of Childhood depression

"There are misconceptions about depression," Ramadan said. "Depression is not just something which can be washed away easy. It's not just 'Well I'm just sad and depressed,' no it is a disease that affects sleeping patterns, eating patterns, social skills, relationships, school performance, all of these are affected, so there are many factors. That's why this can be misdiagnosed."

"Here's an example of how misconceptions can be disastrous when it comes to adolescent depression. A former patient of mine was eight years old, and it seems the parents had some sort of marital problems, and so the child started to have problems. When I looked into his history later on, the symptoms looked exactly like the ones you would have when depressed. But the parents, because of the lack of knowledge and because they were only involved in their problems, they were fighting all the time and did not pay attention to the child, the problem progressed. So the parents reached an agreement with the grandmother and sent the child to live with her, thinking it may solve the problem. By the time the child began living with his grandmother here, the depression has progressed to that last part, when children become suicidal. The child decided to kill himself. When the child becomes suicidal and find that killing themselves will solve the conflict, they become euphoric and they become happy, and this is one sign that is missed. People think the problem is solved. When he moved here, he was happy and they thought him just moving in with his grandmother solved the problem. He went to school and was happy, but one weekend, he asked his grandmother to go get him a sandwich, so she went to get him one and he then told her that he was going to eat it in his room. He turned up the music, and sat in his room. His grandmother was waiting and waiting for him to come down, but no one came. She knocked on the door but it was locked. Finally she called a neighbor and they broke down the door and they found him, hanging in the closet by a bandana. They took him to the emergency room, but he was already dead."

"He ended his life because the home environment was not friendly, his parents were more involved in their problems and neglected him, and whatever was done was not done right and that was because of the lack of knowledge. I will not use the word ignorance, but lack of knowledge. I think that's why the public needs to be informed about childhood depression, it's very important. I don't want to scare people, but I think they need to know that if childhood depression is not picked up early, it could lead to suicide."

Treating Childhood Depression

Like the symptoms, treatments will also very for childhood depression. But if detected early enough, the disease can be greatly modified.

"It's not a permanent state of being," Hargis said. We have a lot of alternative treatments here like neurofeedback, which is a retraining of the brain, that's a great intervention."

"I think depression is a treatable disease," Ramadan said. "If it is diagnosed early and managed properly, children can go through remission, and then they may relapse, because depressed children, when you treat them, can always relapse if they are faced with the stressors associated with depression. We need to know the risk factors and eliminate them as much as we can, modify them. Prevention is more important than treatment."

"There are certain authorities in the field that believe that psychotherapy by itself, may solve the problems of depression without medication. It can solve the problem. I think we shouldn't generalize, and treatment should be tailored according to the individual."

Hargis noted that early symptoms may be corrected without medication and just a stable household and proper diet. "Another real important thing is sleep and diet," she said. "I've had people call saying that they're worried about their child and I will tell them here's what they need to do now. They need to be in bed at a certain time, they need to make sure their consumption of protein is good. Protein is a real brain builder and it makes things level."

"A lot of times people will say their child is hysterical, and I will ask them to tell me what they've had for breakfast and they will say they had cereal and then a donut on the way to school--it's all carbs. Carbs lead to that, that shift in their attitude. Adults can handle that, we can think 'I feel terrible, but I won't yell at you,' but kids don't know why they feel terrible, so they will then act out and carry on. If we could just get those building blocks of what they need going, protein three or four times a day. Parents will call back and say 'They're already acting so much better,' just from improved sleep and getting enough to eat. Sometimes our life is so chaotic, that we don't recognize that we're contributing to our children's problems by not having that stable bed time, a good diet. It's a big contributer."

Having someone to confide in other than the parents can also benefit the child, according to Hargis. "That's normal, that's okay," she said. "Basically, all of the parents say 'You don't say anything I haven't been telling them for a year,' and I say 'I know, it's not magic, it's just finding that outside person that they can ally with and talk to. There are no magic words, it's just having somebody else to talk to.'"

"We as a society, we want a quick fix," Ramadan said. "Go to McDonald's, get a sandwich, kill your hunger pains, quick fix. Get married fast, get divorced fast. We are after a magic pill for a quick fix. There is no quick fix. Pills by themselves cannot solve the problem. It has to be a combination of pharmacology and psychotherapy."

"The average treatment for a child is 15 weeks," Hargis said. "Sometimes it's far less. There's so many specific things that can contribute to a child's treatment. Normally it's more of a long, systematic process. We have to break it down, say 'Okay, what's the underlying problem?' If you treat the base, then the rest of it just kind of fades away. "